Tinea Versicolor ( Pityriasis Versicolor )

Tinea versicolor is a common fungal infection that often affects adolescents and young adults. The term versicolor refers to the fact that it causes the affected skin to change color and become either lighter or darker than surrounding skin. The most common areas it affects are the shoulders, back, and chest. At times, it can affect folds of skin, such as the crook of the arm, the skin under the breasts, or the groin. The face is usually spared, although sometimes children can get it there. There may be just a few spots or so many that it gives the appearance that the affected skin is normal while the unaffected skin around it seems to have a problem.

Causes

Tinea versicolor is caused by a yeast called Malassezia furfur that lives in the skin of most adults. This exists in two forms, one of which causes visible spots. Factors that can cause the fungus to become more visible include high humidity and immune or hormone abnormalities. However, almost all people with this very common condition are perfectly healthy.

Because the tinea versicolor fungus is part of the normal adult skin, this condition is not contagious. It often recurs after treatment, but usually not right away, so that treatment needs to be repeated only every year or two.

Tinea versicolor patches that are brown or reddish-brown go right away after treatment. When this condition produces spots that are lighter than the surrounding skin, it may take several months for overall color to even out. It always eventually does. Tinea versicolor does not leave permanent skin discoloration.

Treatment

There are many antifungal agents available to apply to the skin for the treatment of tinea versicolor. Over-the-counter (OTC) remedies include clotrimazole and miconazole. These should be applied twice a day for 10-14 days but come in small tubes and are hard to apply to large areas. Another OTC option is selenium sulfide shampoo 1% (Selsun Blue) or 1% ketoconazole shampoo. Some doctors recommend applying these for 15 minutes twice a week for two to four weeks. Others suggest applying them overnight and washing them off in the morning for a week. This treatment can be irritating, however, and may lead to missing hard-to-reach spots on the mid-back.

There are also many prescription-strength antifungal creams that 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. A single dose of ketoconazole (brand name Nizoral) or five daily doses of itraconazole (brand name Sporanox) are two therapies your doctor can prescribe. Some common medications, such as Lipitor used to lower cholesterol, may interact with these drugs, so your doctor will need to know what other medications are being taken before treating tinea versicolor orally.

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