Medical Care

Tinea versicolor can be treated with various agents, and skin color alterations usually resolve within a few months of treatment.^[9]It does not leave any permanent scars or pigment changes.

Topical therapy alone is indicated for most patients. Systemic treatment is indicated for extensive involvement, for recurrent infections, or when topical therapy has failed. Because treatment is relatively easy and recurrence is common, therapy must be as safe, inexpensive, and convenient as possible. A plan for prophylactic therapy should be discussed with all patients to reduce the high recurrence rate.

Various regimens involve both topical and oral therapies.^{[10, 11]}The most common is varying regimens of selenium sulfide lotion, topical zinc pyrithione, topical benzoyl peroxide, and topical therapy with imidazoles. Oral imidazole therapy is used in adults but less commonly in children.^{[12, 13, 14]}

Surgical Care

The disease does not require any surgical care.

Diet

Because studies indicate that tinea versicolor may associate with malnutrition the diet of patients have to be rational and not restrictive.

Activity

Activity limitations are not necessary. However, active patients who excessively perspire are more likely to develop recurrences.

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.

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

Long-Term Monitoring

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

Medication

Dourmishev AL. Pityriasis versicolor. Iliev B, Mitov G, Radev M. Infectology. Academic publishing house; 2001. 812-3.
Prohić A, Jovović Sadiković T, Kuskunović-Vlahovljak S, Baljić R. Distribution of Malassezia Species in Patients with Different Dermatological Disorders and Healthy Individuals. Acta Dermatovenerol Croat. 2016 Dec. 24 (4):274-281. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Levy JM, Magro C. Atrophying pityriasis versicolor as an idiosyncratic T cell-mediated response to Malassezia: A case series. J Am Acad Dermatol. 2017 Apr. 76(4):730-735. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
[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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Rosen T. Mycological Considerations in the Topical Treatment of Superficial Fungal Infections. J Drugs Dermatol. 2016 Feb. 15 (2 Suppl):s49-55. [QxMD MEDLINE Link].
Cantrell WC, Elewksi BE. Can pityriasis versicolor be treated with 2% ketoconazole foam?. J Drugs Dermatol. 2014 Jul. 13(7):855-9. [QxMD MEDLINE Link].
Gupta AK, Lyons DC. Pityriasis versicolor: an update on pharmacological treatment options. Expert Opin Pharmacother. 2014 Aug. 15(12):1707-13. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Neamsuvan O, Bunmee P. A survey of herbal weeds for treating skin disorders from Southern Thailand: Songkhla and Krabi Province. J Ethnopharmacol. 2016 Dec 4. 193:574-585. [QxMD MEDLINE Link].
Gobbato AA, Babadópulos T, Gobbato CA, Ilha Jde O, Gagliano-Jucá T, De Nucci G. A randomized double-blind, non-inferiority Phase II trial, comparing dapaconazole tosylate 2% cream with ketoconazole 2% cream in the treatment of Pityriasis versicolor. Expert Opin Investig Drugs. 2015. 24 (11):1399-407. [QxMD MEDLINE Link].
Badri T, Hammami H, Bzioueche N, Zouari B, Mokhtar I. Comparative clinical trial: fluconazole alone or associated with topical ketoconazole in the treatment of pityriasis versicolor. Tunis Med. 2016 Feb. 94 (2):107-11. [QxMD MEDLINE Link].
Tsunemi Y. Oral Antifungal Drugs in the Treatment of Dermatomycosis. Med Mycol J. 2016. 57 (2):J71-5. [QxMD MEDLINE Link].

Media Gallery

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."