Tinea Versicolor
Symptoms
Tinea versicolor presents as hypo‑ or hyperpigmented, finely scaly macules and patches on the chest, back, and upper arms. Lesions may coalesce into large areas with sharp borders. Mild itching is possible, especially with sweating. Color changes become more apparent after tanning due to contrast with surrounding skin. Scaling is accentuated by gentle scraping (“evoked scale” sign).
Cause
Overgrowth of Malassezia yeast, part of normal skin flora, disrupts pigment production. Warm, humid environments and oily skin promote proliferation. Immunosuppression, hormonal changes, and genetic factors can predispose individuals. The yeast produces azelaic acid, which inhibits melanocytes, causing hypopigmentation. High recurrence rates reflect persistent yeast presence.
Treatment
Topical antifungal shampoos or creams containing selenium sulfide, ketoconazole, or zinc pyrithione applied for several days clear most cases. Oral fluconazole or itraconazole treats extensive disease. Recurrence is common; monthly prophylactic topical treatment during warm months helps prevention. Pigment alterations may take weeks to months to normalize. Loose, breathable clothing reduces heat and humidity on the skin.
Dr. Beth Schulz-Butulis
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