Tinea versicolor
Synonyms: pityriasis
versicolor
Major points
• Worldwide distribution
• Superficial chronic fungal infection
• Common
• Majority of cases occur during
adolescence
• Family history is often positive
• Clinical presentation:
- Discrete
or confluent hypopigmented or hyperpigmented (brown) oval macules and
patches with slight, fine scale
- Distribution
over back,upper chest and shoulders, neck and proximal extremities
- The
face is commonly affected in children (rarely in adults)
Diagnosis
• Characteristic skin findings
• Wood’s lamp may aid in diagnosis of
subclinical patches
• KOH preparation
• Culture/biopsy usually unnecessary
Treatment
• Topical therapy
1. Selenium sulfide
2.5% applied once a day for 7 days for 10 minutes, and washed off; then on the
first and third day of the month for 6 months
2. Propylene glycol 50% in water applied once
or twice a day
Topical azoles: ketoconazole, miconazole once or twice a day
Topical terbinafine 1%
cream
• Systemic
therapy: ketoconazole 400 mg in a single dose, repeated 1 week later; exercise
to induce sweating increases skin concentration and increases effectiveness of
systemic therapy
Prognosis
• Repigmentation may take months or years
• Recurrence
rates high, 60–80%, with topical therapy
