Pityriasis Versicolor

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Pityriasis versicolor is a common yeast infection of the skin, in which flaky discoloured patches appear on the chest and back. It is sometimes called tinea versicolor. It is more common in hot climates, and often affects people that perspire heavily. It is a disorder of the healthy but florid cases are seen in the immunosuppressed such as those with diabetes mellitus, HIV/AIDS and topical steroid abuse.

Cause

  • Pityrosporum orbiculare
  • Pityrosporum ovale (malassezia furfur)

Symptoms

  • Asymptomatic
  • Mildly Itchy
  • Pale or dark skin patches

Signs

  • Hypopigmented macules and/or patches 
  • White scaly patches

Investigations

  • Skin scraping for microscopy
  • Fasting blood glucose (for florid cases)
  • Retroscreen (for florid cases)

TreatmentTreatment Objectives

  • To eradicate infection
  • To prevent transmission
  • To address predisposing factors

Non-Pharmacological Treatment

  • Good personal hygiene
  • Avoid sharing bath towels, sponges and clothing

Pharmacological Treatment 

For Mild Tinea Versicolor

Evidence Rating: [C]

  • Miconazole, 2%, topical,

Adults

12 hourly for 4 weeks

Children

> 2 years; 12 hourly for 4 weeks 

< 2 years; 12 hourly for 4 weeks

Or 

  • Clotrimazole, 1%, 

Adults

12 hourly for 4 weeks

Children

> 2 years; 12 hourly for 4 weeks

Or

  • Whitfield’s ointment, topical,

Adults

12 hourly for 4 weeks

Children 

Not recommended

Or

  • Selenium sulphide, shampoo 2.5%, topical,

Adults

Once daily for 5-7 days (washed off after 30 minutes to prevent irritation)

Children

Once daily for 5-7 days 

< 5 years; not recommended

For Severe Tinea Versicolor

Evidence Rating: [B]

  • Itraconazole, oral,

Adults

200 mg daily for 7 days 

Children

> 12 years; 200 mg daily for 7 days

1 month-12 years; 3-5 mg /kg daily for 7 days

Caution - Use of itraconazole is associated with potentially life threatening liver toxicity. Monitor liver function while on long term therapy.

Referral Criteria

  • Refer intractable cases to a dermatologist.