What is Tinea Versicolor?
Tinea versicolor, also known as pityriasis versicolor, is a common skin infection caused by a type of yeast (fungus). This yeast, from the Malassezia family (first known as Pityrosporum), is usually present in normal skin. It’s important to understand that Tinea versicolor is different from other skin infections often referred to as ‘tinea’, as it’s not caused by a specific type of fungus called a dermatophyte.
This skin condition can cause skin spots that are either darker (hyperpigmented) or lighter (hypopigmented) than your regular skin color. These spots also have a fine, flaky surface. The areas most likely to be affected are the torso, neck, and areas of the arms and legs close to the body.
Pityriasis versicolor is usually diagnosed based on its appearance. However, if the doctor isn’t sure, they might use a special light (a Wood’s lamp) to look more closely at the skin, or examine the flaky skin under a microscope after treating it with a chemical called potassium hydroxide.
While this skin condition can be effectively treated with medication, it’s common for it to return over time. Because of this, maintaining prevention practices over the long term might be important. By understanding what causes tinea versicolor, how it’s diagnosed, and how it’s managed, you can better handle this condition.
What Causes Tinea Versicolor?
Tinea versicolor, a skin condition, is caused by a fungus called Malassezia, which was formerly referred to as Pityrosporum. This fungus is actually part of the normal collection of microorganisms that live on our skin. However, problems can occur when this fungus, usually present in a yeast form, changes to a different form known as the “mycelial form”.
There are 14 types of this Malassezia fungus that have been discovered by researchers, but three species are primarily responsible for tinea versicolor: Malassezia furfur, Malassezia globosa, and Malassezia sympodialis. Out of these, Malassezia globosa is usually the most commonly found.
Risk Factors and Frequency for Tinea Versicolor
Tinea versicolor is a common skin condition that occurs around the world, but it is most common in warm and humid areas. For instance, in tropical countries, it can affect up to 50% of the population. However, in colder climates like Sweden, the rate can be as low as 1.1%. It’s most common in teenagers and young adults, potentially because their skin produces more oil, which can promote the growth of the Malassezia fungus that causes the condition. That said, it can also affect infants and children. It’s important to note that tinea versicolor occurs in both men and women equally, and it doesn’t favor any particular ethnic group.
Signs and Symptoms of Tinea Versicolor
Tinea versicolor is an infection characterized by unique skin changes. There are patches or plaques on the skin that are clearly defined and oval in shape. Depending on the individual, these patches may be lighter or darker than the surrounding skin, or they may appear red. These patches can spread and merge together, especially in cases involving a lot of them. The color of these patches can vary, even among people with the same skin tone. When you stretch or scrape the skin, a fine scale appears, referred to as the “evoked scale sign.”
Typically, skin changes are seen on the upper body, and sometimes, the face, especially in kids. This is due to the type of fungus causing the infection, which prefers these areas. These changes are usually not painful, but they can be itchy, especially in hot and humid conditions.
There are different variations of tinea versicolor, including a rare version where the skin becomes thinner:
- Form 1: This type presents with many round or oval patches with clear borders, primarily on the upper body. These patches have a fine scale and can blend together, altering the skin’s pigmentation. Using a scalpel or the end of a microscope slide provokes a fine, powdery scale.
- Form 2: This form is known as the inverse variant and is most common in people with weakened immune systems. Rather than being mainly on the upper body, this form occurs in the skin’s creases, the face, or specific areas of the limbs. This form can easily be mistaken for other skin conditions.
- Form 3: Mainly seen on the back, torso, and limbs, this form involves the hair follicles, which can cause the skin around them to change color. This form can often be mistaken for bacterial folliculitis, another skin condition.
- Form 4: Presents as solid, red or brown bumps on the torso, typically without the fine white scales seen in the other forms. Under a microscope, you can see not only fungal cells but also inflammation in the deeper skin layers.
- Atrophying tinea versicolor: A rare form marked by reddish, sometimes ivory patches that appear wrinkled. Notably, these patches only appear on areas of the skin affected by tinea versicolor. Microscopic examination reveals thinning of the skin and changes to blood vessels and skin structures. This form is often seen in individuals who have been using corticosteroids topically over a long period, but it’s also been noticed in individuals who have not used these medications.
Testing for Tinea Versicolor
Tinea versicolor is a skin condition that causes patches on your skin. These patches can be darker (hyperpigmented) or lighter (hypopigmented) than your normal skin tone. They also have a fine scaly texture. The diagnosis of tinea versicolor can usually be made based on these trademark patches alone.
However, sometimes the symptoms might not be clear enough for a diagnosis. If that’s the case, special examinations, such as dermoscopy and Wood’s lamp examinations, can be helpful. A Wood’s lamp is a special kind of light that makes some skin conditions more visible. In tinea versicolor, it can make the skin glow in gold-yellow, yellow-green, or coppery-orange colors. However, this only occurs in less than half of those with the condition. Dermoscopy is a procedure that magnifies the skin, making it easier to see the small changes caused by the disease. Here, doctors look for things like fine scales and a “contrast halo”, a ring of lighter or darker skin around the main patch.
If a doctor is still not sure, they can take a small sample of the scaly skin and analyze it under a microscope. To do this, they’ll need to soak the scales in a solution containing potassium hydroxide (KOH). This allows the doctor to see the yeast cells causing the infection, which appear in clusters and elongated threads called hyphae. Sometimes special dyes are added to make it easier to see these structures. Growing, or culturing, the yeast directly can be quite difficult because they need very specific conditions to thrive.
Treatment Options for Tinea Versicolor
Tinea versicolor is a common skin condition caused by an overgrowth of naturally-occurring fungus on the skin. Despite its appearance, it’s not contagious. It’s worth noting that even after treatment, it may take several months for your skin to regain its normal color.
Topical medications, or creams and lotions you apply directly to your skin, are usually the first step in treating this condition. An example of this is a specially formulated shampoo which includes an antifungal ingredient. This shampoo isn’t used on your hair and scalp; rather, it’s applied to the parts of your skin affected by tinea versicolor. After a few minutes, rinse it off like normal.
There are also different topical alternatives your healthcare professional might recommend, including lotions and creams that contain other effective ingredients. These options could take a few minutes to half an hour to apply, and vary in usage from daily to just once a week.
For more serious cases, or in instances where the tinea versicolor is widespread and hard to reach, oral medication might be considered. However, these should be evaluated by a professional since the pigmentation changes of the skin might still linger even after the fungus is treated. Some oral antifungal medications, however, are not recommended due to potential side effects including liver function abnormalities and drug interactions.
For individuals who tend to have recurring tinea versicolor, particularly those with compromised immune systems, there are preventative measures that may be taken. This includes the prophylactic use of topical treatments and/or oral medication.
Apart from conventional treatment methods, there are also emerging treatments like the use of laser therapy and phototherapy. However, these techniques are still under study and more clinical trials are required to confirm their effectiveness.
What else can Tinea Versicolor be?
Tinea versicolor is a skin condition that can be mistaken for a variety of other skin issues. The way to confirm a diagnosis of tinea versicolor is by using a potassium hydroxide preparation to identify the condition. Here are some other conditions that are often confused with tinea versicolor, along with their distinguishing characteristics:
- Seborrheic Dermatitis: It typically appears more red and has thicker scales than tinea versicolor. This condition often affects other parts of the body too such as the scalp, eyebrows, and nose and cheek creases.
- Pityriasis Rosea: This condition causes inflamed patches surrounded by scales, which typically follow a “Christmas tree-like” pattern on the torso. A bigger patch usually appears before the rest.
- Erythrasma: This results in red or overly pigmented areas in armpits or groin. When examined under a specific type of light called a Wood’s lamp, the patches glow a coral-red color, unlike tinea versicolor.
- Pityriasis Alba: Is a milder form of skin inflammation resulting in light-colored patches primarily on the face and upper arms and is more common in children with a history of eczema. Under a Wood’s lamp, these patches are noticeable but do not glow.
- Secondary Syphilis: May cause red to brown spots, bumps, or small lesions distributed throughout the body. Palms and soles are often affected.
- Tinea Corporis: Is a fungal skin infection that does not affect the feet, groin, face, scalp hair, or beard hair.
- Vitiligo: Is marked by completely colorless patches on the skin, while tinea versicolor only causes areas of lighter skin color.
- Confluent Reticulated Papillomatosis of Gougerot and Carteaud: This rare skin condition usually affects young adults, causing pigmented, scaly spots that form patches with a network-like appearance. The neck, chest, and upper back are usually affected.
- Guttate Psoriasis: Is characterized by small, red, scaling plaques primarily on the trunk and upper arms. These plaques often appear inflamed and drop-shaped, typically following a strep infection.
- Mycosis Fungoides: May present as patches of lighter skin color, primarily on the trunk and extremities, especially among dark complexioned individuals. It could also have fine scales, redness, or raised plaques.
- Terra Firma-Forme Dermatosis: Is a harmless skin condition presenting as heavily pigmented bumps or patches that look like dirty skin, usually found on the neck and ankle. Unlike tinea versicolor, these can be wiped off using alcohol swabs.
What to expect with Tinea Versicolor
Taking antifungal medicines orally or applying them on the skin can effectively treat fungal infections. However, it’s quite common for the disease to come back, which can affect a patient’s daily life. It’s generally helpful to take steps to prevent the infection from returning. Also, it’s important that patients remember that even after the infection is gone, skin color changes may take several weeks or months to go away. In some cases, the infection can go away on its own. But if it isn’t treated, it can become a long-term condition.
Possible Complications When Diagnosed with Tinea Versicolor
After effectively treating tinea versicolor, a skin infection, people may see changes in skin color that can last for several months. Their skin might become lighter (hypopigmentation) or darker (hyperpigmentation), which may incorrectly lead them to think that the treatment didn’t work. Signs of an active infection include the presence of skin flakes and a positive KOH preparation, a type of skin test. If the disease seems resistant to treatment, keeps returning, or is spreading to other areas, this could suggest a weakened immune system. Some people have reported hair thinning or loss in the areas where the infection had been. This hair loss is most commonly seen on men’s forearms, stomach, neck, and beard areas.
Common Long-term Effects:
- Skin color changes, lighter or darker
- Prescence of skin flakes
- Positive KOH preparation
- Disease resistance or recurrence
- Disease spreading to other areas
- Thinning hair or hair loss
- Most commonly on men’s forearms, stomach, neck, and beard areas.
Preventing Tinea Versicolor
Tinea versicolor is a skin condition caused by a fungus. This fungus usually lives on our skin without causing any troubles. However, it can trigger a rash in people living in very hot and humid environments. This rash is characterized by several small patches on the skin that may have a different color than the surrounding skin. These colors can range from white to light or dark brown, grey-black, or a pink-red shade. This rash is most commonly seen on the upper back, chest, and upper arms. Importantly, tinea versicolor is not something that can spread from person to person.
When it comes to treating tinea versicolor, doctors usually recommend using antifungal creams, lotions, or shampoos. How long you’ll need to use these depends on what your doctor thinks is best and could range from one day to four weeks. If the rash covers a large area of your body or the topical treatments aren’t working, oral medications may be necessary. It’s worth noting that tinea versicolor can often come back, but many people can avoid this by using a preventative treatment once a month for six months.
The changes in skin color caused by the condition can take a bit longer to go away than the actual infection. Generally, these changes start to disappear within two to four months of starting treatment.