Cause:Pityrosporum ovale

Pathophys:A very superficial infection

Common, 20% adults have; often appears at puberty

Sx:Scaly areas of skin especially on shoulders, chest, and arms that are dark in winter, pale (don't tan) in summer

Si:Macular and punctate lesions often coalesce into confluent, scaly patches. Wood's lamp fluorescence not clinically useful

Lab: Bact:Skin scraping with KOH shows "spaghetti and meatballs" (short hyphae and spores)

Rx:

• Selenium 2.5% (Selsun) shampoo qd, leave on 20 min, × 14 d; often recurs
• Ketoconazole 2% shampoo 5 min/day × 3 d (J Am Acad Derm 1998;39:944); may repeat in 1 wk; may repeat in 1 wk
• Fluconazole (Diflucan) 50 mg po qd × 2 wk ($61) or 400 mg po × 1 ($25); 75% cure at 6 wk (Acta Derm Venereol 1992;72:74)
• Itraconazole (Sporanox) 100 mg po qd × 15 d ($74) (Clin Experim Dermatol 1990;15:101), or 200 mg po × 5 d ($50) (J Am Acad Derm 1990;23(part 2):551)
• Ketaconazole (Nizoral) 200 mg po qd × 5 d ($11), or 400 mg po × 1 ($9), repeating in 1 wk or monthly at 200 mg po qd × 2 (DICP 1991;25:395)