Typically, tinea versicolor presents with well defined, variably sized hypopigmented macules and patches covered with fine white scales which are hardly visible to the naked eye. The scales can be made more evident by scraping the affected lesions with a sharp object. Hyperpigmented patches can also occur.

These lesions mainly occur on the neck, axillae, chest, back and proximal extremities are affected. Rarely, face and inframammary folds of females are affected.

Lesions maybe variously coloured ranging from reddish brown, dark brown to blackish. These lesions are usually asymptomatic. Pruritus may be present on the affected areas. The lesions appear hypopigmented in dark skin and hyper pigmented in lighter skin.

• Asymptomatic

  Tinea versicolor (TV) is typically an asymptomatic fungal infection of the stratum corneum owing to Malassezia overgrowth. It presents as hypo or hyperpigmented macules with fine scale that coalesce into patches on the trunk, neck, and/or arms. [ncbi.nlm.nih.gov]

  CONSUMERS: Click here for the Consumer Version Topic Resources Tinea versicolor is skin infection with Malassezia furfur that manifests as multiple asymptomatic scaly patches varying in color from white to tan to brown to pink. [msdmanuals.com]

  Tinea versicolor is skin infection with Malassezia furfur that manifests as multiple asymptomatic scaly patches varying in color from white to tan to brown to pink. [merckmanuals.com]

• Fever

  Call your healthcare provider if you have: Symptoms that don’t get better, or get worse New symptoms Fever of 100.4°F (38°C) or higher, or as directed by your provider Key points about tinea versicolor Tinea versicolor is a fungal skin rash. [massgeneral.org]

  But they do have side effects like nausea and fever, so many people opt for the shampoos or creams. [buzzfeed.com]

  Herpes Simplex/Cold Sores Herpes simplex can be either Type 1, which produces cold sores or fever blisters on the mouth, or Type 2, which is typically spread through sexual contact and produces blisters on the buttocks or genitals. [dermrochester.com]

  It is characterized by chronic hoarseness, with or without systemic or respiratory symptoms involving fever, cough, and tachypnea. It is usually diagnosed by laryngoscopy and biopsy. Systemic antifungal treatment is often effective. [doi.org]

• Chronic Infection

  […] tinea ver·si·col·or | \ -ˈvər-si-ˌkəl-ər \ Medical Definition of tinea versicolor : a common, chronic infection of the skin especially of the trunk and shoulders that is caused by a lipophilic fungus (especially Melassezia furfur and M. globosa ), that [merriam-webster.com]

• Pallor

  Wood lamp (black light) examination — yellow-green fluorescence may be observed in affected areas Dermoscopy of pityriasis versicolor — pallor, background faint pigment network, and scale Microscopy of a skin scraping (using potassium hydroxide (KOH) [dermnetnz.org]

• Nausea

  The side effects of itraconazole include nausea, stomach ache and headache. It can also affect your liver. [informedhealth.org]

  Oral Antifungals Oral anti-fungal medications can cause side effects such as nausea or reversible liver damage, but these side effects are uncommon with the short courses of therapy used for tinea versicolor. [verywell.com]

  But they do have side effects like nausea and fever, so many people opt for the shampoos or creams. [buzzfeed.com]

  Pills Antifungal pills can be prescribed for tinea versicolor, but often have side effects such as nausea, vomiting, diarrhea, fatigue, and can potentially harm the liver. [naturalremedies.org]

  Here are some oral antifungals that are available by prescription: Ketoconazole Itraconazole Fluconazole Treatment regimen: Antifungal pills can cause side effects, such as nausea and reversible liver damage, although these are uncommon because treatment [howtogetridofstuff.com]

• Vomiting

  Pills Antifungal pills can be prescribed for tinea versicolor, but often have side effects such as nausea, vomiting, diarrhea, fatigue, and can potentially harm the liver. [naturalremedies.org]

  Shows hypersensitivity, not recommended for children, nausea, headache, vomiting. Hepatotoxicity may be associated with some oral antifugal medications ( Sunenshine et al., 1998b ). [omicsonline.org]

• Sweating

  However, in our study, itching was also reported following bathing, sweating, and sun exposure, commonly over the hypopigmented lesions. Krishnan et al. [3] in their study found that itching was mainly present during sweating. [doi.org]

  The sweat is allowed to evaporate, and showering is delayed for a day, leaving a film of the medication on the skin. [18] Epidemiology This skin disease commonly affects adolescents and young adults, especially in warm and humid climates. [ipfs.io]

  Other symptoms include: Increased sweating Mild itching Mild swelling Your health care provider will examine a skin scraping under a microscope to look for the fungus. [nlm.nih.gov]

  The sweat is allowed to evaporate, and showering is delayed for a day, leaving a film of the medication on the skin.[18] Epidemiology[edit] This skin disease commonly affects adolescents and young adults, especially in warm and humid climates. [en.wikipedia.org]

  Itching related to tinea versicolor usually accompanies sweating, so products that keep the skin dry also help prevent itching. [web.archive.org]

• Dermatitis

  Skov patients with atopic dermatitis and seborrhoeic dermatitis. J Am Acad Dermatol 1990; 22: 739–742 PubMed CrossRef Google Scholar 46. Kesavan S., Walters C.E., Holland K.T, et al. [doi.org]

  Mild corticosteroids are effective in the treatment of seborrheic dermatitis. However, the disease recurs quickly, often within just a few days. [ncbi.nlm.nih.gov]

  "Management of Seborrheic Dermatitis and Pityriasis Versicolor". Am. J. Clin. Dermatol. 1 (2): 75–80. doi:10.2165/00128071-200001020-00001. PMID 11702314. [en.wikipedia.org]

  "Clinical efficacies of shampoos containing ciclopirox olamine (1.5%) and ketoconazole (2.0%) in the treatment of seborrhoeic dermatitis". J Dermatolog Treat. 18 (2): 88–96. doi : 10.1080/16537150601092944. [ipfs.io]

• Hyperpigmentation

  Hyperpigmentation in lesions of tinea versicolor has previously been reported to be a result of the effects of the fungus Pityrosporon orbiculare on melanosome formation and distribution. [ncbi.nlm.nih.gov]

  References: [4] [5] Clinical features Round, well-demarcated macules that reveal a fine, subtle scale with gentle scraping → can coalesce into patches (which may have irregular shapes) Colors vary from hypopigmentation, pityriasis versicolor alba, to hyperpigmentation [amboss.com]

  Disorders of hyperpigmentation. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 67. Patterson JW. Mycoses and algal infections. In: Patterson JW, ed. Weedon's Skin Pathology. 4th ed. [nlm.nih.gov]

• Pruritus

  A study of the prevalence and precipitating factors of pruritus in pityriasis versicolor. Indian Dermatol Online J 2014;5:223-4 How to cite this URL: Kaushik A, Pinto HP, Bhat RM, Sukumar D, Srinath M K. [doi.org]

  A potassium hydroxide examination and assessment of scaling, erythema, pruritus, and global condition were performed at baseline and at 4 weeks after treatment. [ncbi.nlm.nih.gov]

  Mild pruritus Common sites are the trunk and chest, but the neck, abdomen, upper arms, and thighs may also be affected. [amboss.com]

  "A study of the prevalence and precipitating factors of pruritus in pityriasis versicolor". Indian Dermatology Online Journal. 5 (2): 223–224. doi : 10.4103/2229-5178.131141. PMC 4030364. [ipfs.io]

• Hyperhidrosis

  "Selected Disorders of Skin Appendages-Acne, Alopecia, Hyperhidrosis". The Medical Clinics of North America. 99 (6): 1195–1211. doi : 10.1016/j.mcna.2015.07.003. PMID 26476248. 1 2 Likness, LP (June 2011). [ipfs.io]

  The most important endogenous factors are greasy skin, hyperhidrosis, hereditary factors, corticosteroid treatment and immunodeficiency. There are many ways of treating pityriasis versicolor topically. [ncbi.nlm.nih.gov]

  "Selected Disorders of Skin Appendages-Acne, Alopecia, Hyperhidrosis". The Medical Clinics of North America. 99 (6): 1195–1211. doi:10.1016/j.mcna.2015.07.003. PMID 26476248. ^ a b Likness, LP (June 2011). [en.wikipedia.org]

  The predisposing factors for this change are moist humid conditions, hyperhidrosis, excessive sebum production and other various factors. [symptoma.com]

  Hyperhidrosis Excessive underarm sweating, or hyperhidrosis, can be an embarrassing condition that affects patients in both social and professional settings. Overactive sweat glands can cause excessive sweating on the hands and feet, too. [dermrochester.com]

• Confusion

  Confluent and reticulated papillomatosis is most often clinically confused with tinea versicolor and usually does not respond to therapy with antifungals. Minocycline is the treatment of choice. [ncbi.nlm.nih.gov]

  This unusual pattern of tinea versicolor is seen more often in immunocompromised hosts and can be confused with candidiasis, seborrheic dermatitis, psoriasis, erythrasma, and dermatophyte infections. [emedicine.medscape.com]

  It is also known as pityriasis versicolor and is frequently confused with other skin rashes. While the rash is most common during adolescence and early adulthood, it can occur at any age. [verywell.com]

  Pityriasis versicolor can sometimes be confused with vitiligo, as they both cause the skin to become discoloured in patches. [nhs.uk]

  Some cases of scalp ringworm do not produce obvious rings and can be confused with dandruff or cradle cap. In a few cases, the child will have a reaction to the fungus and develop a large boggy area called a kerion. [healthychildren.org]

Tinea versicolor is easily diagnosed by simple clinical examination. The macules and patches of tinea versicolor are very characteristic and should be differentiated from other skin conditions which mimic this condition.

Physicians can elicit the ‘scratch sign’ or ‘Besnier sign’ which normally accentuates the fine white scales when the affected area is scratched with a pointed object.

When examined with a Wood’s lamp, scales fluoresce golden yellow to green. Microscopic examination of the lesions show typical ‘spaghetti and meatballs’ appearance due to presence of both hyphae and spores of the yeast [7].

No laboratory tests are required for this condition.

• Malassezia Furfur

  versicolor; tinea, Infection by Malassezia furfur, Infection by Pityrosporum furfur, pityriasis versicolor Italian Tinea versicolor, Pityriasis versicolor, Pitiriasi versicolor, Tigna versicolor Dutch pityriasis versicolor, Malassezia furfur; infectie [fpnotebook.com]

  Tinea versicolor due to Malassezia furfur Synonym for Pityriasis versicolor A00-B99 Certain infectious and parasitic diseases (A00-B99)|B35-B49 Mycoses (B35-B49)|B36 Other superficial mycoses Results for Tinea versicolor due to Malassezia furfur and additional [averbis.com]

  Malassezia furfur in skin scale from a patient with tinea versicolor PHIL 3938 lores.jpg 700 × 470; 22 KB Malassezia spores 2.jpg 2.490 × 1.128; 1.007 KB Malassezia spores.jpg 3.726 × 1.142; 1,68 MB P versicolorklein.jpg 1.272 × 954; 532 KB Photographic [commons.wikimedia.org]

The treatment usually consists of topical antifungal creams mainly consisting of selenium sulphide (2%), as well as azoles and other antifungals [8]. Application to the affected area and surrounding skin should be done twice or once a day for 2 weeks. Other topical applications include clotrimazole, miconazole, and terbinafine can also reduce the patches. Antifungal shampoos can also be applied to the body.

Oral antifungals are given; mainly fluconazole and ketoconazole. These are preferred as they are more convenient and simpler. Oral antifungals like ketoconazole 200mg are given once a day for 10 days; they are better reserved for persistence or recurrence [9].
Nowadays, a combination of oral and topical antifungals is given for better results.

Pigmentary changes take about 1-2 months to resolve after antifungal therapy is started; however, fungal activity completely stops by 2 weeks of treatment.

Patient has to be reassured that skin colour will return to normal after a couple of months. The skin colour eventually darkens after sun exposure. Occasionally, pale white marks may remain permanent for unknown reasons.

Prophylactic treatment is given intermittently in the form of oral antifungals, given once a month to reduce the chronicity of this infection.

With treatment this fungal infection has a very good prognosis. Even though pigmentation takes time to disappear may be even months, the fungal activity is controlled within two weeks. So even though hypopigmentation does not go away fast, patient is disease free.

Reappearance of tinea versicolor is very common especially in the hot season thus, making tinea versicolor a chronic skin infection. Intermediate preventive care can prevent the relapse.

Tinea versicolor is said to be caused by an overgrowth and over activity of a fungus which belongs to the genus Malassezia [1]. There are two forms: Malassezia globosa and Malassezia furfur. The saprophytic fungi are a normal part of the skin flora. They inhabit the sebaceous ducts and follicular infundibulum as these are lipophilic microorganisms [2]. As a result these lesions are mainly seen in seborrheic regions of young individuals, as sebaceous glands are most active during adolescence.

Moist and humid conditions along with excessive sweating tend to cause and over activity of these normal saprophytes. Hormonal imbalance along with weakened immune system [3] also seems to play a role in the etiology but the exact mechanism is not clearly understood.

Since this yeast is lipophilic, hyperhidrosis and overactive sebaceous glands are important predisposing factors.

Tinea versicolor is one of the most commonly occurring skin infections which affect young individuals. There is equal incidence among men and women.

It affects all races but more visibly evident in dark skinned individuals. It rarely affects elderly people and occurs more in tropical or subtropical countries.

Sometimes this condition may not even be visible to the individual as a result patient may not even take treatment. The exact prevalence is not known as it is not a reportable infection.

Seborrheic dermatitis and acne vulgaris have common associations with tinea versicolor.

Irregular pigmentation is the main pathology [4] in this condition, which occurs due to increased production of a normal inhabiting yeast Malassezia furfur or Malassezia globosa. They are typically lipophilic and saprophytic in nature.

The change of the fungus from saprophyte to parasitic is the main underlying pathology. The predisposing factors for this change are moist humid conditions, hyperhidrosis, excessive sebum production and other various factors. As a result of this, these microorganisms release azelaic acid which is known to inhibit tyrosinase activity, which is responsible for melanin production as a result hypopigmentation occurs [5].

The exact mechanism of hyperpigmentation is not known but is assumed to be because of large malanosomes.

Microscopically, scrapings from the lesions will show short, broad, septate hyphae and clusters of round spores that look like ‘spaghetti and meatballs’. There will be slight perivascular inflammation and lymphocytic infiltrate may be present. Hyperkeratosis and acanthosis may be present in the epidermis. Microorganisms are only seen in the stratum corneum, no other layers of skin are affected [6].

As the fungus is present normally in all individuals there is no accepted prevention. Prevention mainly will be to prevent recurrence.

Excessive sweating, sun exposure and moist humid climate should be avoided. Oral antifungals are given intermittently once or twice a month to prevent the reappearance.

Medications for prevention are mainly selenium sulphide shampoo, ketoconazole cream, shampoo or tablets. Itraconazole is mainly given as oral preventive therapy [10].

Tinea versicolor is a common cutaneous fungal infection, which results in hypopigmented or hyperpigmented patches on the skin. It is one of the most common fungal infections affecting the skin. The yeast responsible for this belongs to the genus Malassezia, [1] which is a normal inhabitant of the skin.

This fungal infection can be chronic in nature especially in predisposed individuals. It occurs mainly on the trunk and extremities. Hot humid weather and excessive sweating are important predisposing factors, thus it is more common in tropical regions. It is not a contagious disease.

This condition has nothing to do with other tinea conditions (ringworm) that are caused by dermatophytes. Tinea versicolor is restricted till stratum corneum and does not penetrate deeper layers.

Versicolor means variously coloured, as in this skin infection, there are various skin patches of different colours in comparison to the surrounding skin.

Though the treatment for tinea versicolor is very effective, it tends to reappear often. The recurrence is mainly in the hot season as a result this condition becomes chronic.

Tinea versicolor is a common fungal infection that causes patches on the skin which are either lighter or darker than the surrounding skin. This fungus is normally present on the skin in healthy individuals, but when it grows out of control the skin infection arises. The exact mechanism of formation of these patches is not known, but the fungus is the main causative agent.

This mainly affects the chest, back, neck and underarms and usually affects young adults. Excessive sweating, moist humid climate and oil secretion are important factors to promote overgrowth of this fungus.

Symptoms mainly include discoloured patches son the skin which maybe either lighter or darker than the surrounding skin. Mild itching may be present on affected areas.

This condition can be treated with over the counter antifungal creams but it is best to consult a physician. The physician will clinically examine the affected area or may ask for microscopic examination of the skin scrapings from affected lesion if the diagnosis is unclear.

Treatment mainly consists of antifungal creams which need to be applied daily for a minimum two weeks for effectiveness. Oral antifungals will also be given in combination with cream. Once treatment is started the fungal activity stops by two weeks but discoloured patches may take time to return to normal colouration. There is a high tendency for this condition to reoccur. Preventive treatment is given on and off especially during the hot season.

This condition is not contagious and with proper treatment and preventive measures, tinea versicolor can be bought under control.

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3. Burkhart CG, Dvorak N, Stockard H. An unusual case of tinea versicolor in an immunosuppressed patient. Cutis. 1981;27(1):56-8.
4. Mendez-Tovar LJ. Pathogenesis of dermatophytosis and tineaversicolor. Clin Dermatol. 2010 Mar 4;28(2):185-89.
5. Gaitanis G, Velegraki A, Alexopoulos EC, Chasapi V, et al. Distribution of Malassezia species in pityriasis versicolor and seborrhoeic dermatitis in Greece. Typing of the major pityriasis versicolor isolate M. globosa. Br J Dermatol. 2006 May;154(5):854-9.
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9. Gupta AK, Lane D, Paquet M. Systematic review of systemic treatments for tinea versicolor and evidence-based dosing regimen recommendations. J Cutan Med Surg. 2014 Mar-Apr;18(2):79-90.
10. Faergemann J, Gupta AK, Al Mofadi A, Abanami A, et al. Efficacy of itraconazole in the prophylactic treatment of pityriasis (tinea) versicolor. Arch Dermatol. 2002 Jan;138(1):69-73.