Pityriasis versicolor

What is pityriasis versicolor?

Pityriasis versicolor is a common yeast infection of the skin, in which flaky discoloured patches appear
on the chest and back.
The term pityriasis is used to describe skin conditions in which the scale appears similar to bran. The
multiple colours of pityriasis versicolor give rise to the second part of the name, versicolor. Pityriasis
versicolor is sometimes called tinea versicolor, although the term tinea should strictly be used
fordermatophyte fungus infections.

Who gets pityriasis versicolor?

Pityriasis versicolor most frequently affects young adults and is slightly more common in men than in
women. It can also affect children, adolescents and older adults.
Pityriasis versicolor is more common in hot, humid climates than in cool, dry climates. It often affects
people that perspire heavily. It may clear in the winter months and recur each summer.
Although it is not considered infectious in the conventional sense, pityriasis versicolor sometimes
affects more than one member of a family.

What are the clinical features of pityriasis versicolor?

Pityriasis versicolor affects the trunk, neck, and/or arms, and is uncommon on other parts of the body.
The patches may be coppery brown, paler than surrounding skin, or pink. Pale patches may be more
common in darker skin; this appearance is known as pityriasis versicolor alba. Sometimes the patches
start scaly and brown, and then resolve through a non-scaly and white stage.
Pityriasis versicolor is usually asymptomatic, but in some people it is mildly itchy.
In general, pale or dark patches due to pityriasis versicolor do not tend to be more or less prone to
sunburn than surrounding skin.

Pityriasis versicolor

More images of pityriasis versicolor ...

What is the cause of pityriasis versicolor?

Pityriasis versicolor is caused by mycelial growth of fungi of the genus Malassezia.
Malassezia are part of the microbiota (microorganisms found on normal skin). They are dependent on
lipid for survival. Fourteen different species of malassezia have been identified. The most common
species cultured from pityriasis versicolor are M globosa,M restricta and M sympodialis.
Usually malassezia grow sparsely in the seborrhoeic areas (scalp, face and chest) without causing a
rash. It is not known why they grow more actively on the skin surface of patients prone to pityriasis
versicolor. One theory implicates a tryptophan-dependent metabolic pathway.
The yeasts induce enlarged melanosomes (pigment granules) within basal melanocytes in the brown
type of pityriasis versicolor. It is easier to demonstrate the yeasts in scrapings taken from this type of
pityriasis versicolor than in those taken from the white type.
The white or hypopigmented type of pityriasis versicolor is thought to be due to a chemical produced
by malassezia that diffuses into the epidermis and impairs the function of the melanocytes.
The pink type of pityriasis versicolor is mildly inflamed, due to dermatiits induced by malassezia or its
metabolites. Pink pityriasis versicolor andseborrhoeic dermatitis may co-exist, as both are associated
with malassezia.
Hyperpigmented, hypopigmented and inflamed pityriasis versicolor are usually seen as distinct
variants but may sometimes co-exist.

How is pityriasis versicolor diagnosed?

Pityriasis versicolor is usually diagnosed clinically. However, the following tests may be useful.

Wood lamp (black light) examination yellow-green fluorescence may be observed in affected
areas

Microscopy using potassium hydroxide (KOH) to remove skin cellshyphae and yeast cells
that resemble spaghetti and meatballs are observed

Fungal culturethis is usually reported to be negative, as it is quite difficult to persuade the

yeasts to grow in a laboratory

Skin biopsyfungal elements may be seen within the outer cells of the skin (stratum
corneum) on histopathology. Special stains may be required.

Microscopy of Malassezia furfur

What is the treatment of pityriasis versicolor?

Mild pityriasis versicolor is treated with topical antifungal agents.

Propylene glycol solution

Sodium thiosulphate solution

Selenium sulfide

Topical azole cream/shampoo (econazole, ketoconazole)

Terbinafine gel

Ciclopirox cream/solution

The medicine should be applied widely to all the affected areas before bedtime for as long as directed
(usually about two weeks).
Oral antifungal agents, itraconazole and fluconazole, are used to treat pityriasis versicolor when
extensive or if topical agents have failed.
Vigorous exercise an hour after taking the medication may help sweat it onto the skin surface, where
it can effectively eradicate the fungus. Bathing should be avoided for a few hours. A few days'
treatment will clear many cases of pityriasis long term, or at least for several months.

Recurrences of pityriasis versicolor

Pityriasis versicolor generally clears satisfactorily with treatment but often recurs when conditions are
right for malassezia to proliferate. When the scaly component of pityriasis versicolor recurs, antifungal
treatment should be repeated.
In those who have frequent recurrences, antifungal shampoo or oral antifungal treatment may be
prescribed for one to three days each month.
Occasionally white marks persist long after the scaling and yeasts have gone and despite exposure to
the sun. In such cases, further antifungal treatment is unhelpful.