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Tinea versicolor
From WikEM
Contents
Background
- Caused by fungus Pityrosporum ovale (oval form) or obiculare
- Also known as Malassezia furfur
Clinical Features
- Hypopigmented or hyperpigmented lesions predominantly on the trunk
- Circular, scaly patches
- More common in areas of increased sebaceous glands
- Poor hygiene, areas of moisture
- Equally common is light and dark skinned individuals, but more noticeable in the later
Differential Diagnosis
Hyperpigmentation
- Postinflammatory hyperpigmentation (acne, Psoriasis, atopic and contact dermatitis, lichen planus, trauma, drugs, and fixed-drug eruptions)
- Melasma
- Solar lentigines
- Ephelides (freckles)
- Café-au-lait macules
- Nevi
- Melanoma and precursors
Hypopigmentation
- Vitiligo
- Pityriasis alba
- Tinea versicolor
- Postinflammatory hypopigmentation
- Piebaldism
- Tuberous sclerosis
- Hypomelanosis of Ito
Evaluation
- Some demonstrate coppery-orange fluoresence under Woods Lamp
- KOH wet prep (Spaghetti and Meatballs appearance)
- Almost never cultured given difficult culture medium, benign course, and diagnostic KOH prep.
Management
- First line topical treatment is ketoconazole (nightly application x 2 weeks) or selenium sulfide (10 minutes x bid)
- Single dose 400mg ketoconazole PO or fluconazole 150-300mg PO per week x 2-4 weeks for more resistant cases or for easy-of-use
- Griseofulvin is not effective
