Pityriasis Versicolor

Superficial Yeast Infestation of the Skin

Mar 6, 2009 Hanish Babu

Pityriasis versicolor or tinea versicolor is a chronic recurring superficial yeast infestation of the skin caused by Malassezia furfur.

Pityriasis versicolor gets its name from the delicate scales (pityriasis) and different color presentations (versicolor).

Malssezia furfur, previously known as Pityriosporum ovale or P.orbiculare, is a normal resident of the skin and hair follicles of individuals at puberty and beyond, when the sebum production is increased. Malassezia overgrowth occurs when the body conditions becomes favorable for the yeast.

Triggers for Pityriasis Versicolor

Immune deficiency following diseases like diabetes, Cushing’s syndrome or medications like corticosteroids, humid, hot conditions, oily skin, sweaty skin, hereditary predisposition etc. trigger the expression of the yeast on the skin.

Pityriasis versicolor usually appears in summer, though it may be present throughout the year in physically active individuals. Application of oils to the body predisposes young children to pityriasis versicolor. Pregnancy and malnutrition, intake of hot, spicy, fast foods also favor the proliferation of malssezia.

How Does Malssezia Furfur Infection Cause Loss of Skin Color?

Malssezia furfur, forms dicarboxylic acids by enzymatic oxidation of fatty acids in skin surface lipids. Dicarboxylic acids inhibit the enzymes in the epidermal melanocytes that are responsible for producing skin color, thus producing loss of skin color in the affected patches.

Clinical Features of Pityriasis Versicolor

Except for a mild itching in some affected individuals, P.versicolor is usually asymptomatic. Small patches, usually less than 1 cm in diameter, round or oval, appear on the front and back of chest, face and neck. There is a delicate scaling which becomes evident when scraped with a glass slide. In predisposed individuals, the yeast can cause hair follicle inflammation, dandruff or seborrheic dermatitis.
Other areas involved are the armpits, groin, thighs and abdomen.
The color is white or off white in tanned skin, light brown in untanned skin, and dark brown in dark skinned individuals. In some, the P.versicolor can appear as red rashes. The varying colors are the result of relative action of the dicarboxylic acids on the skin surface lipids.
After treatment, in hypopigmented (white) rashes, the color disappears after a few weeks of treatment only.

Diagnosis of Pityriasis Versicolor

Microscopic examination of the scales after dissolving in potassium hydroxide reveals the branched hyphae and round spores of the yeast, the classic spaghetti and meatball appearance.

The hypopigmented Pityriasis versicolor may be confused with other diseases causing loss of skin color, like vitiligo, pityriasis alba, post inflammatory hypo pigmentation (following skin inflammations and allergies), leprosy and following prolonged topical fluorinated steroid applications.

The scaly lesions of P.versicolor resemble ring worm, seborrheic dermatitis, pityriasis rosea, guttate psoriasis and nummular eczema. The brown patches in the armpits, chest, back and groin may resemble erythrasma, a bacterial infection of the skin.

Treatment of Pityriasis versicolor

Management of Pityriasis versicolor involves identification and elimination of the predisposing factors, topical anti-yeast applications, systemic antifungals and preventive measures.

Identification and elimination of predisposing factors. In recurrent and resistant cases of Pityriasis versicolor, the predisposing factors as discussed previously should be sought for and eliminated as far as possible.
Topical treatment in Pityriasis versicolor. Selenium sulfide 2.5% lotion or shampoo or ketoconazole shampoo, is applied to the affected area and scalp for 15-30 minutes daily at night for 1 to 2 weeks. Antifungal creams like ketoconazole, miconazole, clotrimazole, econazole etc. are applied twice daily for 2-3 weeks. Terbinafine 1% solution applied twice daily for 1-2 weeks is also effective.
Systemic antifungals in Pityriasis versicolor. Ketoconazole, fluconazole or itraconazole in appropriate doses are also effective in generalized or recurrent cases of P.versicolor.
Prevention of recurrences. Shampoos containing selenium sulfide, ketoconazole, zinc pyrithione, climbazole, undecylenic acid etc. used weekly twice can effectively suppress the recurrence. Ketoconazole tablet 400 mg monthly once is also effective. Salicylic acid and sulphur soaps are also useful in preventing relapses of Pityriasis versicolor.

Reference

Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology, Fifth Ed, 2005

Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.

The copyright of the article Pityriasis Versicolor in General Medicine is owned by Hanish Babu. Permission to republish Pityriasis Versicolor in print or online must be granted by the author in writing.

Loss of Skin Color: Pityriasis Versicolor	Tinea Versicolor: Hypopigmented Patch Face	Pityriasis Versicolor: Brown Patches
Seborrheic Dermatitis: Also Caused by Malassezia

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Comments

Jul 2, 2009 2:26 PM

EarthMomma :

I have suffered from this condition for years. Unfortunately you can pick this fungus up in a lot of places - tanning beds, lawn furniture, towels, clothing. It is easily passed on. I always forget that once it shows up that I have to take some preventitive measures to get rid of it. Usually I will add about 10 drops each tea tree and lavender oil (which are both antibacterial and antifungal)to 2 oz Dr. Brommer's unscented liquid soap and 4 oz distilled water, I use that in the shower daily on the affected area. In addition, on hot days I will use a dusting powder to help wick perspiration away from my skin. MOST IMPORTANTLY : Because I get it in between and underneath my breasts, I soak all of my bras in a gallon of super hot water with 3 cups vinegar added to it for an hour or so, toss them in the washer for the spin cycle and then hang those babys in the sun to dry. (Hidden benefit - the vinegar will help your whites stay white and colorfast your colors!) I had always wondered why it wasn't going away - the condition was seemingly chronic. The last step is crucial for ridding your body of the spots!

Jul 12, 2009 6:48 PM

Guest :

Ive had an armpit rash for about 10 years. Its usually managable and doesnt bother me unless i go for 2 days without showering and putting on fresh anti-persperent. If I dont keep my armpits dry and clean, they flare up beat red and can even crack and bleed in a rare case because the skin gets so nasty. I think Ive narrowed the problem down, its either this or candida. Its high time I got rid of this thing.

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