Tinea versicolor (Pityriasis versicolor)
- 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
- Professor of Dermatology
- 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
- Professor of Medicine
- Dell Medical School/University of Texas, Austin
- Ted Rosen, MD
Ted Rosen, MD
- Section Editor — Infections and Infestations
- Professor, Department of Dermatology
- Baylor College of Medicine
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 (picture 1A-E). 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 (table 1), but recurrence is common and long-term prophylactic therapy may be necessary. The clinical features, diagnosis, and management of tinea versicolor will be reviewed here.
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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- PATHOGENESIS AND RISK FACTORS
- CLINICAL FEATURES
- DIFFERENTIAL DIAGNOSIS
- Patient education
- First-line therapy
- - Topical antifungals
- - Selenium sulfide
- - Zinc pyrithione
- Severe or recalcitrant disease
- - Oral therapies
- Other therapies
- Treatment failure
- Emerging therapy
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS