Review Question - QID 104214

This patient is presenting with a hypopigmented rash that will not tan which is suggestive of a superficial fungal infection (tinea versicolor). Selenium sulfide or zinc shampoo are the most appropriate initial treatments.

Tinea versicolor is a common superficial fungal infection that classically presents with hypo- or hyperpigmented patchy macules on the chest and back. The causative agent is Malassezia furfur (a lipid-dependent fungus). Diagnosis can be confirmed through microscopy with a KOH preparation which should reveal hyphae and spores in a characteristic "spaghetti and meatballs" pattern. Initial treatment includes application of selenium sulfide or zinc shampoo. Topical antifungals such as ketoconazole can be used if there is no response to initial therapy. Systemic antifungal therapies can be used with resistant infections.

Figure A demonstrates a patient suffering from tinea versicolor. Note the characteristic pattern of hypopigmented macules.

Incorrect Answers:
Answer 1: No treatment is indicated may be appropriate for normal dermatologic findings such as a nevus; however, tinea versicolor will not resolve on its own.

Answer 2: Penicillin would be an appropriate treatment for secondary syphilis, which can appear similar to tinea versicolor. Epidemiologically, tinea versicolor is a more likely diagnosis. Similarly, there is no other history to support a diagnosis of syphilis (such as condyloma lata or a painless chancre).

Answer 4: Triamcinolone is a topical steroid which could be given for a contact dermatitis which presents with a vesicular rash that is highly pruritic.

Answer 5: UV light may be indicated in severe and systemic psoriasis that does not respond to initial less invasive measures such as steroids. It is typically one of the last treatments utilized after immunomodulators given the damage UV light can cause.

Bullet Summary:
The best initial treatment of tinea versicolor is topical selenium sulfide or zinc containing shampoo.