Tinea Versicolor: Clinical Presentation
Tinea versicolor presents as hyperpigmented or hypopigmented scaly macules and patches, most commonly on the upper trunk, neck, and upper arms, caused by Malassezia species overgrowth. 1, 2
Primary Clinical Features
The hallmark presentation includes:
- Scaly macules or patches that may be hypopigmented (more common in dark-skinned individuals), hyperpigmented, or a combination of both 2, 3
- Fine scale overlying the lesions, which is characteristic of this superficial fungal infection 1, 2
- Round or oval configuration of the lesions 4
Distribution Pattern
The infection shows a predilection for specific body areas:
- Upper trunk is the most commonly affected site 2
- Neck and upper arms are frequently involved 2
- Lesions may become more widespread in immunocompromised patients 1
Associated Symptoms
- Typically asymptomatic, though some patients may experience mild pruritus 2, 3
- No surface changes beyond scaling—no erythema or induration in uncomplicated cases 4
Diagnostic Confirmation
When clinical diagnosis is uncertain:
- Potassium hydroxide (KOH) preparation reveals the pathognomonic "spaghetti and meatballs" appearance—short, stubby hyphae intermixed with clusters of round yeast cells 1, 2, 4
- Wood's lamp examination shows yellowish-white or copper-orange fluorescence, which can help distinguish tinea versicolor from other conditions like erythrasma 1
- Culture on Sabouraud agar can confirm the diagnosis if needed 1
Key Differential Considerations
Tinea versicolor must be distinguished from:
- Vitiligo (no scale present, complete depigmentation) 5
- Pityriasis alba (less distinct borders, minimal scale) 3
- Seborrheic dermatitis (more erythema, different distribution) 3
- Confluent and reticulated papillomatosis 3
Treatment Overview
Topical antifungal therapy is the first-line treatment due to better safety profile, fewer drug interactions, and lower cost compared to systemic options 2, 6:
- Ketoconazole 2% cream applied once daily for two weeks to affected areas and immediate surrounding skin 7
- Selenium sulfide lotion applied to affected areas, lathered with water, left on for 10 minutes, then rinsed daily for 7 days 8
- Zinc pyrithione is another effective topical option 6
Oral antifungal therapy (itraconazole or fluconazole) is reserved for extensive disease, frequent recurrences, or topical treatment failure, offering better compliance and reduced recurrence rates but at higher cost and with potential drug interactions 2, 6
Recurrence Prevention
- Avoid excessive heat and humidity 1
- Wear loose-fitting, breathable clothing 1
- Keep affected areas clean and dry 1
- Consider prophylactic maintenance therapy for patients with frequent recurrences, though evidence is limited 6
Important Caveat
Repigmentation of hypopigmented areas may take weeks to months after successful mycological cure, so patients should be counseled that skin color changes will not resolve immediately even with effective treatment 2