Tinea versicolor is a skin rash caused by a fungus that can present with brown spots or white patches on the skin.
Generally, white patches are more commonly seen in people with darker or black skin, while brown spots are usually seen in individuals with lighter skin. Additionally, white patches may be more prominent during the summer.
In most cases, tinea versicolor can be effectively treated with topical antifungals, although the discolored patches may take some time to regain their original color.
What is tinea versicolor?
Tinea versicolor is a fungal skin rash caused by an overgrowth of the fungus Malassezia. This fungus can affect skin pigmentation, leading to discolored patches.
Malassezia is part of the normal flora of our skin, meaning we all have it on our skin. This group has several species, such as Malassezia furfur and Malassezia globosa.
In addition to tinea versicolor, Malassezia is also associated with other skin conditions like Malassezia folliculitis, dandruff, seborrheic dermatitis, etc.
Tinea versicolor is commonly seen in young adults. While the condition is usually harmless, it can lead to psychological distress due to the cosmetic changes it causes.
Tinea versicolor vs. pityriasis versicolor: Tinea versicolor and pityriasis versicolor are two names for the same skin condition.
Note: Despite its name, tinea versicolor is not related to ringworm and is not caused by the same fungus as ringworm.
Causes
Tinea versicolor is the result of an overgrowth of the fungus Malassezia. However, the exact reason why this fungus proliferates in some individuals is not entirely clear. Factors that may contribute include:
- Immunosuppression
- Excessive sweating
- Hot and humid weather
- Oiliness of skin
- Hormonal changes such as pregnancy
Although anyone can develop tinea versicolor, it’s more common in teenagers and young adults, possibly due to higher oil gland activity.
It’s also more frequently seen in tropical or subtropical climates due to the heat and humidity.
Symptoms
Tinea versicolor commonly affects the back, chest, upper arms, and neck. In children, it is also commonly seen on the face.
The condition often presents as discolored patches on the skin, which are sharply demarcated from the surrounding skin.
The color of these patches can vary, ranging from white, brown, and pink, to tan or pale. An individual may have patches of just one color or a variety of different colors.
- White patches are more common in individuals with black or darker skin. The white patches may become more prominent in the summer when the surrounding skin tans, but these white patches do not. These patches are thought to occur due to the interference of a chemical called dicarboxylic acid, produced by Malassezia fungi, with melanin synthesis.
- Brown spots are more commonly seen in individuals with lighter skin. Also, in winter, brown spots may be more noticeable when the tanned skin returns to its original color. These brown spots are thought to occur due to an increase in the size of granules that store the melanin pigment (melanosomes).
- Pink patches may be seen if there is any inflammation.
Sometimes, the affected area may become slightly raised to form thin plaques or raised skin lesions.
If you scrape the surface of these patches, you will notice fine scaling that resembles bran flakes.
Even after treatment, the affected area may take a while before returning to its original color. In some individuals, this condition can recur in hot and humid climates.
Tinea versicolor is usually asymptomatic, although in some cases it can cause mild itchiness.
Pictures
The pictures of tinea versicolor below show discolored spots on the skin, which can be white, brown, or pink.
Is it contagious?
Tinea versicolor is not considered to be contagious and cannot be transferred by merely touching. The fungus causing it is part of the flora of our skin, and a lot of us already have it on our skin.
However, for some reason, it proliferates in some individuals and causes tinea versicolor.
Diagnosis
Pityriasis versicolor can be diagnosed by clinical examination by a doctor. In some cases, they might do additional tests to diagnose and rule out other skin conditions. These tests may include the following:
- Wood lamp examination: In this test, a special ultraviolet light is used that makes the affected areas glow with a yellowish-orange color.
- Skin scrapings: In this test, the cells are scraped off from the affected area and examined under a microscope to identify any fungal elements.
- Skin biopsy: In this test, a sample is taken from the skin lesion. This is sent to a pathology lab where it is processed and examined under a microscope by a pathologist for a final diagnosis.
Look-alikes
Tinea versicolor can be confused with several other skin conditions. Here are some of them:
- Vitiligo: The white patches of vitiligo are smooth, unlike tinea versicolor which presents with scaly patches. Vitiligo cannot be cured. On the other hand, tinea versicolor is a fungal infection that can be effectively treated with antifungals.
- Seborrheic Dermatitis: Seborrheic dermatitis can lead to white patches in dark skin. In fact, Seborrheic dermatitis is also associated with the same Malassezia fungus. However, the scales of seborrheic dermatitis are much thicker and greasier than the fine scales of tinea versicolor.
- Pityriasis Rosea: The reddish-brown patches of pityriasis rosea can be confused with the brown spots of tinea versicolor. However, pityriasis rosea characteristically leads to spots in a ‘Christmas tree’ pattern.
- Pityriasis Alba: It can also present with dry or scaly white patches. It is much more common in children and often occurs on the face. The progression of the disease in pityriasis alba is different. First, a pink patch appears which then forms a hypopigmented or white patch with a fine scale, and finally, the area becomes smooth. Unlike tinea versicolor, pityriasis alba patches have ill-defined borders and it does not require specific treatment. (Read more: Pityriasis Alba Vs. Tinea Versicolor)
Treatment
Tinea versicolor can be treated with over-the-counter topical treatments in cream, lotion, or shampoo form. These include:
- Lotrimin (clotrimazole)
- Monistat (miconazole)
- Lamisil (terbinafine)
- Over-the-counter anti-dandruff shampoos with antifungal ingredients like ketoconazole, sulfur, zinc pyrithione, and selenium sulfide (these should be lathered and left on the affected areas for 5-10 minutes)
In some cases, one may need prescription topical antifungals such as ketoconazole (2%) or ciclopirox.
If the infection is resistant to treatment or covers a large area of the body, oral antifungals like fluconazole or itraconazole may be prescribed.
It is important to know that even with effective treatment, the discolored areas may persist and it may take a while before color returns to normal.
Read more: Tinea versicolor healing and treatment
Can it recur?
Despite complete treatment, tinea versicolor can sometimes recur, especially in a warm and humid climate. If the recurrence is too frequent, your doctor may recommend the maintenance use of topical antifungals.
Prevention
The fungus Malassezia, which causes tinea versicolor, is part of the normal flora of the skin so it’s difficult to prevent it completely. However, certain steps may reduce the chances of getting it or its recurrence after treatment.
- Regularly shower after heavy sweating.
- Avoid hot and humid environments.
- Wear breathable clothes.
- Regular use of anti-dandruff shampoo may keep the fungus under check.
- In some cases, your doctor might recommend regular use of a topical antifungal as a preventative measure.
Key points
Tinea versicolor is a fungal skin rash that can present with brown spots or white patches on the skin. This rash occurs due to the overgrowth of the fungus Malassezia, which is part of the normal flora of our skin.
This infection is often effectively treated with topical antifungals, although it may recur in some individuals.
References
- Saunders CW, Scheynius A, Heitman J. Malassezia fungi are specialized to live on skin and associated with dandruff, eczema, and other skin diseases. PLoS Pathog. 2012;8(6):e1002701. doi: 10.1371/journal.ppat.1002701. Epub 2012 Jun 21. PMID: 22737067; PMCID: PMC3380954.
- Oakley A. (2004). Skin conditions associated with malassezia. DermNet.
Disclaimer: This article is for information purposes only and does not replace medical advice.