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Tinea Versicolor -ˈvər-si-ˌkəl-ər

(Pityriasis Versicolor)

By Denise M. Aaron, MD, Assistant Professor of Surgery;Staff Physician, Dartmouth-Hitchcock Medical Center;Veterans Administration Medical Center, White River Junction

Tinea versicolor is a fungal infection of the topmost layer of the skin causing scaly, discolored patches.

  • This infection is caused by yeast.

  • Typically, people have scaly patches of skin.

  • The diagnosis is based on appearance and skin scrapings.

  • This infection often returns.

  • Antifungal skin products, shampoos, and sometimes drugs taken by mouth are used to treat the infection.

The infection, caused by the yeast Malassezia furfur, is quite common, especially among young adults. Malassezia furfur is typically a harmless yeast that normally lives on the skin but in some people causes tinea versicolor. Most affected people are healthy. Some people may be genetically predisposed to overgrowth of this yeast.

Other risk factors for tinea versicolor include heat and humidity and an immune system weakened by corticosteroid use, pregnancy, undernutrition, diabetes, or other disorders.

Tinea versicolor is a mild infection and is not considered contagious.

Symptoms

Tinea versicolor usually does not cause symptoms. However, it does cause many tan, brown, salmon, or white scaly patches to appear on the trunk, neck, abdomen, and occasionally the face. The patches may join to form larger patches. The patches do not tan, so in summer, when the surrounding skin tans, the patches may become obvious. People with naturally dark skin may notice lighter patches. People with naturally fair skin may get darker or lighter patches.

Diagnosis

  • A doctor's examination of the skin and skin scrapings

  • Sometimes a Wood light examination

Doctors diagnose tinea versicolor by the appearance of the skin and by looking at skin scrapings under a microscope to see the fungus.

Doctors may use an ultraviolet light (called a Wood light) to show the infection on the skin more clearly.

Prognosis

The skin may not regain its normal pigmentation for many months or years after the infection is gone.

Tinea versicolor commonly comes back after successful treatment because the yeast that causes it normally lives on the skin.

Treatment

  • Antifungal drugs applied to the affected areas or sometimes taken by mouth

Any antifungal drugs applied directly to the affected areas (topical) may be used to treat tinea versicolor. Prescription-strength selenium sulfide shampoo is effective if applied to affected skin (not just the scalp) for 10 minutes a day for 1 week or for one 24-hour application each week for one month. Other treatments include applying topical ketoconazole daily for 2 weeks and bathing with zinc pyrithione soap or sulfur-salicylic shampoo for 1 to 2 weeks.

Antifungal drugs taken by mouth, such as fluconazole, are sometimes used to treat people who have a widespread infection (see Table: Drugs for Serious Fungal Infections) or frequent infections.

To lower the chance of the infection coming back, many doctors recommend practicing meticulous hygiene and using zinc pyrithione soap regularly or one of the other topical treatments monthly.

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