Tinea versicolor

Background

Normal dermal anatomy.

• 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

Differential Diagnosis

Hyperpigmentation

• Postinflammatory hyperpigmentation (acne, Psoriasis, atopic and contact dermatitis, lichen planus, trauma, drugs, and fixed-drug eruptions)
• Melasma
• Solar lentigines
• Ephelides (freckles)
• Café-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

• Tinea