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Editors

PekkaAutio

Pityriasis Versicolor

Essentials

  • In pityriasis versicolor, the rash is caused by exceptionally abundant growth of Malassezia yeast.
  • The reason why this lipophilic yeast fungus grows in large numbers in some patients is not known.
  • The condition is not contagious.

Symptoms

  • Fairly common in young adults
  • Irregular, mildly scaling maculae/patches are seen on the trunk (pictures 1 23), neck and proximal parts of the limbs.
  • The colour varies from pale to brown, even "dirty" grey. On light skin the maculae/patches are brown, on tanned skin they are more light-coloured than the surrounding skin (picture 4).

Investigations

  • The clinical appearance is diagnostic.
  • Malassezia also grows on normal skin. Therefore fungal culture is of no benefit.
  • In microscopy of a scraped sample (methyl blue staining) the appearance of Malassezia is typical ("spaghetti and meatballs").

Treatment

  • Local azoles (ketoconazole, miconazole, clotrimazole) as an ointment (recommended dosing 1-2 times daily for 1-3 weeks) or ketoconazole shampoo (application once daily for 5 days; also a shorter treatment, even a single dose, may be sufficient). Before the summer season ketoconazole may used, as a prophylactic treatment, once daily for 3 days.
  • Alternatively, the following may be used:
  • If, in more severe cases, oral treatment is chosen, the alternatives are itraconazole 200 mg once daily for one week or fluconazole 50 mg once daily for 2-4 weeks or 300-400 mg once a week for 1-3 weeks.
  • Especially light maculae/patches may require months to heal even after successful treatment until the skin becomes tanned on exposure to sunlight.
  • Pityriasis versicolor should not be handled as a contagious disease. Treatment does not mean eradication but merely control of the skin colonisation.

    References

    • Gupta AK, Lane D, Paquet M. Systematic review of systemic treatments for tinea versicolor and evidence-based dosing regimen recommendations. J Cutan Med Surg 2014;18(2):79-90. [PubMed]
    • Gupta AK, Lyons DC. Pityriasis versicolor: an update on pharmacological treatment options. Expert Opin Pharmacother 2014;15(12):1707-13. [PubMed]
    • Hald M, Arendrup MC, Svejgaard EL ym. Evidence-based Danish guidelines for the treatment of Malassezia-related skin diseases. Acta Derm Venereol 2015;95(1):12-9. [PubMed]
    • Lange DS, Richards HM, Guarnieri J ym. Ketoconazole 2% shampoo in the treatment of tinea versicolor: a multicenter, randomized, double-blind, placebo-controlled trial. J Am Acad Dermatol 1998;39(6):944-50. [PubMed]