Pityriasis Versicolor (Tinea Versicolor)

What is Pityriasis Versicolor?

Pityriasis Versicolor is a superficial yeast infection of the skin caused by Malassezia furfur species (normal commensals on the skin)

Predisposing factors:

  • Common in warm humid climates
  • Occlusion of the skin with pomades and Hyperhidrosis greases
  • Immune suppression
  • Heat

Symptoms and clinical features of Pityriasis Versicolor

  1. Usually asymptomatic (or just mild itching)
  2. May be generalized in the immuno
    compromised
  3. Fine scaly, guttate or nummular patches, particularly on young adults who perspire freely
  4. Individual patches are dirty, yellowish / brownish / hypopigmented macules (hence
    the term versicolor)
  5. Larger irregular patches may evolve
  6. Sometimes follicular tendency is marked; more noticeable at the advancing edges of the irregular patches

Sites of predilection:

  • Sternal region
  • Sides of the chest
  • Shoulders
  • Upper back
  • Face

Differential diagnoses

Complications of Pityriasis Versicolor

  • None usually; only of cosmetic significance
  • M. furfur sepsis
    • From contamination of the lipid containing medium in
      immunocompromised patients receiving hyperalimentation through tubes

Investigations

  • Skin scraping for KOH microscopy

Treatment for Pityriasis Versicolor

Treatment objectives

  • Improve appearance of skin

Drug treatment

Topical:

Selenuim sulphide shampoo

  • Apply on affected areas daily, leave on for 10-30 minutes and wash off. Continue for 3 weeks

Ketoconazole shampoo

  • Use as above

Miconazole cream

  • For limited areas
  • Apply twice daily for 3 weeks

Supportive measures

  • Deal with underlying predisposing factor(s)

Prevention of Pityriasis Versicolor

  1. Avoid hot, humid environments or clothings
  2. Take a cold shower after perspiration that promote perspiration
  3. Use any of the above shampoo washes once a month if predisposed