Tinea Versicolor

Pityriasis versicolor skin bleaching
Pityriasis versicolor skin bleaching

Tinea versicolor is a common fungal skin condition characterised by small areas of discoloured skin. The name versicolor refers to this variation in colour from the normal skin colour and to the blotchy or motley nature of these skin lesions. The discoloured areas may be pink, red, brown or white. Sometimes these small individual discoloured areas may merge to form larger areas. Although it can occur on any area of skin, it is most commonly encountered on the chest, abdomen, back,neck and upper arms.

The word tinea is normally used to demote an infection due to a dermatophyte fungus such as that responsible for conditions such as ringworm or athlete’s foot but in this case, the infection is due to the malassezia yeast. Yeasts and fungi belong to the same family but yeasts grow and reproduce in different ways and are unicellular plants unlike most fungi. An alternative and possibly more correct name for this condition is pityriasis verticolor which refers to the slightly scaly nature of affected skin. Both names are commonly used and may be regarded as interchangeable. The condition may be symptomless, other than the visual discolouration, or may be slightly itchy. The skin has a tendency to be flaky or scaly.

Tinea Versicolor Skin Scale
Tinea Versicolor Skin Scale

Tinea Versicolor Causes

There is some uncertainty about the actual causes of tinea versicolor and some people simply seem to have a predisposition to this condition suggesting that genetics may play a part and it may tend to run in families. It is important to realise that the malassezia yeast responsible for tinea versicolor is not regarded as being in any way pathogenic and is in fact a perfectly normal inhabitant of healthy skin. Around 90% of the adult population carry this yeast on their skin usually with no ill effects whatsoever. Tinea versicolor is therefore not considered to be infectious and is not spread from one person to another.

The skin discolouration is generally regarded as being due to the bleaching effect of azelaic acid which is released as the yeast grows. The reasons for this excessive growth are by no means certain but, as a plant, the yeast will thrive under specific environmental conditions. Warmth, moisture and suitable nutrients are required and such conditions can arise on human skin.

Pityriasis versicolor skin bleaching
Pityriasis versicolor skin bleaching

Living in an area of high temperatures and humidity can be a factor as can excessive sweating (hyperhidrosis). An oily skin type or hormonal changes may also cause the condition and it is most commonly seen during the teenage years or the early twenties. A weakened immune system has also been suggested as possibly being involved. Poor hygiene is not a factor and frequent bathing will not provide a cure. The good news is that tinea versicolor is generally regarded as having little or no medical significance but any skin infection, especially an itchy one, has the potential for the skin surface to be damaged leading to a risk of secondary bacterial infections.

Tinea Versicolor Treatment

As with any medical condition, successful treatment depends on an accurate diagnosis and in most cases a doctor can identify the condition by its appearance. Where there is any uncertainty, the skin may be examined under ultraviolet light where the discoloured areas will clearly be seen. In some cases a skin scraping may be taken for microscopic examination where the characteristic “penne and meatball” structure of the yeast gives a simple confirmation of the diagnosis. Due to the slightly flaky nature of the skin, it is sometimes possible to obtain a suitable sample simply by using an adhesive tape.

Fungus spaghetti and meatballs appearance
Fungus spaghetti and meatballs appearance

Treatment concentrates on the killing of the yeast and the usual first step is to use a suitable anti-fungal shampoo such as selenium sulphide or ketoconazole. These are available as over-the-counter products or in higher strengths by prescription. They are typical used daily for around a week. For smaller areas, a topical cream may be sufficient and clotrimazole or miconazole are often prescribed. The cream is usually applied twice a day for several weeks. For particularly persistent cases of tinea versicolor or where other treatments have proved ineffective, tablets such as fluconazole or itraconazole may be prescribed. In most cases, the yeast infection is easily eradicated but patients often feel that the cure has been ineffective as the discoloured skin persists. It often takes several weeks or months for the skin to fully return to its natural colour. It may be noted that brown discolouration tends to clear rather more quickly than white areas.

Tinea Versicolor Prognosis

Although the treatment of tinea versicolor is fairly simple and highly effective, the chances of a recurrence remain fairly high and those prone to the condition need to remain vigilant and be prepared to take future action. Some people choose to simply keep the yeast at bay by using a suitable shampoo a couple of times a year or possibly for a week before taking a holiday in a hot country. With very persistent cases, doctors may even consider the periodic use of tablets.

Tinea Versicolor Pictures

The examination of pictures of affected skin will show that there is a wide range of colours and the lesions may be lighter or darker than the surrounding skin. There are similarities however and the affected skin is often slightly scaly. The particular areas of the body affected also give a clue to the nature of the infection.

Other Conditions Causing Skin Discolouration

Tinea versicolor is by no means the only condition which causes skin discolouration and it is important to have it diagnosed by a doctor. Vitiligo is another condition which causes white patches on the skin but these are quite different in nature to those caused by tinea versicolor. Vitiligo is caused by the absence of melamin in the skin and it usually occurs symmetrically especially around the eyes, mouth, fingers, wrists armpits and groin. In this case, the skin texture remains normal. Another condition, tinea nigra, results in the palms of the hands or soles of the feet turning brown or black. This is due to a mould infection.

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