eMedicine Specialties > Pediatrics: General Medicine > Dermatology

Tinea Versicolor: Differential Diagnoses & Workup

Author: Mark A Crowe, MD, Assistant Clinical Instructor, Department of Medicine, Division of Dermatology, University of Washington School of Medicine
Contributor Information and Disclosures

Updated: Aug 5, 2009

Differential Diagnoses

Leprosy
Pityriasis Alba
Pityriasis Rosea
Syphilis
T-Cell Disorders

Other Problems to Be Considered

  • Acanthosis nigricans
  • Confluent and reticulated papillomatosis of Gougerot and Carteaud
  • Cutaneous T-cell lymphoma
  • Erythrasma: Erythrasma may closely mimic tinea versicolor with pigmentary change and scaling, but satellite lesions are less common, and erythrasma fluoresces pink under a Wood lamp.
  • Psoriasis (guttate)
  • Seborrheic dermatitis, tinea corporis: Seborrheic dermatitis, pityriasis rosea, secondary syphilis, pinta, and tinea corporis show more inflammatory change than tinea versicolor.
  • Vitiligo: Vitiligo and chloasma are normally distinguished by a complete absence of scaling.

Workup

Laboratory Studies

  • The diagnosis of tinea versicolor is usually made based on clinical examination findings; however, the diagnosis is easily confirmed with microscopic examination of scales soaked in 10%-15% potassium hydroxide (KOH).
  • Microscopic examination
    • Microscopic examination demonstrates the characteristic thick-walled spherical or oval yeast forms and coarse septate mycelium, often broken up into short filaments.
    • This combination of mycelium strands and numerous spores is commonly referred to as "spaghetti and meatballs."
    • Liquid blue ink, methylene blue, or Swartz-Medrik stain can be added to the KOH preparation for better visualization of the causative organism.
    • Scales may also be removed using clear adhesive tape; they are then directly examined. The tape must be clear and is pressed several times over involved areas of skin. The tape is then lightly pressed, sticky side down, onto a microscope slide. A small drop of methylene blue or other appropriate stain is placed at the edge of the tape and allowed to run between the tape and the glass slide. Spores, often in grapelike clumps, and mycelium are easily seen.
  • Cultures
    • M furfur is a dimorphic lipophilic organism, which is cultured only in media enriched with C12-sized to C14-sized fatty acids. It is not a dermatophyte, does not grow on DTM, and does not respond to griseofulvin therapy.
    • If inoculated into lipid-rich media, the scales of tinea versicolor show spherical yeasts that produce the mycelial phase of the normal flora yeast P orbiculare. Scales that show mycelium and clusters of oval yeasts on direct microscopy grow P ovale on culture.
    • Colonization by M furfur is especially dense in the scalp, the upper trunk, and the flexures. In patients with clinical disease, the organism occurs in both the filamentous (hyphal) and the yeast (spore) stage forms.

Histologic Findings

  • The characteristic histological changes include hyperkeratosis, parakeratosis, and slight acanthosis with a mild perivascular inflammatory infiltrate in the upper dermis.
  • The organism is usually present in the upper layers of the stratum corneum, and electron microscopy reveals invasion between and within the keratinized cells.
  • In addition to the common findings noted above, acanthosis nigricans–like changes have been reported in more papular lesions, and dilated blood vessels are prominent in erythematous lesions.
  • M furfur is detected by hematoxylin and eosin (H and E) stain alone, although periodic acid-Schiff (PAS) or methenamine-silver staining facilitates detection.

More on Tinea Versicolor

Overview: Tinea Versicolor
Differential Diagnoses & Workup: Tinea Versicolor
Treatment & Medication: Tinea Versicolor
Follow-up: Tinea Versicolor
Multimedia: Tinea Versicolor
References
[ CLOSE WINDOW ]

References

  1. Crespo Erchiga V, Ojeda Martos A, Vera Casano A, et al. Malassezia globosa as the causative agent of pityriasis versicolor. Br J Dermatol. Oct 2000;143(4):799-803. [Medline].

  2. Plensdorf S, Martinez J. Common pigmentation disorders. Am Fam Physician. Jan 15 2009;79(2):109-16. [Medline].

  3. [Guideline] Drake LA, Dinehart SM, Farmer ER, et al. Guidelines of care for superficial mycotic infections of the skin: Pityriasis (tinea) versicolor. Guidelines/Outcomes Committee. American Academy of Dermatology. J Am Acad Dermatol. Feb 1996;34(2 Pt 1):287-9. [Medline].

  4. Muhammad N, Kamal M, Islam T, Islam N, Shafiquzzaman M. A study to evaluate the efficacy and safety of oral fluconazole in the treatment of tinea versicolor. Mymensingh Med J. Jan 2009;18(1):31-5. [Medline].

  5. Albright SD III, Hitch JM. Rapid treatment of tinea versicolor with selenium sulfide. Arch Dermatol. Apr 1966;93(4):460-2. [Medline].

  6. Ashbee HR, Evans EG. Immunology of diseases associated with Malassezia species. Clin Microbiol Rev. Jan 2002;15(1):21-57. [Medline]. [Full Text].

  7. Bamford JT. Treatment of tinea versicolor with sulfur-salicylic shampoo. J Am Acad Dermatol. Feb 1983;8(2):211-3. [Medline].

  8. Burkhart CG, Dvorak N, Stockard H. An unusual case of tinea versicolor in an immunosuppressed patient. Cutis. 1981;27(1):56-8. [Medline].

  9. Crowson AN, Magro CM. Atrophying tinea versicolor: a clinical and histological study of 12 patients. Int J Dermatol. Dec 2003;42(12):928-32. [Medline].

  10. Di Silverio A, Zeccara C, Serra F, et al. Pityriasis versicolor in a newborn. Mycoses. May-Jun 1995;38(5-6):227-8. [Medline].

  11. Elewski BE. Cutaneous mycoses in children. Br J Dermatol. Jun 1996;134 Suppl 46:7-11: discussion 37-8. [Medline].

  12. Faergemann J. Pityrosporum yeasts--what's new?. Mycoses. 1997;40 Suppl 1:29-32. [Medline].

  13. Faergemann J, Hersle K, Nordin P. Pityriasis versicolor: clinical experience with Lamisil cream and Lamisil DermGel. Dermatology. 1997;194 Suppl 1:19-21. [Medline].

  14. Fernandez-Nava HD, Laya-Cuadra B, Tianco EA. Comparison of single dose 400 mg versus 10-day 200 mg daily dose ketoconazole in the treatment of tinea versicolor. Int J Dermatol. Jan 1997;36(1):64-6. [Medline].

  15. Gupta AK, Batra R, Bluhm R, Faergemann J. Pityriasis versicolor. Dermatol Clin. Jul 2003;21(3):413-29, v-vi. [Medline].

  16. Gupta AK, Batra R, Bluhm R, et al. Skin diseases associated with Malassezia species. J Am Acad Dermatol. Nov 2004;51(5):785-98. [Medline].

  17. Gupta AK, Batra R, Bluhm R, et al. Skin diseases associated with Malassezia species. J Am Acad Dermatol. Nov 2004;51(5):785-98. [Medline].

  18. Gupta AK, Cooper EA, Ryder JE, et al. Optimal management of fungal infections of the skin, hair, and nails. Am J Clin Dermatol. 2004;5(4):225-37. [Medline].

  19. Gupta AK, Einarson TR, Summerbell RC, Shear NH. An overview of topical antifungal therapy in dermatomycoses. A North American perspective. Drugs. May 1998;55(5):645-74. [Medline].

  20. Gupta AK, Ryder JE, Nicol K, Cooper EA. Superficial fungal infections: an update on pityriasis versicolor, seborrheic dermatitis, tinea capitis, and onychomycosis. Clin Dermatol. Sep-Oct 2003;21(5):417-25. [Medline].

  21. Hickman JG. A double-blind, randomized, placebo-controlled evaluation of short-term treatment with oral itraconazole in patients with tinea versicolor. J Am Acad Dermatol. May 1996;34(5 Pt 1):785-7. [Medline].

  22. Hull CA, Johnson SM. A double-blind comparative study of sodium sulfacetamide lotion 10% versus selenium sulfide lotion 2.5% in the treatment of pityriasis (tinea) versicolor. Cutis. Jun 2004;73(6):425-9. [Medline].

  23. Janaki C, Sentamilselvi G, Janaki VR, Boopalraj JM. Unusual observations in the histology of Pityriasis versicolor. Mycopathologia. 1997;139(2):71-4. [Medline].

  24. Karakas M, Durdu M, Memisoglu HR. Oral fluconazole in the treatment of tinea versicolor. J Dermatol. Jan 2005;32(1):19-21. [Medline].

  25. Katsambas A, Rigopoulos D, Antoniou C, et al. Econazole 1% shampoo versus selenium in the treatment of tinea versicolor: a single-blind randomized clinical study. Int J Dermatol. Sep 1996;35(9):667-8. [Medline].

  26. Kaur I, Handa S, Kumar B. Tinea versicolor: involvement of unusual sites [letter]. Int J Dermatol. Aug 1996;35(8):604-5. [Medline].

  27. Kose O. Fluconazole versus itraconazole in the treatment of tinea versicolor. Int J Dermatol. Jul 1995;34(7):498-9. [Medline].

  28. Leeming JP, Sansom JE, Burton JL. Susceptibility of Malassezia furfur subgroups to terbinafine. Br J Dermatol. Nov 1997;137(5):764-7. [Medline].

  29. Mellen LA, Vallee J, Feldman SR, Fleischer AB Jr. Treatment of pityriasis versicolor in the United States. J Dermatolog Treat. Jun 2004;15(3):189-92. [Medline].

  30. Nakabayashi A, Sei Y, Guillot J. Identification of Malassezia species isolated from patients with seborrhoeic dermatitis, atopic dermatitis, pityriasis versicolor and normal subjects. Med Mycol. Oct 2000;38(5):337-41. [Medline].

  31. Okuda C, Ito M, Naka W, et al. Pityriasis versicolor with a unique clinical appearance. Med Mycol. Oct 1998;36(5):331-4. [Medline].

  32. Partap R, Kaur I, Chakrabarti A, Kumar B. Single-dose fluconazole versus itraconazole in pityriasis versicolor. Dermatology. 2004;208(1):55-9. [Medline].

  33. Rausch LJ, Jacobs PH. Tinea versicolor: treatment and prophylaxis with monthly administration of ketoconazole. Cutis. Nov 1984;34(5):470-1. [Medline].

  34. Savin RC. Systemic ketoconazole in tinea versicolor: a double-blind evaluation and 1-year follow-up. J Am Acad Dermatol. May 1984;10(5 Pt 1):824-30. [Medline].

  35. Schmidt A. Malassezia furfur: a fungus belonging to the physiological skin flora and its relevance in skin disorders. Cutis. Jan 1997;59(1):21-4. [Medline].

  36. Silva V, Di Tilia C, Fischman O. Skin colonization by Malassezia furfur in healthy children up to 15 years old. Mycopathologia. 1995-96;132(3):143-5. [Medline].

  37. Silva V, Fischman O, de Camargo ZP. Humoral immune response to Malassezia furfur in patients with pityriasis versicolor and seborrheic dermatitis. Mycopathologia. 1997;139(2):79-85. [Medline].

  38. Sunenshine PJ, Schwartz RA, Janniger CK. Tinea versicolor: an update. Cutis. Feb 1998;61(2):65-8, 71-2. [Medline].

  39. Vermeer BJ, Staats CC. The efficacy of a topical application of terbinafine 1% solution in subjects with pityriasis versicolor: a placebo-controlled study. Dermatology. 1997;194 Suppl 1:22-4. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

tinea versicolor, Malassezia furfur, M furfur, Malassezia globosa, M globosa, Malassezia sympodialis, M sympodialis, Malassezia slooffiae, M slooffiae, Malassezia ovalis, M ovalis, Pityrosporum orbiculare, P orbiculare, Pityrosporum ovale, P ovale, chromophytosis, dermatomycosis furfuracea, pityriasis versicolor, tinea flava, Cushing syndrome, malnutrition, atopic dermatitis, diabetes mellitus, HIV, drug allergies, treatment, diagnosis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Mark A Crowe, MD, Assistant Clinical Instructor, Department of Medicine, Division of Dermatology, University of Washington School of Medicine
Mark A Crowe, MD is a member of the following medical societies: American Academy of Dermatology and North American Clinical Dermatologic Society
Disclosure: Nothing to disclose.

Medical Editor

Kevin P Connelly, DO, Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center
Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.