Tinea Versicolor

The Spots of Tinea Versicolor

What is tinea versicolor? What are symptoms of tinea versicolor?

Tinea versicolor is a common fungal infection that often affects adolescents and young adults. The term versicolor refers to the fact that it causes the affected skin to change color and become either lighter or darker than surrounding skin. In Jacksonville, the most common areas that we see affects the shoulders, back, and chest. At times, it can affect folds of skin, such as the crook of the arm, the skin under the breasts, or the groin. The face is usually spared, although sometimes children can get it there. There may be just a few spots or so many that it gives the appearance that the affected skin is normal while the unaffected skin around it seems to have a problem.

What causes tinea versicolor?

Tinea versicolor is caused by a yeast called Malassezia furfur that lives in the skin of most adults. This exists in two forms, one of which causes visible spots. Factors that can cause the fungus to become more visible include high humidity and immune or hormone abnormalities. However, almost all people with this very common condition are perfectly healthy.

Because the tinea versicolor fungus is part of the normal adult skin, this condition is not contagious. It often recurs after treatment, but usually not right away, so that treatment needs to be repeated only every year or two.

Tinea versicolor patches that are brown or reddish-brown go right away after treatment. When this condition produces spots that are lighter than the surrounding skin, it may take several months for overall color to even out. It always eventually does. Tinea versicolor does not leave permanent skin discoloration.

What other conditions resemble tinea versicolor?

To diagnose the condition, the providers at ADAS will often perform a scraping of the skin. Under the microscope (left), they will see yeast and spaghetti like structures. The following conditions look a little like tinea versicolor but are really quite different:

Atopic Dermatitis: This is a mild form of inherited dermatitis that produces mild, patchy lightening of the face, shoulders, or torso.

Vitiligo: This condition results in a permanent loss of pigment. Vitiligo is more likely to affect the skin around the eyes and lips or the knuckles and joints. Spots are porcelain-white and, unlike those of tinea versicolor, are permanent.

How is tinea versicolor treated?

There are many antifungal agents available to apply to the skin for the treatment of tinea versicolor. Over-the-counter (OTC) remedies include clotrimazole and miconazole. These should be applied twice a day for 10-14 days but come in small tubes and are hard to apply to large areas. Another OTC option is selenium sulfide shampoo 1% (Selsun Blue™) or 1% ketoconazole shampoo. Some doctors recommend applying these for 15 minutes twice a week for two to four weeks. Others suggest applying them overnight and washing them off in the morning for a week. This treatment can be irritating, however, and may lead to missing hard-to-reach spots on the mid-back.

There are also many prescription-strength antifungal creams that can treat tinea versicolor, as well as a stronger form of selenium sulfide (2.5%) and prescription-strength ketoconazole shampoo (2%). However, these pose the same application problems as their OTC counterparts.

Oral treatment for tinea versicolor has the advantage of simplicity. A single dose of ketoconazole (brand name Nizoral™) or five daily doses of itraconazole (brand name Sporanox™) are two therapies your doctor can prescribe. Some common medications, such as Lipitor™ used to lower cholesterol, may interact with these drugs, so the providers at ADAS will need to know what other medications are being taken before treating tinea versicolor orally.

What happens after the tinea versicolor has been treated?

As noted above, the eruption tends to linger even after successful treatment, especially if the spots are lighter than surrounding skin. This persistent discoloration often leads our patients in Jacksonville, Ponte Vedra Beach and Fleming Island to think that the condition is still present long after it has been eradicated. It may take months for skin color to blend and look normal, but it always does. The red or brown variety of rash, on the other hand, clears up visually right away. It is, therefore, a good idea to have the condition treated as soon as new spots appear so that any discoloration lasts as short a time as possible.

Recurrence of the rash is all but inevitable, though it won't recur necessarily every year. Applying selenium sulfide, Loprox™ or ketoconazole shampoo on affected areas once or twice a week may slow the onset of visible recurrence.

For more information on tinea versicolor or to set up a consultation, click here or call 904-285-7546. Thank you and we look forward to helping you recurrence.