Pityriasis versicolor is a superficial fungal infection of the stratum corneum, due to dimorphic yeasts of the genus Malassezia, leading to hypo- or hyperpigmented macular lesions on seborrhoeic areas of the trunk.
Eruption is most common in the summer months in adolescents. Often has a relapsing nature requiring frequent treatment or prophylaxis.
Primarily a clinical diagnosis that is confirmed by a KOH preparation demonstrating fungal elements with a characteristic spaghetti-and-meatballs appearance indicating the presence of both yeast and short hyphae.
Easily treated with either topical medications, including zinc pyrithione shampoo, selenium sulfide shampoo, or azole-class topical antifungal creams. More extensive disease may require systemic therapy with antifungal drugs.
After successful treatment, remind patients that it may take up to 6 weeks before their normal skin pigmentation returns.
Recurrence of the disease is common, and prophylactic treatment with selenium shampoo and, for more extensive disease, systemic therapy with antifungal drugs may be necessary.
Pityriasis versicolor (PV), also known as tinea versicolor, is a common superficial fungal infection of the stratum corneum (outer layer of the epidermis) resulting from a change to the mycelial (filamentous fungus or mould) state of dimorphic yeasts of the genus Malassezia. It leads to hypo- or hyperpigmented coalescing scaly macules on the trunk and upper arms. The eruption is most common in the summer months in adolescents and young adults, favours oily areas of the skin, and often has a relapsing nature requiring frequent treatment.
History and exam
Key diagnostic factors
- presence of risk factors
- lack of pruritus or pain
- macules or patches
- seborrhoeic distribution
- fine overlying scale
Other diagnostic factors
- yellow fluorescence under Wood lamp examination
- high ambient temperature and humidity
- adolescent and young adult age
- systemic corticosteroid or other immunosuppressant use
- participation in athletics
- greasy skin
- family history of PV
- use of oral contraceptives
- HIV infection and other immunosuppressive conditions
- use of occlusive ointments or creams
1st investigations to order
- microscopical examination with KOH preparation
Investigations to consider
- skin biopsy
- Gram stain
recurrent disease after successful pathogen eradication
Brian L. Swick, MD
Departments of Dermatology and Pathology
University of Iowa
BLS declares that he has no competing interests.
Hobart Walling, MD, PhD
Private Practice of Dermatology
HW declares that he has no competing interests.
Helen Goodyear, MBChB, MRCP, FRCPCH, MD, MMed
HG declares that she has no competing interests.
- Tinea corporis
- Seborrhoeic dermatitis
- Guidelines of care for superficial mycotic infections of the skin: Pityriasis (tinea) versicolor
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