Core Dermatology Diagnoses / CategoriesInfectious

Tinea versicolor

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Publish date: Posted on
Last updated: May 11, 2022

Keywords #

tinea versicolor
pityriasis versicolor

Diagnosis #

Tinea versicolor, also known as pityriasis versicolor, is a common fungal infection of the skin caused by Malassezia spp. and M. globosa.[1] The fungal infection causes alteration to pigment in the epidermis via inhibition of tyrosinase in melanocytes, leading to pink, white, or tan patches of varying sizes. Areas most commonly affected include the extremities, neck, back, chest and abdomen sometimes referred to as the “cape distribution.”[2,3]

Key Concepts #
  • Tinea versicolor is a superficial fungal infection of the skin leading to inhibition of tyrosinase in melanocytes
  • The infection typically appears as pink, white or tan patches with overlying scale
  • Tinea versicolor is often asymptomatic. [2,3]
  • Mild pruritus or cosmetic concerns can lead patients to seek medical care.[4]
Epidemiology #

Tinea versicolor is a common fungal infection found in nearly 1% of the population.[4] This condition can affect all age groups, however, young adults and individuals with increased sebum production and hyperhidrosis are more commonly affected, especially in tropical climates.[2,4]

Clinical Features #
  • Often present as pink, hypo- or hyperpigmented macules coalescing into patches with minimal scale on the proximal extremities, neck, back, chest and abdomen.[3]
  • Tinea versicolor is typically asymptomatic, but can cause pruritus and cosmetic concerns.[4]
  • Patients often notice lesions and seek care after sun exposure/tanning which enhances contrast between rash and background skin.
  • Lesions can remain present for years without treatment.[2]
Differential Diagnoses #
Diagnostic Workup #

Tinea versicolor is a benign cutaneous finding that is typically diagnosed clinically. Work-up involves viewing fine scale, spores, and short hyphae via microscopy/potassium hydroxide preparation (“spaghetti and meatballs”).[2,3] Wood’s light examination reveals hypopigmented lesions with scale (in comparison, vitiligo appears bright white without scale). Biopsy is not generally warranted.[4]

Treatment #

Treatment options involve ketoconazole or zinc pyrithione shampoos, topical selenium sulfide, azole creams and oral fluconazole (most effective). Oral ketoconazole therapy can also be used. Patient should be counseled that dyspigmentation can linger for months post treatment.[2] Recurrence is common.

References #
  1. Karray, Mehdi and William McKinney. Tinea Versicolor. StatPearls Publishing, 2020.
  2. Wolff, Klaus, et al. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. McGraw-Hill Education, 2017. Print.
  3. Plensdorf, Scott, et al. “Pigmentation Disorders: Diagnosis and Management.” American Family Physician vol. 15, no. 12, 2017, pp. 797-804.
  4. Marks, James and Jeffrey Miller. Lookingbill and Marks’ Principles of Dermatology. Elsevier, 2019. Print.
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