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Pediatric Tinea Versicolor Follow-up

  • Author: Lyubomir A Dourmishev, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Feb 05, 2016
 

Further Outpatient Care

Tinea versicolor tends to be associated with recurrences that must be properly treated.

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Further Inpatient Care

No inpatient care is needed.

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Inpatient & Outpatient Medications

Some authors recommend prophylaxsis with varying regimens of selenium sulfide shampoo or lotion.

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Transfer

Tinea versicolor is caused by M furfur, which is normally present on the skin surface and, therefore, is not considered a contagious disease. In past contaminated clothes and underwear were believed to play a role in disease transfer; however, climate factors, hyperhidrosis, sebum secretion, and genetic factors appear to be involved in disease pathogenesis.

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Deterrence/Prevention

Tinea versicolor has a high recurrence rate and may require frequent prophylactic treatment with intermittent topical or oral therapy.

Good personal hygiene may help limit recurrences. Specifically, patients should shower as soon as possible after participating in activities or exercise that produce significant perspiration.

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Complications

The disease has benign course; however, it tends to have recurrences that must be properly treated. Some patients report for itching, burning and irritation of lesions. Severe depigmentation may cause significant psychological discomfort.

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Prognosis

Prognosis is excellent. Although tinea versicolor is recurrent in some patients, the condition remains treatable.

Morbidity primarily results from the discoloration. The adverse cosmetic effect of lesions may lead to significant emotional distress, particularly in adolescents. Tinea versicolor frequently recurs despite adequate initial therapy. Even with adequate therapy, residual pigmentary changes may take several weeks to resolve.

The yeasts of the genus Malassezia have been associated with numerous other diseases that affect the human skin, such as Malassezia (Pityrosporum) folliculitis, seborrheic dermatitis, atopic dermatitis, psoriasis, confluent and reticulated papillomatosis, onychomycosis, and transient acantholytic dermatosis.

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Patient Education

Tinea versicolor is caused by a fungus that is normally present on the skin surface and, therefore, is not considered a contagious disease. The disease causes no permanent sequelae, and any pigmentary alterations resolve entirely within a few months of adequate treatment. Effective therapy is available. Recurrences are common, and prophylactic therapy may be required.

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Contributor Information and Disclosures
Author

Lyubomir A Dourmishev, MD, PhD Associate Professor, Department of Dermatology and Venereology, Medical University of Sofia, Bulgaria

Lyubomir A Dourmishev, MD, PhD is a member of the following medical societies: European Academy of Dermatology and Venereology

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Kevin P Connelly, DO Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; 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, American Osteopathic Association

Disclosure: Nothing to disclose.

References
  1. Dourmishev AL. Pityriasis versicolor. Iliev B, Mitov G, Radev M. Infectology. Academic publishing house; 2001. 812-3.

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

  3. 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. 2000 Oct. 38(5):337-41. [Medline].

  4. Day T, Scurry J. Vulvar pityriasis versicolor in an immunocompetent woman. J Low Genit Tract Dis. J Low Genit Tract Dis. 2014 Jul;. 18(3):e71-3. [Medline].

  5. Lodha N, Poojary SA. A Novel Contrast Stain for the Rapid Diagnosis of Pityriasis Versicolor: A Comparison of Chicago Sky Blue 6B Stain, Potassium Hydroxide Mount and Culture. Indian J Dermatol. 2015 Jul-Aug. 60(4):340-4. [Medline]. [Full Text].

  6. Wigger-Alberti W, Elsner P. Fluorescence with Wood's light. Current applications in dermatologic diagnosis, therapy follow-up and prevention. Hautarzt. 1997 Aug. 48(8):523-7. [Medline].

  7. [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. 1996 Feb. 34(2 Pt 1):287-9. [Medline].

  8. 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. 2009 Jan. 18(1):31-5. [Medline].

  9. Cantrell WC, Elewksi BE. Can pityriasis versicolor be treated with 2% ketoconazole foam?. J Drugs Dermatol. 2014 Jul. 13(7):855-9. [Medline].

  10. Gupta AK, Lyons DC. Pityriasis versicolor: an update on pharmacological treatment options. Expert Opin Pharmacother. 2014 Aug. 15(12):1707-13. [Medline].

  11. Gupta AK, Lane D, Paquet M. Systematic review of systemic treatments for tinea versicolor and evidence-based dosing regimen recommendations. J Cutan Med Surg. 2014 Mar-Apr. 18(2):79-90. [Medline].

  12. Abdul Bari MA. Comparison of Superficial Mycosis treatment using Butenafine and Bifonazole nitrate Clinical Efficacy. Glob J Health Sci. 2012 Nov 11. 5(1):150-4. [Medline].

  13. Dehghan M, Akbari N, Alborzi N, Sadani S, Keshtkar AA. Single-dose oral fluconazole versus topical clotrimazole in patients with pityriasis versicolor: A double-blind randomized controlled trial. J Dermatol. 2010 Aug. 37(8):699-702. [Medline]. [Full Text].

  14. Shi VS, Lio PA. Diagnosis of pityriasis versicolor in paediatrics: the evoked scale sign. Arch Dis Child. 2011 Apr. 96(4):392-3. [Medline].

 
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In patients with lighter skin color, lesions frequently are a light tan or salmon color.
Upon potassium hydroxide (KOH) examination, hyphae are visible and grow into strands within clumps of keratinocytes. Thick-walled spores frequently occur in grapelike clumps. Individual spores and short stubby hyphae float in the clear areas between clumps of keratinocytes. Many of the short hyphae are dystrophic.
Scale is frequently difficult to appreciate upon clinical examination.
This individual developed skin discoloration and mild itching every summer for the past few years. These patients should be instructed on the prophylactic use of topical therapy.
This superficial plaque of tinea versicolor is located in the right antecubital fossa of an adult. This appearance and distribution is uncommon but not rare. A potassium hydroxide (KOH) preparation confirmed the diagnosis.
Although tinea versicolor is uncommon in children in temperate climates, when it does occur, it is more likely to be atypical in distribution. This 7-year-old boy had areas of tinea versicolor across the forehead and both temples. He was in good health and lived in Washington state when he was diagnosed.
In some patients, the areas affected by tinea versicolor are not always obvious. In this patient, the abnormal areas are hypopigmented.
Clear adhesive tape can be pressed onto areas of tinea versicolor to collect hyphae and spores. The tape is then lightly pressed onto a glass slide, and a drop of methylene blue is placed at the edge of the tape. The methylene blue is allowed to run under the tape staining Malassezia furfur. The spores and hyphae easily are seen against a background clutter of keratinocytes and glue.
Some patients present with extensive tinea versicolor. This patient related that his discoloration had been present for more than 20 years. The light-colored areas on the abdomen are the normal areas of skin. Although topical therapy alone is usually effective, this patient may benefit from initial therapy with oral ketoconazole, followed by selenium sulfide applications in the shower 2-3 times a month.
Significant hyperpigmentation caused by a tinea versicolor infection.
Confluent and reticulated Gougerot and Carteaud papillomatosis.
Mycelium strands and numerous spores observed on a potassium hydroxide (KOH) preparation of tinea versicolor. This combination is commonly referred to as "spaghetti and meatballs."
 
 
 
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