Tinea Versicolor

Tinea versicolor, also known as pityriasis versicolor, is a common non-cancerous (benign) skin condition caused by surface (superficial) infection with a yeast that commonly lives on the skin. In the right conditions, such as warm, oily, and moist skin, the yeast (Malassezia) can overgrow and cause a rash consisting of tan, pink, brown, or white flaky patches. Although it is an infection, tinea versicolor is not contagious, as the yeast is found commonly in the environment.

Who's At Risk
Tinea versicolor can develop in people from adolescence and beyond, of all races, and of either sex.

However, tinea versicolor is most commonly found in tropical areas with high humidity and high temperatures. In milder climates, teens and young adults are affected most frequently. Tinea versicolor is uncommon in young children or in adults older than 65.

Some conditions make tinea versicolor more likely to occur:

•Living in a warm, humid climate

•Having oily skin

•Sweating frequently or excessively

•Using corticosteroids (cortisone)

•Taking medications that weaken the immune system

The first sign of tinea versicolor is often spots on the skin. The other signs and symptoms are:

The spots are lighter (sometimes darker) than the surrounding skin. The color of the spots can be white, pink, salmon, red, tan, or brown.
The spots can appear anywhere on the body.
Spots can be dry and scaly.
Skin may itch where the spots appear.
Spots become more noticeable as the skin tans. The yeast prevents the skin from tanning.
Spots grow slowly.
As the yeast grows, the spots can combine and form patches of lighter (or darker) skin.
The spots may disappear when the temperature drops and return in the spring or summer when the air gets warm and humid.

The most common locations for tinea versicolor include:
Chest and upper back
Upper arms
Tinea versicolor appears as many white, pink, salmon-colored, tan, or brown patches ranging in size from 1 to 3 cm. The individual lesions can join together to form large patches. Most lesions have a very fine, flaky surface (scale).

The yeast that causes the condition produces a substance that can temporarily bleach the underlying skin to a lighter color. Even after the infection has gone away, the spots may be visible as lighter (hypopigmented) patches on the skin that may not get their normal color back for many months. These hypopigmented spots do not tan normally. The hypopigmented areas are more obvious in darker-skinned people. Even if the color has not returned to normal after treatment, the flakiness of the skin should have resolved. Tinea versicolor does not usually cause any symptoms, though some people report minor itching, especially when they get sweaty.

Self-Care Guidelines

If you suspect that you have tinea versicolor, you might try an over-the-counter antifungal cream such as terbinafine, clotrimazole, or miconazole. An over-the-counter shampoo containing selenium sulfide can be used as a lotion by applying it to the affected areas overnight and rinsing it off in the morning. However, if the condition does not seem to be getting better after 2 weeks of daily treatment, see a dermatologist or another physician for evaluation.

If you have been treated for tinea versicolor, avoid wearing tight, restrictive clothing. Also, sun exposure may make the light-colored areas more apparent, so avoid sun exposure or wear sunscreen until the spots have returned to their normal color.

When to Seek Medical Care and treatment

If the above self-care measures do not work or if you develop a rash all over that seems to be getting worse, see your doctor. To confirm the diagnosis, your physician might scrape some of the surface skin material (scales) onto a glass slide and examine them under a microscope. This procedure, called a KOH (potassium hydroxide) preparation, allows the doctor to look for tell-tale signs of yeast infection.

Once a diagnosis of tinea versicolor has been confirmed, the physician may recommend one of the following treatments:

•Selenium sulfide lotion (or shampoo, which can be used as a lotion and then rinsed off)

•Pyrithione zinc shampoo (used as a lotion and then rinsed off)

•Antifungal cream or lotion such as ketoconazole, econazole, oxiconazole, or ciclopirox

•Antifungal pills such as ketoconazole, fluconazole, or itraconazole

Recurrence of the infection after treatment is common. Because some people are more likely than others to get the infection, your doctor may recommend a preventive or maintenance treatment to use during the warmer, more humid months, consisting of antifungal cream, lotion, or shampoo, applied every week or two.