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Pityriasis versicolor (tinea versicolor) (Risk factors (Tight clothes,…
Pityriasis versicolor
(tinea versicolor)
Definition
Fungal infection of the
skin, causing a rash
Epidemiology
Common
Summer>winter
Teens and YAs
Pathophysiology
Yeast/fungal infection
Yeast Masassezia, part of normal flora in stratum corneum
Switches from normal to pathological form
Lipophilic, lives in sebum from sebaceous glands
Risk factors
Tight clothes
Hyperhidrosis
Warm/humid environment
Malnutrition
Immunodeficiency
Diagnosis
Examination
Dermatological
Multiple round/ovoid macules,
hyper/hypopigmented, scaly,
pink/brown/fawn coloured
History
DH
Immunosuppressants, allergies
SH
Occupation, leisure activities,
smoking, alcohol
PMH
Immunosuppression
PC/HPC
Widespread hypo/hyperpigmented rash,
mild itch, slightly scaly, no red flags
Investigation
Skin scrapings
Indication: diagnostic uncertainty
Microscopy - hyphae and spores
Management
Conservative
Information and advice
Not contageous (commensal)
Treatment very effective
Recurrence common
Pigment change may persist for a few months
Referral
Widespread disease
Not responsive to treatment
Medical
Antifungal shampoo
Indication: extensive area
E.g. ketoconazole 2% shampoo
MOA: kills fungal cells
SEs: skin irritation, dryness
Topical antifungal
Indication: small area
E.g. clotrimazole, ketoconazole cream
MOA: 2x/d for 2-3wk, kills fungal cells
SEs: skin irritation
Prognosis
Very good if treated, pigment
changes often resolve <2-3m
Does not spontaneously remiss
Recurrence is common
Clinical
presentation
Skin lesions
Round/oval macules, fawn/pink/brown, fine scale
Often multiple and coalesce
Back, chest, upper arms
Often asymptomatic, mild itch
