A chronic, superficial, fungal infection, tinea versicolor (also known as pityriasis versicolor) may produce a multicolored rash, commonly on the upper trunk. Recurrence is common.
The agent that causes tinea versicolor is Pityrosporum orbiculare, also known as P. ovale and Malassezia furfur. Whether this condition is infectious or merely a proliferation of normal skin fungi is uncertain. Tinea versicolor is more common in hot climates — tropical countries or in those with high humidity — and associated with increased sweating. It usually affects adolescents and young men when sebaceous gland activity is at its highest.
Tinea versicolor typically produces raised or macular, round or oval, slightly scaly lesions on the upper trunk, which may extend to the lower abdomen, neck, arms, groin, thigh, genitalia and, rarely, the face. These lesions are usually tawny but may range from hypopigmented (white) patches in dark-skinned patients to hyperpigmented (brown) patches in fair-skinned patients. Some areas don’t tan when exposed to sunlight, causing the cosmetic defect for which most people seek medical help. Inflammation, burning, and itching are possible but usually absent.
Visualization of blue-green fluorescent lesions during Wood’s light examination strongly suggests tinea versicolor.However, if the patient has recently showered, this fluorescence may not show because the chemical that causes fluorescence is water-soluble.
The most economical and effective treatment is selenium sulfide lotion 2.5% applied once a day for seven days. It’s left on the skin for 10 minutes, then rinsed off thoroughly. In persistent cases, therapy may require a single 12- or 24-hour application of this lotion, repeated once a week for 4 weeks. Either treatment may cause temporary redness and irritation.
Other treatments include the following: sodium thiosulfate 25% solution, applied twice daily to affected areas for 2 to 4 weeks; sulfur salicylic shampoo applied as a lotion at bedtime each night and washed off each morning for 2 weeks; zinc pyrithione shampoo 1% lathered into affected areas for 5 minutes before showering, and repeated every day for 2 weeks; or imidazole antifungal agents applied twice daily for 2 weeks.
Ketoconazole and other azole-based creams, such as topical ketoconazole, may be applied once or twice daily for 2 weeks. Oral ketoconazole or another oral azole-based medication, such as oral ketoconazole, may be used if the patient has extensive disease that fails to respond to other therapies.
❑ Instruct the patient to apply selenium sulfide lotion as ordered. Tell him that this medication may cause temporary adverse effects.
❑ Assure the patient that once his fungal infection is cured, discolored areas will gradually blend in after exposure to the sun or ultraviolet light.
❑ Because recurrence of tinea versicolor is common, advise the patient to watch for new areas of discoloration.
❑ Teach the patient proper hand-washing technique, and encourage good personal hygiene.
❑ Stress the importance of not scratching or picking lesions to avoid the risk of skin breaks and secondary bacterial infections.
❑ Provide written instructions for using prescribed medications. Tell the patient to contact the physician if adverse reactions occur.
Read excerpts from these other book chapters related to Tinea:
Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2008 Williams & Wilkins.
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Title: Professional Guide to Diseases (Eighth Edition)
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2005
ISBN: 1-58255-370-X
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