Tinea versicolor is a common skin infection that causes discolored patches of skin, usually on the chest, back and upper arms. The patches may be covered with fine scale and can cause some itching (pruritus).

Tinea versicolor occurs most often in adolescents and young adults and is particularly prevalent in tropical climates that experience high temperatures and humidity year-round.

Tinea versicolor is caused by an overgrowth of Pityrosporum orbiculare, a type of yeast. Factors that increase a patient’s risk of developing tinea versicolor include heredity, excessive sweating (hyperhidrosis) and malnutrition.

Usually, the only symptom of tinea versicolor is the presence of discolored patches of skin that may be various shades of white, red or brown. They are usually flat and without texture.

Tinea versicolor is diagnosed during a physical examination that includes a medical history and a list of medications. A physician can usually diagnose the condition by visually inspecting the affected areas of skin.

Tinea versicolor is a common, superficial skin infection characterized by patches of skin that are lighter or darker than normal.

In patients with tinea versicolor, discolored patches of skin are most commonly found on the chest, back or upper arms. It can also affect the scalp. In children, the face may be affected. Discoloration differs in individual patients and can range from white to red to brown in color. People with naturally dark skin may develop lighter patches. Those with naturally light skin may develop darker or lighter patches.

In some cases, the patches are covered with fine scale, which may become apparent when the skin is scraped. Tinea versicolor may produce some itching, but it rarely causes pain. Also known as pityriasis versicolor, the condition may prevent the skin from tanning.

Tinea versicolor is a benign (harmless) condition, but may cause cosmetic problems for patients. It occurs most often in adolescence and early adulthood, but can affect people of any age. It is rare in young children and the elderly, except in tropical climates. People with dark and light skin are equally as prone to the condition.

There are several different types of tinea versicolor. They include:

• Form 1. The most common type of tinea versicolor. It is characterized by the appearance of numerous, well-defined, fine scales and oval-to-round macules (small localized patches of discolored skin) located over the trunk and/or chest and sometimes the lower parts of the abdomen and neck. The condition is usually more noticeable during the summer months.
  
  
• Form 2. An inverse form of tinea versicolor in which discolored patches of skin are found in the face or isolated areas of the extremities. This form is seen more often in patients with weakened immune systems.
  
  
• Form 3. Fungal infections that involve the hair follicle (tiny, tubular structure from which hair grows). This condition is usually localized to the back, chest and extremities. It may be difficult to distinguish from another condition, called bacterial folliculitis (infection of hair follicles that occurs on the skin or scalp).

Tinea versicolor is caused by an overgrowth of Pityrosporum orbiculare. Also known as Malassezia furfur, Pityrosporum ovale or Malassezia ovalis, Pityrosporum orbiculare is a type of yeast which is normally present in small amounts on the surface of the skin.

Under normal circumstances, the yeast lives in the pores but remains on the skin’s surface. Under certain conditions (such as high heat and humidity), the yeast changes from its usual round or oval form to a string-like, branching shape. When the yeast changes shapes, it is called hyphae. In this form, the yeast migrates under the skin and produces azelaic acid, a substance that can change the amount of pigment (color) in new skin cells. It is not known why some people develop tinea versicolor and others do not.

In tropical climates where the temperature and humidity are high year-round, tinea versicolor may occur throughout the year. In areas with cooler temperatures, the condition generally occurs during the warm months of the year.

Other factors that have been associated with an increased risk of developing tinea versicolor include:

• Age. The condition is more common among adolescents and young adults when the sebaceous glands (glands in the skin that secrete oil to the skin’s surface) are more active.
  
  
• Heredity. The condition tends to run in families.
  
  
• Oily skin. The yeast that causes tinea versicolor requires oil to grow, so people with oily skin are more likely to develop the condition.
  
  
• Use of bath oils and skin lubricants. Because the yeast that causes tinea versicolor is lipophilic (attracted to fat), use of these products may increase the risk of developing the condition.
  
  
• Excessive sweating (hyperhidrosis). May cause excess growth of the yeast that causes the condition.
  
  
• Immunodeficiency. People with conditions that weaken the immune system, such as acquired immune deficiency syndrome (AIDS) are more likely to develop tinea versicolor.
  
  
• Corticosteroids. A group of anti-inflammatory drugs used to provide relief for inflamed areas of the body by lessening swelling, redness, itching and allergic reactions.
  
  
• Cushing’s disease. A hormonal disorder caused by prolonged and high levels of the hormone cortisol.
  
  
• Poor nutrition.
  
  
• Pregnancy.
  
  
• Oral contraceptives.

Usually, the only symptom of tinea versicolor is the presence of discolored patches of skin that may be various shades of white, red or brown. They are usually flat and without texture. They may begin as small, round spots that become larger and combine with other areas. The discolored patches may scale slightly or itch, but the condition rarely causes pain.

Other common characteristics of the discolored patches of skin may include:

• Infection usually occurs on the top layers of the skin (epidermis) in the stratum corneum.
  
  

  

• Usually occurs on the trunk of the body but rarely on the face. However, it may affect the face in children.
  
  
• May be worse during the heat or humidity. Lesions generally fade in cooler and drier months.
  
  
• May be worse among patients using corticosteroids or those that have a weakened immune system.
  
  
• May be more noticeable during the summer months because tanning makes the difference between normal skin and skin affected by tinea versicolor more pronounced.

Tinea versicolor is usually diagnosed during a physical examination that includes a medical history and a list of medications. Patients may be treated by a dermatologist (a physician that specializes in the treatment of skin, hair and nails).

Although tinea versicolor often resembles other skin conditions, physicians can usually diagnose it by visual examination of the discolored patches of skin. To confirm the diagnosis, a physician may use a special ultraviolet black light (Wood’s lamp) to view the skin more clearly. A wood's lamp will show a yellow-green color where yeast is present.

A physician may also perform a skin scraping. This involves scraping cells from a patch of discolored skin with scales on it. The sample is sent to a laboratory where it is studied under a microscope for the presence of the yeast that causes tinea versicolor.

There are several factors a physician may consider when treating a patient with tinea versicolor, including:

• Severity of the condition
  
  
• Areas of the skin that are affected
  
  
• Climate
  
  
• Patient preference

Treatment may include:

• Topical antifungal creams, lotions or sprays. Available over-the-counter and by prescription, these drugs are applied directly to the affected areas of the skin. They are usually used several times a day over a period of time to be effective.
  
  
• Antifungal shampoos. They are available by prescription and sometimes left on the skin overnight and rinsed off in the morning.
  
  
• Oral antifungal medications. Persistent cases that do not respond to other types of treatment are sometimes treated with oral (pill) medications.

Topical treatment may take several weeks as opposed to oral treatment which is quicker. Although the yeast that causes tinea versicolor is easy to kill, it may take months for the skin discoloration to return to normal. In some people the discoloration is permanent. Also, cases of tinea versicolor are likely to recur.

Since it is not known why some people develop tinea versicolor and others do not, it cannot be totally prevented. However, the effects of the condition may be minimized in some cases by using an antifungal shampoo weekly to prevent recurrences. In some cases, an oral antifungal drug may be taken one to three times a month to help prevent recurrence.

Patients should avoid excessive heat or sweating and the use of skin lotions because they may worsen the condition. Tight, restrictive clothing or nonventilated clothes should also be avoided.

In addition, patients may benefit from using sunscreen. Wearing sunscreen may help to minimize the difference in color between normal skin and skin affected by tinea versicolor. It is often difficult to tell if the tinea versicolor is resolved if the patient has a dark tan, as the affected areas do not tan with sun exposure.

Preparing questions in advance can help patients have more meaningful discussions with physicians regarding their conditions. Patients may wish to ask their doctor the following questions about tinea versicolor:

1. Do my symptoms indicate tinea versicolor?
   
   
2. What type of tinea versicolor do I have?
   
   
3. What may have caused me to develop this condition?
   
   
4. Does the condition pose a danger to my overall health?
   
   
5. Can I spread the condition to other parts of my body or to other people?
   
   
6. What are my treatment options?
   
   
7. When can I expect my skin discoloration to return to normal?
   
   
8. Am I likely to develop tinea versicolor again? If so, how can I prevent recurrences?
   
   
9. Am I more likely to develop the condition at certain times of year or can it occur year-round?
   
   
10. I have tinea versicolor. How likely is it that my children will develop the condition?