- Beth G Goldstein, MD
Beth G Goldstein, MD
- Adjunct Clinical Assistant Professor
- Department of Dermatology
- University of North Carolina at Chapel Hill
- Adam O Goldstein, MD, MPH
Adam O Goldstein, MD, MPH
- Department of Family Medicine
- University of North Carolina at Chapel Hill
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — Dermatology
- Associate Professor of Dermatology and Public Health
- Denver VA Medical Center, University of Colorado School of Medicine and Colorado School of Public Health
- Moise L Levy, MD
Moise L Levy, MD
- Section Editor — Pediatric Dermatology
- Clinical Professor of Dermatology and Pediatrics
- Baylor College of Medicine
- Clinical Professor of Dermatology, UTSW Medical School
- Dell Children's Medical Center
Tinea versicolor (ie, pityriasis versicolor) is a common superficial fungal infection. Patients with this disorder often present with hypopigmented, hyperpigmented, or erythematous macules on the trunk and proximal upper extremities. Unlike other disorders utilizing the term tinea (eg, tinea pedis, tinea capitis), tinea versicolor is not a dermatophyte infection. The causative organisms are saprophytic, lipid-dependent yeasts in the genus Malassezia (formerly known as Pityrosporum) .
Tinea versicolor responds well to medical therapy, but recurrence is common and long-term prophylactic therapy may be necessary.
Tinea versicolor occurs worldwide, but the highest incidence is found in tropical climates. Prevalence of up to 50 percent has been reported in some tropical countries . In Scandinavia, the prevalence has been estimated to be approximately 1 percent .
Tinea versicolor most commonly affects adolescents and young adults, but can also occur in children and has been reported in infants [3-6]. The disorder is not contagious, although successful inoculation has occurred under experimental conditions utilizing topical oils and occlusion [7,8].
PATHOGENESIS AND RISK FACTORS
Malassezia is a lipid-dependent, dimorphic fungus that is a component of normal skin flora. Transformation of Malassezia from yeast cells to a pathogenic mycelial form is associated with the development of clinical disease. External factors suspected of contributing to this conversion include exposure to hot and humid weather, hyperhidrosis, and the use of topical skin oils . Tinea versicolor is not related to poor hygiene.
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- Güleç AT, Demirbilek M, Seçkin D, et al. Superficial fungal infections in 102 renal transplant recipients: a case-control study. J Am Acad Dermatol 2003; 49:187.
- Borelli D, Jacobs PH, Nall L. Tinea versicolor: epidemiologic, clinical, and therapeutic aspects. J Am Acad Dermatol 1991; 25:300.
- Morishita N, Sei Y. Microreview of Pityriasis versicolor and Malassezia species. Mycopathologia 2006; 162:373.
- Prohic A, Ozegovic L. Malassezia species isolated from lesional and non-lesional skin in patients with pityriasis versicolor. Mycoses 2007; 50:58.
- Karakaş M, Turaç-Biçer A, Ilkit M, et al. Epidemiology of pityriasis versicolor in Adana, Turkey. J Dermatol 2009; 36:377.
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- Drake LA, Dinehart SM, Farmer ER, et al. Guidelines of care for superficial mycotic infections of the skin: Pityriasis (tinea) versicolor. Guidelines/Outcomes Committee. American Academy of Dermatology. J Am Acad Dermatol 1996; 34:287.
- Savin RC, Horwitz SN. Double-blind comparison of 2% ketoconazole cream and placebo in the treatment of tinea versicolor. J Am Acad Dermatol 1986; 15:500.
- Lange DS, Richards HM, Guarnieri J, et al. Ketoconazole 2% shampoo in the treatment of tinea versicolor: a multicenter, randomized, double-blind, placebo-controlled trial. J Am Acad Dermatol 1998; 39:944.
- Savin R, Eisen D, Fradin MS, Lebwohl M. Tinea versicolor treated with terbinafine 1% solution. Int J Dermatol 1999; 38:863.
- Vermeer BJ, Staats CC. The efficacy of a topical application of terbinafine 1% solution in subjects with pityriasis versicolor: a placebo-controlled study. Dermatology 1997; 194 Suppl 1:22.
- Treatment of tinea versicolor with a new antifungal agent, ciclopirox olamine cream 1%. Clin Ther 1985; 7:574.
- Sánchez JL, Torres VM. Double-blind efficacy study of selenium sulfide in tinea versicolor. J Am Acad Dermatol 1984; 11:235.
- Leeming JP, Sansom JE, Burton JL. Susceptibility of Malassezia furfur subgroups to terbinafine. Br J Dermatol 1997; 137:764.
- Köse O, Bülent Taştan H, Riza Gür A, Kurumlu Z. Comparison of a single 400 mg dose versus a 7-day 200 mg daily dose of itraconazole in the treatment of tinea versicolor. J Dermatolog Treat 2002; 13:77.
- Karakaş M, Durdu M, Memişoğlu HR. Oral fluconazole in the treatment of tinea versicolor. J Dermatol 2005; 32:19.
- Amer MA. Fluconazole in the treatment of tinea versicolor. Egyptian Fluconazole Study Group. Int J Dermatol 1997; 36:940.
- Faergemann J. Treatment of pityriasis versicolor with a single dose of fluconazole. Acta Derm Venereol 1992; 72:74.
- Faergemann J, Todd G, Pather S, et al. A double-blind, randomized, placebo-controlled, dose-finding study of oral pramiconazole in the treatment of pityriasis versicolor. J Am Acad Dermatol 2009; 61:971.
- Hay RJ, Midgeley G. Short course ketoconazole therapy in pityriasis versicolor. Clin Exp Dermatol 1984; 9:571.
- Zaias N. Pityriasis versicolor with ketoconazole. J Am Acad Dermatol 1989; 20:703.
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- Hu SW, Bigby M. Pityriasis versicolor: a systematic review of interventions. Arch Dermatol 2010; 146:1132.
- Goodless DR, Ramos-Caro FA, Flowers FP. Ketoconazole in the treatment of pityriasis versicolor: international review of clinical trials. DICP 1991; 25:395.
- http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2013/07/news_detail_001855.jsp&mid=WC0b01ac058004d5c1 (Accessed on July 26, 2013).
- http://www.fda.gov/Drugs/DrugSafety/ucm362415.htm (Accessed on July 26, 2013).
- Silva H, Gibbs D, Arguedas J. A comparison of fluconazole with ketoconazole, itraconazole, and clotrimazole in the treatment of patients with pityriasis versicolor. Current Therapeutic Research. 1998; 59:203.
- del Palacio Hernanz A, Delgado Vicente S, Menéndez Ramos F, Rodríguez-Noriega Belaustegui A. Randomized comparative clinical trial of itraconazole and selenium sulfide shampoo for the treatment of pityriasis versicolor. Rev Infect Dis 1987; 9 Suppl 1:S121.
- Faergemann J, Gupta AK, Al Mofadi A, et al. Efficacy of itraconazole in the prophylactic treatment of pityriasis (tinea) versicolor. Arch Dermatol 2002; 138:69.
- PATHOGENESIS AND RISK FACTORS
- CLINICAL FEATURES
- Differential diagnosis
- Topical therapy
- - Topical antifungals
- - Selenium sulfide
- - Other topical agents
- Systemic therapy
- - Itraconazole
- - Fluconazole
- - Pramiconazole
- - Ketoconazole
- Comparison studies
- Treatment failure
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS