English Village, Gulan Street, Erbil, Kurdistan Region of Iraq

www.bcm-medical.com
Tinea versicolor
Tinea versicolor (also known as
Dermatomycosis furfurace, Pityriasis versicolor,
and Tinea flava) is a condition characterized by
a rash on the trunk and proximal extremities.
Recent research has shown that the majority of
Tinea versicolor is caused by the Malassezia
globosa fungus, although Malassezia furfur is
responsible for a small number of cases. These
yeasts are normally found on the human skin
and only become troublesome under certain
circumstances, such as a warm and humid
environment, although the exact conditions that
cause initiation of the disease process are poorly understood.
The condition pityriasis versicolor was first identified in 1846. Versicolor comes from the
Latin, from versre to turn + color.
Symptoms
The symptoms of this condition include:
Occasional fine scaling of the skin producing a very superficial ash-like scale
Pale, dark tan, or pink in color, with a reddish undertone that can darken when
the patient is overheated, such as in a hot shower or during/after exercise.
Tanning typically makes the affected areas contrast more starkly with the
surrounding skin.
Sharp border
Pityriasis versicolor is more common in hot, humid climates or in those who
sweat heavily, so it may recur each summer.
Sometimes severe "pin-prick" itching in the affected areas; usually when the
person's body temperature is elevated by exercise or a hot/warm environment,
but the person hasn't started sweating yet. Once sweating begins the "pin-prick"
itching subsides.
The yeasts can often be seen under the microscope within the lesions and typically have
a so-called "spaghetti and meat ball appearance" as the round yeasts produce filaments.
In people with dark skin tones, pigmentary changes such as hypopigmentation (loss of
color) are common, while in those with lighter skin color, hyperpigmentation (increase in
skin color) are more common. These discolorations have led to the term "sun fungus".


Pityriasis versicolor commonly causes hypopigmentation in people with dark skin tones

English Village, Gulan Street, Erbil, Kurdistan Region of Iraq
www.bcm-medical.com
Prevalence
This skin disease commonly affects adolescents and young adults, especially in warm
and humid climates. It is thought that the yeast feeds on skin oils (lipids) as well as
dead skin cells. Infections are more common in people who have seborrheic dermatitis,
dandruff, and hyperhidrosis.
Diagnosis


Tinea Versicolor fluorescence under Wood's lamp
Tinea versicolor may be diagnosed by a potassium
hydroxide (KOH) preparation and lesions may
fluoresce copper-orange when exposed to Wood's
lamp.
The differential diagnosis for Tinea versicolor
infection includes:
Pityriasis alba
Pityriasis rosea
Seborrheic dermatitis
Erythrasma
Vitiligo
Leprosy
Syphilis
Post-inflammatory hypopigmentation
[12]

Treatment


Malassezia furfur in skin scale from a patient
with tinea versicolor
Treatments for tinea versicolor include:
Topical antifungal medications
containing 2.5% selenium sulfide are often
recommended. Selsun Blue works for some
people, but not all, because it only contains 1% selenium sulfide. Preparations
containing more than 1% selenium sulfide are considered prescription strength.
Products that contain 1% selenium sulfide include [ZunSpot] medicated cream.
Ketoconazole (Nizoral ointment and shampoo) is another treatment. It is
normally applied to dry skin and washed off after 10 minutes, repeated daily for

English Village, Gulan Street, Erbil, Kurdistan Region of Iraq
www.bcm-medical.com
2 weeks. Ciclopirox (Ciclopirox olamine) is an alternative treatment to
ketoconazole as it suppresses growth of the yeast Malassezia furfur. Initial
results show similar efficacy to ketoconazole with a relative increase in subjective
symptom relief due to its inherent anti-inflammatory properties. Other topical
antifungal agents such as clotrimazole, miconazole or terbinafine can lessen
symptoms in some patients. Additionally, hydrogen peroxide has been known to
lessen symptoms, and on certain occasions, remove the problem, although
permanent scarring has occurred with this treatment in some sufferers.
Clotrimazole (1%) is also used combined with selenium sulfide (2.5%) (Candid-
TV).
Oral antifungal prescription-only medications include 400 mg of ketoconazole or
fluconazole in a single dose, or ketoconazole 200 mg daily for 7 days, or
itraconazole 400 mg daily for 37 days. The single-dose regimens, or pulse
therapy regimes, can be made more effective by having the patient exercise 12
hours after the dose, to induce sweating. The sweat is allowed to evaporate, and
showering is delayed for a day, leaving a film of the medication on the skin.
[17]

Some success with Senna alata has been reported.
Recurrence is common and may be reduced by intermittent application of topical
anti-fungal agents like tea tree oil or selenium sulfide.
References
1. Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-
Volume Set. St Louis: Mosby. pp. Chapter 76. ISBN 1-4160-2999-0.
2. Morishita N; Sei Y. (December 2006). "Microreview of Pityriasis versicolor and
Malassezia species". Mycopathologia 162 (6): 37376. doi:10.1007/s11046-006-
0081-2.
3. Prohic A; Ozegovic L. (January 2007). "Malassezia species isolated from lesional
and non-lesional skin in patients with pityriasis versicolor". Mycoses 50 (1): 58
63. doi:10.1111/j.1439-0507.2006.01310.x.
4. Weedon, D. (2002). Skin pathology (2nd edition ed.). Churchil Livingstone.
ISBN 0-443-07069-5.
5. Inamadar AC, Palit A (2003). "The genus Malassezia and human disease". Indian
J Dermatol Venereol Leprol 69 (4): 26570. PMID 17642908.
6. "versicolor". Collins English Dictionary Complete & Unabridged 10th Edition.
HarperCollins Publishers. Retrieved March 2, 2013.
7. "What to Avoid While Treating Tinea Versicolor". Retrieved 2013-01-05.
8. http://www.dermnetnz.org/fungal/pityriasis-versicolor.html
9. "Adolescent Health Curriculum - Medical Problems - Dermatology -
Papulosquamous Lesions (B4)". Retrieved 2008-12-10.
10. "Tioconazole (Topical Route) - MayoClinic.com". Retrieved 2008-12-10.
11. Likness, LP (June 2011). "Common dermatologic infections in athletes and
return-to-play guidelines.". The Journal of the American Osteopathic Association
111 (6): 373379. PMID 21771922.

English Village, Gulan Street, Erbil, Kurdistan Region of Iraq
www.bcm-medical.com
12. http://dermind.tripod.com/tv.htm
13. MedlinePlus Medical Encyclopedia: Tinea versicolor
14. Ratnavel RC, Squire RA, Boorman GC (2007). "Clinical efficacies of shampoos
containing ciclopirox olamine (1.5%) and ketoconazole (2.0%) in the treatment
of seborrhoeic dermatitis". J Dermatolog Treat 18 (2): 8896.
doi:10.1080/16537150601092944. PMID 17520465.
15. Faergemann J, Gupta AK, Al Mofadi A, Abanami A, Shareaah AA, Marynissen G
(January 2002). "Efficacy of itraconazole in the prophylactic treatment of
pityriasis (tinea) versicolor". Arch Dermatol 138 (1): 6973.
doi:10.1001/archderm.138.1.69. PMID 11790169.
16. Mohanty J, Sethi J, Sharma MK (2001). "Efficacy of itraconazole in the treatment
of tinea versicolor". Indian J Dermatol Venereol Leprol 67 (5): 2401.
PMID 17664760.
17. Ketoconazole
18. Damodaran S, Venkataraman S (March 1994). "A study on the therapeutic
efficacy of Cassia alata, Linn. leaf extract against Pityriasis versicolor". J
Ethnopharmacol 42 (1): 1923. doi:10.1016/0378-8741(94)90018-3.
PMID 8046939.
19. http://www.drugs.com/npp/tea-tree-oil.html