Pityriasis versicolor, also known as tinea versicolor, is a common, benign, superficial fungal infection of the skin. Tinea versicolor is not considered contagious.

Pityriasis versicolor is caused by Malassezia fungus, also known as Pityrosporum. It is a component of normal skin flora. It is more common in warm and humid conditions.

Clinical Features

Patients with pityriasis versicolor present with multiple, well-demarcated, oval, finely scaling patches or plaques. Skin lesions may be hypopigmented, hyperpigmented, or erythematous and occasionally become confluent and widespread.

The most frequently affected sites are the trunk, neck, and proximal extremities. The face also may be affected, particularly in children.

Pityriasis versicolor skin lesions are usually asymptomatic or slightly pruritic. However, severe pruritus can be present in very warm and humid conditions.

Evaluation

Diagnosis of pityriasis versicolor is usually easily made on the basis of its characteristic clinical presentation (hyperpigmented or hypopigmented, finely scaling patches or plaques).

The diagnosis is confirmed by microscopic examination of scales soaked in potassium hydroxide examination. A Wood light examination reveals golden-white fluorescence.

Treatments

Topical medications are considered the first-line therapy for pityriasis versicolor.

Topical treatments are divided into-

Nonspecific antifungal agents (sulfur-salicylic shampoo 2%, selenium sulfide 2.5% shampoo and zinc pyrithione soap 2% daily) that primarily remove dead tissue and prevent further invasion, and

Specific antifungal drugs that have fungicidal or fungistatic effects.

Antifungal agents include imidazole (clotrimazole 1%, ketoconazole 2%), ciclopirox olamine 1%, and allylamine (terbinafine 1%).

Foaming solutions in shampoo are preferable to creams because creams are oilier and more difficult to apply, especially in widespread areas.

Ketoconazole (ketoconazole 2% shampoo daily for 2 weeks) is the most common topical treatment used to treat pityriasis versicolor to cover large surface areas.

Oral medications are viewed as a second-line of treatment for pityriasis versicolor in the event of widespread, severe, recalcitrant or recurrent cases. Systemic therapies include itraconazole (200 mg daily for seven days) and fluconazole (150 to 300 mg weekly dose for 2 to 4 weeks)

In cases of recurrent pityriasis versicolor, maintenance therapy may be necessary.

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