Tinea Versicolor - Causes, symptoms and Treatments

A chronic, superficial, fungal infection, tinea versicolor (also known as pityriasis versicolor) may produce a multicolored rash, commonly on the upper trunk. This condition, primarily a cosmetic defect, usually affects young people, especially during warm weather, and is most prevalent in tropical countries. Recurrence is common.

Causes of Tinea Versicolor:

The agent that causes tinea versicolor is Malasseziafuifur (Pityrosporum orbiculare). Whether this condition is infectious or merely a proliferation of normal skin fungi is uncertain.

Signs and symptoms of Tinea Versicolor:

Tinea versicolor typically produces raised or macular, round or oval, slightly scaly lesions on the upper trunk, which may extend to the lower abdomen, neck, arms, and, rarely, the face. These lesions are usually tawny but may range from hypopigmented (white) patches in dark-skinned patients to hyperpigmented (brown) patches in fair-skinned patients. Some areas don't tan when exposed to sunlight, causing the cosmetic defect for which most persons seek medical help. Inflammation, burning, and itching are possible but usually absent.

Diagnosis of Tinea Versicolor:

Visualization of lesions during Wood's light examination strongly suggests tinea versicolor.

Microscopic examination of skin scrapings prepared in potassium hydroxide solution confirms the disorder by showing hyphae, clusters of yeast, and large numbers of variously sized pores (a combination referred to as "spaghetti and meatballs").

Other conditions to consider include vitiligo, clear psoriasis, nummular eczema, and pityriasis rosea.

Treatment of Tinea Versicolor:

The most economical and effective treatment is selenium sulfide lotion 2.5% applied once a day for 7 days. It's left on the skin for 10 minutes, then rinsed off thoroughly. In severe or persistent cases, therapy may require systemic ketoconazole. Topical treatment may cause temporary redness and irritation.

More expensive treatments for tinea versicolor include topical antifungals such as imidazole creams, which are applied twice daily for a month, and oral antifungals such as ketoconazole for extensive cases.

Special considerations of Tinea Versicolor:

1. Instruct the patient to apply selenium sulfide lotion, as ordered. Tell him that this medication may cause temporary adverse effects.

2. Assure the patient that once his fungal infection is cured, discolored areas will gradually blend in after exposure to the sun or ultraviolet light.

3. Because recurrence of tinea versicolor is common, advise the patient to watch for new areas of discoloration.

4. Teach the patient proper hand-washing technique, and encourage good personal hygiene.

5. Stress the importance of not scratching or picking lesions to avoid the risk of skin breaks and secondary bacterial infections.

6. Provide written instructions for using prescribed medications. Tell the patient to contact the doctor if adverse reactions occur.