PubMed Central: November, 2022

Tinea versicolor is a common superficial fungal infection of the skin with various clinical manifestations. This review aims to familiarize physicians with the clinical features, diagnosis and management of tinea versicolor.

Tinea versicolor is caused by Malassezia species, notably M. globosa, M. furfur and M. sympodialis.

Sign & Symptoms

Patients with tinea versicolor typically present with asymptomatic hypopigmented or hyperpigmented, finely scaled, oval or round macules/patches on the upper trunk, neck and upper arms. Facial involvement is less common in adults. On the other hand, facial involvement is common in children and may be the only site involved.

The eruption varies in colour from individual to individual, but each individual usually has lesions of a single hue. Lesions are usually evenly pigmented. In general, hyperpigmented lesions tend to occur in fair-skinned patients whereas hypopigmented lesions tend to occur in dark-skinned individuals.

When hyperpigmented lesions occur in dark-skinned individuals, they are often grey-black, dark brown or black whereas these are often tan, light brown, red or pink in fair-skinned individuals. Lesions may become more apparent following exposure to the sun and are thus more noticeable during the summer months.

Mixed hyperpigmented and hypopigmented lesions may be found, especially in the axilla and groin.

Tinea versicolor lesions are typically asymptomatic, although some patients complain of mild pruritus, which may become worse in hot and humid conditions.

Diagnosis

The diagnosis is usually based on characteristic clinical features.

Examination of the lesion with a Wood lamp may show gold-yellow, yellowish-green or coppery-orange fluorescence, although some lesions do not fluoresce.

Dermoscopy is a useful ancillary tool for the diagnosis of tinea versicolor.

If necessary, a potassium hydroxide preparation test can be performed to reveal numerous short, stubby hyphae intermixed with clusters of spores.

Treatment

Most patients with tinea versicolor respond to topical antifungal therapy, which has a better safety profile (fewer adverse events, fewer drug interactions) and lower cost compared to systemic treatment and is therefore the treatment of choice.

Oral antifungal therapy is typically reserved for patients with extensive disease, frequent recurrences or disease that is refractory to topical therapy. Advantages of oral antifungal therapy include increased patient compliance, shorter duration of treatment, increased convenience, less time involved with therapy and reduced recurrence rates.

For resistant or stubborn cases, combining oral and topical therapies may be considered.

On the other hand, oral antifungal therapy is associated with higher cost, greater adverse events and potential drug-drug interactions and is therefore not the first-line treatment for tinea versicolor.

Long-term intermittent prophylactic therapy should be considered for patients with frequent recurrence of the disease.

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