Clinical Appearance of Tinea Versicolor
Tinea versicolor presents as scaly hypopigmented or hyperpigmented macules and patches, primarily on the upper trunk, neck, and upper arms, with fine scale that coalesces into larger patches. 1
Primary Morphology and Distribution
The characteristic lesions are asymptomatic macules or patches with fine scale that can be either hypopigmented (lighter than surrounding skin), hyperpigmented (darker than surrounding skin), or a combination of both presentations 2, 1
The upper trunk, neck, shoulders, and upper arms are the most commonly affected sites, though the condition can appear in atypical locations 1, 3
Color Variations by Skin Type
In dark-skinned individuals, the majority present solely with hypopigmented lesions that are more noticeable against their baseline skin tone 2
Hyperpigmented macules are also common and may predominate in some patients, or both color patterns can coexist simultaneously 2, 1
Surface Characteristics
Fine, superficial scaling is a hallmark feature that distinguishes tinea versicolor from other pigmentary disorders 1
The scale may not be immediately apparent but becomes visible with gentle scraping of the lesion 1
Atypical Presentations
Uncommon locations include the face, scalp, arms, legs, intertriginous sites (groin, popliteal fossa), genitalia, areolae, and even palms and soles 3
Folliculocentric variants can present as perifollicular hypopigmented macules, particularly on the lower back 4
Key Distinguishing Features from Vitiligo
Unlike vitiligo, tinea versicolor has surface scale and does not cause complete depigmentation 5
Vitiligo presents as completely white patches without surface change or scaling, often symmetrical, affecting fingers, wrists, axillae, groins, and body orifices 5
Tinea versicolor should be included in the differential diagnosis of hypopigmented conditions alongside vitiligo and postinflammatory hypopigmentation 6