Updated: 7/7/2020

Tinea Versicolor

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Snapshot
  • A 21-year-old man presents to his dermatologist for a rash on his face. He reports that there is no itch or pain associated with it. Although he spent a summer at the beach as a lifeguard and the rest of his face tanned, the area with the rash has not tanned, resulting in a white and yellow colored patches on his face. On physical exam, there are multiple yellow-white macules along his jawline and a large patch on his left cheek. There are also multiple similar patches on his trunk. A skin scraping and KOH preparation reveals tinea versicolor as a diagnosis. He is prescribed a medicated shampoo to use on his skin.
Introduction
  • Clinical definition
    • very common cutaneous fungal infection
      • characterized variably colored macules and patches
      • also known as pityriasis versicolor
  • Epidemiology
    • prevalence
      • 30-40% in tropical climates
      • 1-4% in temperate climates
    • demographics
      • most common in adolescents and young adults
    • risk factors
      • hot and humid weather
      • excessive sweating
      • immunosuppression
  • Etiology
    • Malassezia spp.
      • formerly Pityrosporum
  • Pathogenesis
    • when there is excessive heat and moisture, there may be increased growth of Malassezia spp. compared with other normal flora
  • Associated conditions
    • seborrheic dermatitis
  • Prognosis
    • often recurs
Presentation
  • Symptoms
    • asymptomatic
    • inability to tan in affected areas
  • Physical exam
    • macules and patches affecting the trunk, neck, and face
      • lesions have overlying fine scaling
      • variable color
        • pale yellow
        • white
        • hypopigmentation
        • hyperpigmentation
        • yellowish brown
Studies
  • KOH preparation   
    • skin scrapings mixed with KOH
    • short multibranching hyphae and budding cells
      • “spaghetti and meatballs” appearance
  • Wood lamp examination
    • affected areas fluoresce yellow to yellow-green
    • < 50% sensitivity
Differential
  • Vitiligo 
    • affected areas also fluoresce
    • lesions are depigmented
  • Eczema 
  • Psoriasis 
  • Seborrheic dermatitis 
Treatment
  • Medical
    • topical treatment 
      • indications
        • avoid systemic effects of oral medications
        • first-line therapy
      • drugs
        • zinc pyrithione 1% shampoo
        • selenium sulfide 2.5% shampoo 
          • often also used for prophylaxis
        • ketoconazole shampoo
        • sulfur salicylic acid shampoo
        • azole creams
    • oral antifungals
      • indication
        • if disease is widespread or refractory to topical treatment
      • drugs
        • itraconazole
        • fluconazole
Complications
  • Areas of discoloration may be permanent

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(M2.DM.13.3) A 21-year-old male college student returns from spring break complaining of a rash. He has no other specific complaints and the rest of his past medical history is unremarkable. He does mention that he engaged in unprotected sexual intercourse while in the Caribbean and used many different sun tan lotions. Physical exam is notable for the finding in Figure A. What is the best next step in management?

QID: 104214
FIGURES:
1

No treatment is indicated

57%

(13/23)

2

Penicillin

0%

(0/23)

3

Selenium sulfide

17%

(4/23)

4

Triamcinolone

13%

(3/23)

5

UV light

0%

(0/23)

M 7 E

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