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Candida albicans
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Human papillomavirus
Malassezia furfur
Staphylococcus aureus
Trychophyton microsporium
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This patient who presents with hypopigmented macules that fail to tan but are otherwise asymptomatic most likely has tinea versicolor. This disease is caused by superficial infection with Malassezia furfur. Tinea versicolor is a common cutaneous fungal infection that is characterized by hypopigmented macular lesions on the body. These lesions may have variable coloration and can appear pale yellow, white, or yellowish-brown. Lesions are asymptomatic so often they will remain undetected until patients notice that they do not tan during the summer. Potassium hydroxide preparation of skin scrapings can confirm the diagnosis by showing a "spaghetti and meatballs" appearance of the hyphae and budding cells. Kallini et al. discuss the presentation of tinea versicolor in darker-skinned individuals. They find that these patients will have hypopigmented lesions with thicker stratum corneum, more tonofilaments in the granulosum, and more sequestered melanosomes. Figure A shows numerous hypopigmented macules that appear distinct from the surrounding tanned skin. The flat round nature of the peripheral lesions is characteristic of tinea versicolor, though the confluent nature of these lesions near the center of the chest makes individual macules difficult to distinguish. Incorrect Answers: Answer 1: Candida albicans can cause intertrigo in intertriginous regions such as the breasts, axilla, and inguinal folds; however, these patients will present with erythematous plaques with erosions and macerations. Answer 2: Human papillomavirus can cause flat warts; however, these lesions will present with "cauliflower-like hyperkeratotic papules" and deviations in skin striae. Answer 4: Staphylococcus aureus can cause multiple types of skin and soft tissue infections including scalded skin syndrome, cellulitis, and fascitis. All of these infections present with severe pain, swelling, and possible systemic symptoms such as fever. Answer 5: Trychophyton microsporium can cause tinea corporis (ringworm); however, this disease would present as a pruritic annular patch with a central clearing and an erythematous, raised scaling edge. Bullet Summary: Malassezia furfur causes tinea versicolor, which is characterized by hypopigmented macular lesions on the body.
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