Tinea versicolor is a fungal skin rash that can result in discolored patches on the skin. This condition usually does not go away on its own but can be treated with antifungal medications.
Tinea versicolor healing passes through several stages and with antifungal treatment, it may heal in 2-4 weeks. As the condition improves, the surface scaliness decreases and eventually the discolored areas become smooth. However, the discolored patches may take weeks to months to improve.
What is tinea versicolor?
Tinea versicolor, also known as pityriasis versicolor or “TV”, is a skin condition in which the Malassezia fungus overgrows on the skin, resulting in discoloration.
Although Malassezia is part of the normal skin flora, why it overgrows in some individuals is not clear. Oily skin, hot and humid climates, a suppressed immune system, hormonal changes, and excess sweating are all associated predisposing factors.
Appearance
Tinea versicolor results in spots that may be darker or lighter than the surrounding skin. These can be white, brown, tan, or pink spots.
These patches often have a scaly surface that becomes visible upon scraping. The scales look like bran scales, hence the term ‘pityriasis’. The term ‘versicolor’ refers to the various colors of skin patches or spots.
White patches appear due to the inhibition of melanin synthesis by a chemical produced by Malassezia, while brown spots result from enlarged melanosomes, which are structures in our skin that store the melanin pigment. Pink patches usually occur due to skin inflammation or irritation.
While tinea versicolor is usually asymptomatic, it may occasionally cause mild itching. It is commonly seen on the trunk, neck, and arms.
Healing stages of tinea versicolor
Tinea versicolor healing stages mentioned below extend from the start of the disease to the clearance of the infection.
- Initial symptoms: Tinea versicolor usually presents initially as small scaly spots of varying colors (white, brown, or pink). A person may have patches of just one color or more colors.
- Progression: The smaller spots may eventually merge to form larger scaly patches.
- Start of treatment: With appropriate antifungal treatment, the fungus may begin to decrease, leading to an improvement in scaling. These changes may indicate that tinea versicolor is healing.
- Clearance of infection: After about 2-4 weeks of effective treatment, once the infection is cleared, the discolored patches may become smooth.
- Regain of skin color: The smooth discolored patches may take time to regain their color – in some cases, this can take anywhere from 6 months to a year.
The healing of tinea versicolor may vary from person to person and also depends on the severity and extent of the infection.
The picture above shows tinea versicolor with a few pink patches and many large white patches.
In the pictures above, one can see tinea versicolor with fine, bran-like scales on the brown patches. However, the picture below shows a smooth brown patch with no scaliness.
Note: It’s important to complete the treatment course to prevent the recurrence of the infection.
How to tell if tinea versicolor is healing?
One way to tell if tinea versicolor is healing is by the reduction in scaling. Although patches of tinea versicolor are usually asymptomatic, if there was any itching, that may be reduced.
As the infection is completely cleared, the affected areas become smooth.
It is important to know that even when the fungal infection is cleared, the area may remain discolored for weeks or even months.
Discoloration without scaling does not mean that the infection is still there. This discoloration happens due to the effects of the fungus on melanin pigment, and it takes time to completely regain the original skin color.
Treatment
Tinea versicolor can be treated with several over-the-counter treatments or prescription medications, depending on the extent of the infection.
1. Over-the-counter treatments
There are several antifungal creams, lotions, or sprays which can help clear mild cases of tinea versicolor. Some of these include:
- Terbinafine (Lamisil)
- Clotrimazole (Lotrimin)
- Miconazole (Micaderm)
These should be applied as directed by your doctor or according to the instructions of a particular medication.
In addition, antidandruff shampoos and soap with antifungal ingredients can help clear skin fungus. Antifungal ingredients include selenium sulfide, zinc pyrithione, sulfur, and ketoconazole.
Some of the options include:
- Selsun Blue is a dandruff shampoo based on selenium sulfide.
- Head and Shoulders and Vanicream dandruff shampoos are based on zinc pyrithione.
There are several soaps that can be used for tinea versicolor. These can be based on zinc pyrithione such as Noble Formula, Vanicream Z-bar, DermaHarmony ZnP soap, DermaZinc soap, or on sulfur.
How to use dandruff shampoo or soap for tinea versicolor?
It’s best to follow the recommendations given by your doctor. In general, the following measures may be helpful.
For example, when using shampoos like Selsun Blue for tinea versicolor, lather the shampoo to create a foam and apply it to the skin, leaving it on for 5-10 minutes. This will allow time for the antifungal ingredients to act on the fungi causing the tinea versicolor.
However, bear in mind that many antidandruff products can be harsh on the skin. Therefore, it’s advisable to perform a patch test with any new product, especially when using it on sensitive areas like your face or neck.
If you are treating tinea versicolor on your face or neck, opt for a dandruff shampoo or cleanser that is free of fragrance. Some suitable options include Vanicream Dandruff Shampoo and Dermadoctor Calm Cool & Corrected Tranquility Cleanser.
2. Prescription medications
If over-the-counter medications are not clearing the tinea versicolor rash, your doctor may prescribe antifungal medication.
Topical antifungal medications include:
- Nizoral (ketoconazole 2% cream or shampoo)
- Ciclopirox (Loprox)
Tinea versicolor treatment pills may be prescribed for more extensive or widespread disease. These include:
- Fluconazole (Diflucan)
- Itraconazole (Sporanox)
When taking oral treatment pills for tinea versicolor, it is often recommended to sweat heavily sometime after taking medication (like by doing exercise) and let the sweat remain on for a couple of hours before taking a bath.
The metabolites of the antifungal medication get secreted in the sweat and can help control the growth of the fungus.
3. Natural home remedies
There are some natural remedies like tea tree oil, coconut oil, and honey which may be helpful, but there is no solid evidence to suggest that they will clear the infection. If you plan to use these, it’s best to talk to your doctor.
Recurrence
Despite effective treatment, tinea versicolor may recur, especially under conditions that favor the growth of Malassezia fungus on the skin, such as oily skin, hormonal changes, hot and humid climate, or excessive sweating.
Is it harmful?
Tinea versicolor is not harmful, but the discolored patches may be a cosmetic issue and can make one self-conscious.
Note: There are other tinea infections, unrelated to tinea versicolor, like tinea corporis, which is ringworm of the body and is contagious, unlike tinea versicolor.
Diagnosis
Most cases can usually be diagnosed by a doctor based on the physical examination of the skin lesions.
If necessary, your doctor may do additional tests such as:
- Wood’s lamp examination, in which a special ultraviolet light is used. The affected areas usually display a yellow-orange fluorescence.
- Skin scrapings, where a small sample of the affected skin is scraped off for microscopic examination to confirm the diagnosis.
- Skin biopsy, where a sample is taken and sent to a lab for examination by a pathologist.
Prevention
The fungus Malassezia, which causes tinea versicolor, is part of the flora of our skin. It is not clear why it increases in some people.
If you experience recurrent tinea versicolor, your doctor may recommend a maintenance treatment regimen. This often involves the use of antidandruff shampoos, such as Selsun Blue, once or a few times per month to keep the Malassezia fungus under control.
In addition, the following measures may lower your risk of getting tinea versicolor:
- Wear loose-fitting clothes made of breathable material.
- Avoid extremely hot and humid environments.
- Avoid excessive sweating and take a shower after exercise or excessive sweating.
- Protect your skin from the sun as tanning can make the white patches more prominent.
- Avoid the use of excessively oily skincare products.
Key points
Tinea versicolor begins as small discolored spots that can be white, brown, or pink in color; these may merge to form larger patches. These spots and patches have fine scales on them.
Tinea versicolor can be treated using over-the-counter antifungal creams, antidandruff shampoos, soaps, or prescription topicals or pills.
With effective treatment, tinea versicolor can heal within 2-4 weeks. As the condition improves, the surface scaliness decreases, and the discolored areas eventually become smooth.
References
- Dyer JM, Foy VM. Revealing The Unseen: A Review of Wood’s Lamp in Dermatology. J Clin Aesthet Dermatol. 2022 Jun;15(6):25-30. PMID: 35783566; PMCID: PMC9239119.
- Gupta AK, Foley KA. Antifungal Treatment for Pityriasis Versicolor. J Fungi (Basel). 2015 Mar 12;1(1):13-29. doi: 10.3390/jof1010013. PMID: 29376896; PMCID: PMC5770013.
Disclaimer: This article is for information purposes only and does not replace medical advice.