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Updated: Dec 16 2021

Tinea Versicolor

Images spaghetti and meatballs.jpg
  • 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
    • Associated conditions
      • seborrheic dermatitis
  • 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
  • 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
  • Prognosis
    • Often recurs
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