Tinea Versicolor

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Description

  • A benign superficial skin infection commonly caused by Malassezia yeast species that leads to well-demarcated scaly hypopigmented or hyperpigmented macules/patches, primarily located on the upper trunk, neck, and upper arms.
  • System(s) affected: skin/exocrine
  • Synonym(s): pityriasis versicolor

Epidemiology

Incidence

  • Common, occurs worldwide, especially in tropical climates
  • Predominant age: adolescents and young adults between 21 and 30 years of age
  • Predominant sex: male = female

Pediatric Considerations
Skin eruptions usually occur after puberty, when sebaceous glands are more active. However, tinea versicolor can also be seen in children, especially in tropical climates; facial lesions are more common in children.Geriatric Considerations
Not common in the geriatric population

Prevalence

Prevalence can reach up to 50%, especially in warm climates.

Etiology and Pathophysiology

  • Hypopigmented lesions (more commonly noted in darker skin tones) is likely due Malassezia species producing azelaic acid that damages melanocytes by inhibiting tyrosinase. The small melanosomes and lipid-like material accumulates in the stratum corneus blocking ultraviolet light.
  • Hyperpigmented lesion is due to inflammatory response to pathogen leading to thicker stratum corneum and abnormally large melanosome.
    • Tinea versicolor is caused by saprophytic yeast: Pityrosporum orbiculare (also known as Plasmodium ovale, Malassezia furfur, or Malassezia ovalis), which is a known colonizer of all humans.
    • Development of clinical disease is associated with transformation of Malassezia from yeast cells to pathogenic mycelial form. Several endogenous (host) and exogenous/external factors may play a role in the transformation to active disease.
    • Tinea versicolor is generally not contagious.

Genetics

Genetic predisposition may exist.

Risk Factors

  • Hot, humid weather
  • Application of oily lotion or cream to the skin
  • Wearing masks
  • Hyperhidrosis
  • HIV infection/immunosuppression
  • High cortisol levels (Cushing syndrome/disease, prolonged steroid administration)
  • Pregnancy
  • Malnutrition and poor general health
  • Oral contraceptives

General Prevention

  • Prophylactic use of antifungal products including ketoconazole 2% shampoo or selenium sulfide 2.5% lotion once weekly for 6 to 12 months after initial cure in patients with ≥2 episodes/year
  • Wear loose clothes
  • Avoid tanning bed or sun lamp
  • Avoiding oily skin products
  • Avoid excessive sun exposure

Commonly Associated Conditions

  • Seborrheic dermatitis and Malassezia folliculitis share similar yeast
  • Atopic dermatitis, HIV or other immunodeficiency, Cushing disease and biologic induced dermatomycoses increase risk of tinea versicolor

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