Tinea versicolor

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Background

  • Caused by fungus Pityrosporum ovale (oval form) or obiculare
  • Also known as Malassezia furfur

Clinical Features

  • Hypopigmented or hyperpigmented lesions predominantly on the trunk
  • Circular, scaly patches
  • More common in areas of increased sebaceous glands
  • Poor hygiene, areas of moisture
  • Equally common is light and dark skinned individuals, but more noticeable in the later
Tinea versicolor.JPG

Differential Diagnosis

Hyperpigmentation

  • Postinflammatory hyperpigmentation (acne, Psoriasis, atopic and contact dermatitis, lichen planus, trauma, drugs, and fixed-drug eruptions)
  • Melasma
  • Solar lentigines
  • Ephelides (freckles)
  • CafĂ©-au-lait macules
  • Nevi
  • Melanoma and precursors

Hypopigmentation

  • Vitiligo
  • Pityriasis alba
  • Tinea versicolor
  • Postinflammatory hypopigmentation
  • Piebaldism
  • Tuberous sclerosis
  • Hypomelanosis of Ito

Evaluation

  • Some demonstrate coppery-orange fluoresence under Woods Lamp
  • KOH wet prep (Spaghetti and Meatballs appearance)
  • Almost never cultured given difficult culture medium, benign course, and diagnostic KOH prep.

Management

  • First line topical treatment is ketoconazole (nightly application x 2 weeks) or selenium sulfide (10 minutes x bid)
  • Single dose 400mg ketoconazole PO or fluconazole 150-300mg PO per week x 2-4 weeks for more resistant cases or for easy-of-use
  • Griseofulvin is not effective

See Also

References

Authors

Neil Young