Tinea Versicolor

Jennifer C. Li, BS and Roopal V. Kundu, MD

Tinea versicolor is a fungal infection that leads to a change (darker or lighter) in color in areas on the skin. One may notice round to oval spots, with fine dust-like scaling as well as mild itching. In severe tinea versicolor, the spots can coalesce to form patches. The fungus that causes tinea versicolor is normally present on human skin and usually poses no problems. Many factors, including warm and humid climates, can increase the risk of developing tinea versicolor.

What is the cause of tinea versicolor?
Tinea versicolor is caused by fungus of the Malassezia spp. (formerly known as Pityrosporum). Since this fungus is normally present on the skin’s surface, it is NOT contagious. The two most common species in tinea versicolor are M globosa and M furfur.

The main predisposing factors of tinea versicolor include:

• Warm and humid climates
• Exposure to sunlight
• Adolescence
• Corticosteroid administration
• Application of oily preparations
• Genetic predisposition
• Malnutrition
• Immunosuppression
• Hyperhidrosis or excessive sweating

How do I know if I have tinea versicolor?
Signs of tinea versicolor include spots or patches or variable color, which may range from white to light or dark brown to pink or red to gray-black. These spots or patches are visible. You may also have mild itching.

The classic presentation is that tinea versicolor primarily affects the trunk and upper arms. In most patients, the spots or patches of tinea versicolor become more lightly pigmented after a period of darker pigmentation, either spontaneously or with sunlight exposure.

However, tinea versicolor can look different in patients with skin of color:

• Some research has shown that dark-skinned individuals with tinea versicolor or those who have tanned skin are likely to present with secondary skin changes that result in lighter color.
• Inverse tinea versicolor, commonly seen in skin of color, affects the face, knees, elbows, armpits, groin, hands, and feet.
• The variant tinea versicolor alba, has been especially noted in black patients, in which the more lightly pigmented spots or patches appear without a darker pigmentation stage.²
• Atrophying tinea versicolor, associated with thinning and loss of elasticity of the skin, has been recently reported in Korea, and may be a concern for patients of color.³

Your physician will typically diagnose tinea versicolor based on clinical exam and patient history; if needed, the ultraviolet black light (Wood’s light) may be supportive, revealing coppery-orange fluorescence. The diagnosis can be confirmed by potassium hydroxide (KOH) preparation, which demonstrates the classic “spaghetti and meatballs” of short, cigar butt hyphae and spores.

What treatments are available for tinea versicolor?
Treatment of tinea versicolor for people with skin of color typically involves using topical antifungal agents. Clearance of the disease can be achieved but recurrence is common. There is  no permanent scarring or skin color changes, though the change in skin color can take 3-4 months or more to improve.

In addition to following standard treatments it is recommended that skin of color patients are given more aggressive treatment due to the secondary skin color changes, which can last several months even with successful treatment.

Overall, topical therapy is preferred.  However, systemic treatment may be used if there is inadequate response to topical treatments, extensive involvement, multiple relapses, or for ease of use.

Since the causative fungus lives on skin, recurrence of tinea versicolor is common. The return rate can be as high as 60% in the first year of tinea versicolor diagnosis, and increase to 80% in the second year. Preventative therapy such as weekly applications of any of the topical treatment options once weekly for 2-3 months following treatment and then during summer months may help prevent recurrence.

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Additional Resources

American Academy of Dermatology
Dermnet Skin Disease Atlas

References

1. Mellen LA, Vallee J, Feldman SR, Fleischer AB Jr. Treatment of pityriasis versicolor in the United States. J Dermatolog Treat. 2004 Jun;15(3):189-92.
2. Thoma W, Krämer HJ, Mayser P. Pityriasis versicolor alba. J Eur Acad Dermatol Venereol. 2005 Mar;19(2):147-52.
3. Yang YS, Shin MK, Haw CR. Atrophying pityriasis versicolor: is this a new variant of pityriasis versicolor? Ann Dermatol. 2010 Nov;22(4):456-9.