Tinea Versicolor

Tinea versicolor is a common fungal infection of the skin that often affects adolescents and young adults. The term versicolor refers to the fact that it frequently alters the color of the involved skin.

Careful examination of the affected areas will reveal a slight increase in superficial scale. The disease rarely produces any symptoms.

A yeast called Malassezia causes tinea versicolor; it normally lives on the skin of most adults without producing disease. It exists in two forms, a yeast form and a form that resembles "penne and meatballs" when viewed microscopically. This second form makes patches of discolored slightly scaly skin called tinea versicolor. Medical professionals believe that a chemical produced by Malassezia, azelaic acid, is responsible for the loss of pigment. Most people with this condition are perfectly healthy.

Because the tinea versicolor fungus is part of the normal adult skin flora, this condition is not overtly contagious. It often recurs after treatment, but usually not immediately, so treatment may need to be repeated only every year or two.

Although tinea versicolor rarely produces symptoms, it typically alters the color of the affected skin.

The most common areas tinea versicolor affects include:

• Shoulders
• Back
• Chest

At times, tinea versicolor may affect skin folds, such as the crook of the arm, the skin under the breasts, or the groin. It usually spares the face, although this is not always true for children.

The following conditions are sometimes indistinguishable from tinea versicolor on simple inspection:

• Pityriasis alba: This is a mild form of eczema (seen in young people) that produces mild, patchy lightening of the face, shoulders, or torso.
• Vitiligo: This condition results in a permanent loss of pigment. Vitiligo is more likely to affect the skin around the eyes and lips or the knuckles and joints. Spots are porcelain white and, unlike those of tinea versicolor, are permanent without therapy.

It is a relatively simple procedure to confirm this diagnosis. A drop of potassium hydroxide is applied to a small scraping of the involved skin and then examined under the microscope. The penne-and-meatball forms can be seen and confirm the diagnosis.

Many antifungal agents are available to apply to the skin to treat tinea versicolor.

Over-the-counter (OTC) remedies include:

• clotrimazole (Lotrimin, Mycelex)
• miconazole (Lotrimin)
• ciclopirox (Ciclodan, Penlac, Loprox)

Apply these twice a day for 10-14 days. Unfortunately, these come in small tubes and are hard to apply to large areas. Sprays of clotrimazole are available and can be a more practical treatment approach. Another OTC option is selenium sulfide shampoo 1% (Selsun Blue) or 1% ketoconazole shampoo (Nizoral). Some doctors recommend applying these for 15 minutes twice a week for two to four weeks.

Many prescription-strength antifungal creams can treat tinea versicolor, as well as a stronger form of selenium sulfide (2.5%) and prescription-strength ketoconazole shampoo (2%). However, these pose the same application problems as their OTC counterparts.

Oral treatment for tinea versicolor has the advantage of simplicity. Two doses of fluconazole (Diflucan) or itraconazole (Sporanox) a week for four weeks can be pretty effective. Some common medications such as alprazolam (Xanax) and montelukast (Singulair) may interact with fluconazole, so your doctor will need to know what other drugs you take before treating tinea versicolor orally.

Terbinafine is not an effective treatment for this disease.

As noted above, the white spots of tinea versicolor tend to linger even after successful treatment. This persistent discoloration often leads people to think that the condition is still present long after its eradication. It may take months for skin color to blend and look normal, but it always does. The red or brown variety of rash, on the other hand, clears up much sooner. It is, therefore, a good idea to have the condition treated as soon as new spots appear so that any discoloration lasts as short a time as possible.

Recurrence of the rash is standard, though it won't necessarily recur every year. Applying selenium sulfide or ketoconazole shampoo on affected areas once a week may slow the onset of recurrence but is cumbersome and often not worth the effort, since the condition may not return for a long time anyway.

Since the organism that causes tinea versicolor is a normal inhabitant of the skin and the disease does not affect the patient's general health, there is no widely accepted approach to prevention.