Tinea versicolor is skin infection with Malassezia furfur that manifests as multiple asymptomatic scaly patches varying in color from white to tan to brown to pink. Diagnosis is based on clinical appearance and potassium hydroxide wet mount of skin scrapings. Treatment is with topical or sometimes oral antifungals. Recurrence is common.
Malassezia furfur is a fungus that can exist as both a yeast and as a mold (a dimorphic fungus). It is normally a harmless component of normal skin flora but in some people causes tinea versicolor. Most affected people are healthy.
Factors that may predispose to tinea versicolor include heat and humidity and immunosuppression due to corticosteroids, pregnancy, undernutrition, diabetes, or other disorders.
Hypopigmentation in tinea versicolor is due to the inhibition of tyrosinase caused by M. furfur
Symptoms and Signs of Tinea Versicolor
Tinea versicolor is asymptomatic. Classically, it causes the appearance of multiple tan, brown, salmon, pink, or white scaling patches on the trunk, neck, abdomen, and occasionally face. The lesions may coalesce. In light-skinned patients, the condition is often diagnosed in summer months because the lesions, which do not tan, become more obvious against tanned skin. Tinea versicolor is benign and is not considered contagious.
In this photo, tinea versicolor manifests as multiple hypopigmented scaly patches on the trunk.
Image provided by Thomas Habif, MD.
A well-demarcated brown patch is visible, along with two incidental hemangiomas.
© Springer Science+Business Media
© Springer Science+Business Media
Image courtesy of Karen McKoy, MD.
Image courtesy of Karen McKoy, MD.
In this photo, tinea versicolor manifests as multiple hypopigmented scaly patches on the trunk.
Image provided by Thomas Habif, MD.
A well-demarcated brown patch is visible, along with two incidental hemangiomas.
© Springer Science+Business Media
© Springer Science+Business Media
Image courtesy of Karen McKoy, MD.
Image courtesy of Karen McKoy, MD.
Diagnosis of Tinea Versicolor
Clinical appearance
Potassium hydroxide wet mount
Sometimes Wood light examination
Diagnosis of tinea versicolor is based on clinical appearance and by identification of hyphae and budding cells (“spaghetti and meatballs”) on potassium hydroxide wet mount of fine scale scrapings. Vitiligo with depigmented macules should also be considered.
A Wood light examination reveals golden-white fluorescence.
Treatment of Tinea Versicolor
Topical antifungals
Sometimes oral antifungals
(See table Options for Treatment of Superficial Fungal Infections.)
Hypopigmentation resulting from tinea versicolor is reversible in months to years after the yeast has cleared.
Key Points
Although tinea versicolor can occur in patients who are immunosuppressed, most affected patients are healthy.
The disorder is frequently diagnosed in the summer because hypopigmented lesions become more obvious against tanned skin.
Try to confirm the diagnosis by finding hyphae and budding cells on potassium hydroxide wet mount of fine scale scrapings.
Treat with topical or oral antifungals.
