An Overview of Tinea Versicolor Fungal Infection

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Tinea versicolor, also known as pityriasis versicolor, is a superficial fungal infection of the skin that is often confused with other common rashes. The fungus affects the skin's pigmentation and results in small, light- or dark-colored patches that typically appear on the trunk and shoulders.

Symptoms

The rash of tinea versicolor appears as a discolored, flat eruption that has a fine, scaly texture. Tinea versicolor develops mainly on the back, chest, and shoulders, but can also appear on the arms, neck, and face.

Symptoms of tinea versicolor include:

  • Patches or spots of skin discoloration that appear lighter or darker than normal
  • Mild itching
  • Dryness and scaling

The patches of skin discoloration have very defined borders. The rash may be hypopigmented (lighter than the surrounding skin) or hyperpigmented (darker than the surrounding skin), in shades ranging from white, red, pink, or brown.

Hypopigmentation occurs when the yeast produces a specific chemical that turns off melanocytes, resulting in a decreased production of melanin (the pigment central to the skin, eye, and hair color). Hyperpigmentation is the result of inflammation caused by the fungal infection.

The spots of tinea versicolor can slowly grow larger, joining with other spots to create large patches of discolored skin.

Sun exposure may make tinea versicolor more obvious because the affected areas won't tan.

In some cases, the spots diminish or disappear during the cooler seasons, but come back with the return of hot, humid weather.

Causes

Tinea versicolor is a fungal infection caused by the yeasts of the Malassezia family, including Pityrosporum orbiculare and Pityrosporum ovale. These yeasts are found on the outer layer of skin (stratum corneum) and hair follicles of normal, healthy skin.

Though generally harmless, these yeasts can sometimes experience overgrowth and convert into their pathogenic mycelial phase known as Malassezia furfur, resulting in the outbreak of the rash.

There are a number of things that lead to yeast overgrowth, including:

Tinea versicolor can occur at any age but is most common in adolescence and early adulthood (a time when the sebaceous glands are at their more active). It is also commonly seen in tropical and semi-tropical climates.

Of people previously infected, tinea versicolor has a recurrence rate of around 80% after two years.

Tinea versicolor isn't contagious, so it can't be passed along to someone else.

Diagnosis

Doctors diagnose tinea versicolor based on the appearance of the rash. Additional testing is usually unnecessary, although it may be used in more severe cases.

Outside of a physical examination, there are three tests that doctors use to confirm tinea versicolor:

  • A KOH test can confirm the rash's characteristic "spaghetti and meatballs" appearance beneath the microscope.
  • The Wood's light examination will make the yeast glow a pale yellow beneath a black light.
  • Fungal cultures, while infrequently used, can confirm infection by growing the fungus on a culture medium.

There are a number of rashes that are frequently confused with tinea versicolor, including:

If there is any doubt, your doctor is more likely to order tests to determine the exact cause of your rash.

Treatment

There are several medications commonly used to treat tinea versicolor. Of these, topical, over-the-counter antifungal soaps, shampoos, or creams are usually effective in eradicating the fungus.

They include such popular products as:

  • Lotrimin AF (clotrimazole)
  • Selsun Blue (selenium sulfide)
  • Zinc pyrithione soap
  • Monistat (miconazole)
  • Lamisil (terbinafine)

If you have a particularly severe case of tinea versicolor, or if your body doesn't respond to over-the-counter treatment, prescription medications may be required. Oral antifungals such as Diflucan (fluconazole) as well as prescription antifungal creams and shampoos, such as Nizoral (ketoconazole), are just some of the options doctors will consider.

It is important to remember that even though treatment kills the pathogenic yeasts, skin discoloration can persist for weeks or months until melanocytes are able to produce melanin again.

Even after the infection has healed, occasional re-treatment may be needed given the high rate of disease recurrence.

If you're prone to developing tinea versicolor, regular use of an antifungal soap or wash can help prevent the rash from recurring. Once a month use is customarily recommended but you may need to use more often, especially in the warm weather months. Ask your doctor for recommendations for your particular situation.

Coping

Tinea versicolor is a benign skin condition, but it can still cause distress to those who have it. Many people with this rash feel embarrassed or self-conscious about the skin discoloration.

In most cases, the skin will return to its normal color after the yeast colonies have been eradicated. But, as mentioned before, it can take several months for that to happen.

Until then, protecting your skin from the sun is helpful. This helps minimize the drastic contrast between tanned skin and skin affected by the rash.

You should also steer clear of oily body lotions or creams, since oil can make the rash worse. For sunscreen, choose a product that is labeled oil-free or noncomedogenic.

A Word From Verywell

Tinea versicolor is a harmless rash that is very common in those who live in hot, humid areas. While it's a benign condition, the discolored rash motivates most who develop it to seek treatment.

Luckily, treatment is fairly simple and straightforward with topical antifungals and, in some cases, oral antifungal medications. Skin discoloration can take many weeks to resolve, though, even after treatment.

In most cases, preventative use of OTC antifungals can help keep the rash from coming back.

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Article Sources

  1. Harada K, Saito M, Sugita T, Tsuboi R. Malassezia species and their associated skin diseases. J Dermatol. 2015 Mar;42(3):250-7. doi:10.1111/1346-8138.12700

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