Pityriasis Versicolor (Tinea Versicolor)

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Introduction

  • Superficial yeast infection of the skin caused by Malassezia furfur species (normal commensals on the skin)
  • Common in warm humid climates

Predisposing factors:

  • Occlusion of the skin with pomades and greases
  • Immune suppression
  • Hyperhidrosis
  • Heat

Clinical features

  • Usually asymptomatic (or just mild itching)
  • May be generalized in the immuno-compromised
  • Fine scaly, guttate or nummular patches, particularly on young adults who perspire freely
  • Individual patches are dirty, yellowish/ brownish/hypopigmented macules (hence the term versicolor)
  • Larger irregular patches may evolve
  • Sometimes follicular tendency is marked; more noticeable at the advancing edges of the irregular patches
  • Sites of predilection:
    • Sternal region
    • Sides of the chest
    • Shoulders
    • Upper back
    • Face

Differential diagnoses

  • Seborrhoeic dermatitis
  • Pityriasis alba
  • Pityriasis rosea
  • Leprosy

Complications

  • None usually; only of cosmetic significance
  • M. furfur sepsis
    • From contamination of the lipid-containing medium in immunocompromised patients receiving hyperalimentation through tubes

Investigations

  • Skin scraping for KOH microscopy

Treatment goals

  • Improve appearance of skin

Drug treatment

Topical:

Selenuim sulphide shampoo

  • Apply on affected areas daily, leave on for 10 – 30 minutes and wash off
  • Continue for 3 weeks

Ketoconazole shampoo

  • Use as above

Miconazole cream

  • For limited areas
  • Apply twice daily for 3 weeks

Supportive measures

  • Deal with underlying predisposing factor(s)

Prevention

  • Avoid hot, humid environments or clothings that promote perspiration
  • Take a cold shower after perspiration
  • Use any of the above shampoo washes once a month if predisposed