Tinea Versicolor

Aka: Tinea Versicolor

1. Etiology
   1. Not a true dermatophyte (tinea) infection
   2. Pityrosporum orbiculare
   3. Pityrosporum ovale
   4. Malassezia furfur (prior name for organisms above)
2. Signs
   1. Characteristics
      1. Scaly Macules with fine scale
      2. Hyperpigmented or hypopigmented
   2. Distribution
      1. Involves trunk and proximal extremities
3. Diagnosis
   1. Potassium Hydroxide (KOH)
      1. Scrape fine powdery scale with #15 blade
      2. Spaghetti (hyphae) and meatball (yeast) appearance
   2. Wood's Lamp (variably present)
      1. Irregular pale yellow fluorescence
      2. Fluorescence disappears with resolution
4. Differential Diagnosis
   1. Vitiligo
   2. Seborrhea dermatitis
   3. Tinea Corporis
   4. Pityriasis Rosea
   5. Pityriasis alba
5. Management
   1. Hypopigmentation resolves slowly after treatment
   2. Recurrent infections (recurrence rate is high)
      1. Consider repeat treatment prior to summer
      2. Frequently worn clothing may harbor fungus
         1. Consider discarding suspected clothing
         2. Consider boiling suspected clothing
   3. First Line: Topical Antifungal
      1. Selenium sulfide (Selsun, Exsel) 2.5% lotion
         1. Apply lather neck to knees
         2. Course
            1. Apply once daily for 7 days
            2. Wash off after 5-10 minutes
         3. Alternative regimen 1
            1. Apply three to five times per week for 2-4 weeks
            2. Wash off after 5-10 minutes
         4. Alternative regimen 2
            1. Apply once weekly for 4 weeks
            2. Wash off after 24 hours
      2. Ketoconazole 2% cream apply once daily for 14 days
   4. Second line: Systemic Antifungal
      1. General
         1. Exercise to sweating after each dose
            1. May help distribute more medication to skin
         2. Avoid bathing for 12 hours after application
      2. Ketoconazole
         1. 400 mg PO for one single dose or
         2. 200 mg PO qd for 7 days
      3. Fluconazole
         1. 400 mg PO for one single dose
      4. Itraconazole
         1. 400 mg PO qd for 3-7 days
6. References
   1. Habif (1996) Clinical Dermatology, Mosby, p. 402-5
   2. Savin (1996) J Fam Pract 43(2):127-32
   3. Zuber (2001) Postgrad Med 109(1):117-32