NURSING CARE

MANAGEMENT OF A
CLIENT WITH TINEA
VERSICOLOR
A Case Presentation presented to
Baliuag University’s College of
Nursing and Allied Health Sciences

In partial fulfillment for the requirements

of
NCM 109 – Care of Mother and Child
at Risk or with Problems, Acute and
Chronic

By:
Castro, Ana Marie B.
Cruz, Darylle M.
Fatalla, Dominic M.
Julian, Reuvenell
Laurente, Patrizja Ysabel B.
Rimando, Jaymie Lee M.

Group 11 (BSN II)

Batch 2026

Submitted on
February 21, 2023

Copyright © Baliuag University College of Nursing and Allied Health Sciences. All rights reserved.

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 OVERVIEW OF THE CASE SCENARIO:
This case study features a client with tinea versicolor. Mr. M is a 20-year-old male and
currently a grade 10 student enrolled in Mariano Ponce National High School. Upon assessment,
the client presents with dry white spots on his back, neck, and right cheek. While other findings,
such as the vital signs, remain normal.

SCOPE AND DELIMITATION:

Scope:
This case presentation is about the following data:

• Presentation of the client's biographical information, health history, developmental level

(according to Eric Erickson)and significant findings for physical assessment
• Discussion of the Anatomy and Physiology, Overview of the disease, Pathophysiology of
the disease, and Nursing Management.
• Presentation of Nursing Care Plan about one actual diagnosis

Delimitations:
The case study conducted within the designated area of DepEd (Department of Education) has
certain limitations and exclusions. The following aspects are deemed unavailable and were not
included in the case study:
- Laboratory Examinations/Diagnostic Tests: The case study does not incorporate
information about specific laboratory examinations or diagnostic tests. This exclusion
means that detailed analysis of laboratory results, such as blood tests, skin scrapings, or
any other diagnostic procedures, is not part of the provided information.

- Surgical Management: Information related to surgical interventions or management is

not included in the case study. Surgical procedures, if applicable, are not discussed, and
the focus remains on non-surgical aspects of care.

By acknowledging these limitations, it is made clear that the case study does not delve into
certain medical aspects such as specific diagnostic tests or surgical interventions, aligning with
the constraints and scope defined by the designated area of DepEd.
Additionally, the case study does not include an in-depth drug study about the provided
ointment (Bioderm) and soap (Dr. S. Wong’s sulfur soap with moisturizer). This exclusion is due
to inadequate references regarding specific information about these medications. As a result,
detailed pharmacological profiles, mechanisms of action, and specific drug interactions are not
covered in the case study.
By acknowledging these delimitations, it clarifies the scope and limitations of the case study,
ensuring transparency about the areas that are intentionally excluded or not thoroughly explored
due to constraints related to available information.

DEFINITION OF TERMS:

• Tinea Versicolor is a common fungal infection of the skin. These patches may be lighter
or darker in color than the surrounding skin and most commonly affect the trunk and
shoulders

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• Malassezia furfur – is a species of yeast (a type of fungus) that is naturally found on the
skin surfaces of humans and some other mammals.

• Melanin – group of pigments primarily responsible for skin, hair, and eye color.

• Melanocyte – produce melanin and is an irregularly shaped cells with many long
processes that extend between the epithelial cells of the deep part of the epidermis.

• Chemotaxis – phenomenon whereby bacterial cells direct their movements according to

certain chemicals in their environment.

• Cytokines - act as messengers between cells, regulating immune responses and

inflammation.

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 NURSING HEALTH HISTORY

I. BIOGRAPHICAL DATA
Name: Mr. M
Address: Sta. Barbara, Baliuag, Bulacan
Contact no.: 0926*******
Birthdate: May 3, 2003
Birthplace: Malolos, Bulacan
Age: 20 years old
Occupation: Student
Sex: Male
Civil Status: Single
Religion: Born-Again Christian
Educational Attainment: Junior High School Undergraduate
Ordinal Position in the Family: 1st born
Chief Complaint/s: _____
Diagnosis: Tinea Versicolor
Date of Interview: February 19, 2024 (Monday)

II. REACTIONS AND EXPECTATIONS TO ILLNESS, HOSPITALIZATION,

DIAGNOSTIC STUDIES AND
PERSONNEL.
A. History of Present Illnesses
The client presents with a recent onset of dry white spots on the right cheek, neck, and back
coinciding with increased outdoor activities including biking, gym sessions, and basketball
training for an upcoming league. The client verbalized, “Napansin ko po ito nung
nagsimula po ako mag bike at mag basketball, hindi naman po siya makati pero nagtry po
ako ng sabon online para maalis yung puti pero dumadami lang po,” indicating the onset
of the dry white spots was noticed during the initiation of the said physical activities.
According to the client, despite his efforts to address the condition with numerous online
skin care soaps, due to growing self-consciousness about its presence, no resolution has
been achieved.

B. Past Health History

A. Childhood Illness
- He stated that during his childhood, he never had any other diseases. According to him,
he simply had the flu, cough, and common colds.

B. Allergies
- He stated that he doesn't have any allergies to any kinds of food and medications.

C. Accidents/Injuries
- He stated that he was not involved in any major accidents.

D. Hospitalization
- He stated that he has never been hospitalized.

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 E. Medications
- The client stated he is not taking any vitamins and medications for maintenance.

C. Family History of Illnesses

- The client stated that both of his parents were hypertensive and diabetic. He also stated
that his two younger siblings are alive and well.

III. ACTIVITIES OF DAILY LIVING

A. Circulation
- The client has normal capillary refill time, there is no cyanosis present. His blood
pressure is 110/70 mmHg.

B. Respiration
- The client has no reports of any difficulty in breathing or shortness of breath.

C. Food/Fluid
- The client stated that he usually eats two meals a day. At 6:30 am, the client usually
drinks a cup of coffee and eats rice meals for lunch time and another one for dinner.
Client claims that he drinks 2-3 liters of water per day and drinks alcohol just
occasionally.

D. Elimination
- He mentioned that he regularly defecates once a day every morning and usually voids
urine 4-5 times a day.

E. Personal Hygiene
- Mr. M brushes his teeth two times a day and wash his hands when necessary. He stated
the he takes a bath once a day every morning. He added that he usually doesn’t take a
bath after outdoor activities. He also verbalized, “Hindi ako naliligo or naghihilamos
katawan pagkatapos lumaro tsaka mag-gym dahil baka malamigan ako, hinahayaan
ko nalang matuyo.” He also shared that he always perspires too much but is too tired
to dry his sweat after his physical activities and go straight to bed immediately. He also
mentioned that he loves to wear bright and fitted sportswear. According to the client,
he does not usually care about skin care products and does not wash his face every
night, not until dry white spots become visible on his skin.

F. Rest/Sleep
- The client claims that he usually goes to bed around 10 pm and wakes up at about 6
am.

G. Exercise
- He stated that his form of exercising is playing basketball every afternoon after school
with his friends, biking every week ends, and sometimes going to gym 2-3 times a week
whenever there is free time. He also considers his daily walking and activities inside
Mariano Ponce as form of exercise since it requires strength and effort such as
practicing for dance presentation numerous times in a day.

H. Usual Pain/Discomfort
- The client does not report any pain or discomfort.

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IV. COMPETENCIES

A. Physical
- The client stated that he is able to perform activities of daily living normally. The client
reports a regular exercise routine involving a mix of cardiovascular and strength
training exercises. No history of chronic illnesses or significant physical limitations.
Body mass index (BMI) falls within the normal range.

B. Emotional
- The client reports situations of feeling self-conscious sometimes when meeting new
people because of the dry white spots on his back, neck, and right cheek. According to
the client, playing basketball and doing other physical activities became his coping
mechanism and escape whenever he is stressed.

C. Mental
- During the client's interview and assessment, no indicators of psychological
deterioration were noted or seen on the client. He was able to respond to the questions
in a consistent and comprehensible manner.

D. Spiritual
- He stated that his family members respect one another’s choice of religion. "Hindi po
ako kasama sa religion nila Papa (Catholic), nagpaconvert po ako sa Born-Again
Chrisitan kasi mas nagustuhan ko po yung mga gawain at sermon po sa Christian
Church.”, as verbalized by the client.

E. Social
- He identified himself as “taong-gala”. The client stated that he spends most of his time
with his teammates in their basketball team in their barangay. “Diretso court kami ng
mga tropa ko tapos hanggang magdilim nayun, ineenjoy na naming bago magkahiwa-
hiwalay, pag nag college”, as verbalized by the client. The client also stated that he
loves having road trips and doing other outdoor activities.

F. Environmental
- The client and his family resided in a small bungalow house with 1 bedroom, 1
bathroom, a living room, and a dining room. He specified that their home has only 1
window and 1 door which causes poor ventilation and humid atmosphere in the house.
He verbalized that, “Para po kaming nasa oven kapag nasa loob ng bahay,
nakakasuffocate nga po eh, kaya lagi din po pawisin mga tao samin”.

They have a tricycle for transportation and source of income, and it takes 10 minutes
to get into the establishments such as public schools and grocery. However, it takes at
least 20 minutes before they reach the town center which has the clinics and hospitals.

PHYSICAL ASSESSMENT
General Survey:
The client is a male Filipino around 170 cm in height and 65 kg in weight. Appear well nourished
based on the computation of body mass index (BMI). The body parts are proportion and
symmetrical with no extremities or digits missing. No involuntary movement observed. Sexual
characteristics are evident as evidenced by the deep voice and leaner muscles. Walks smoothly
with an accurate foot placement. Posture appears to be in an erect and comfortable manner. No
sign of distress or pain. Alert and oriented to time, person, and place. Attends to questions politely.
No noted sign of jaundice, erythema, or cyanosis. Dry white spots are noted on the right cheek,
neck, and back

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 - Blood Pressure: 110/70 mmHg - Temperature: 36.9°
- Pulse Rate: 72 beats/minute - Respiratory Rate: 18 breaths/minute
- Oxygen Saturation: 98% - BMI: 22.5 kg/m2

Focused Physical Assessment:

Skin:
• Face, Back, Neck, and Right Cheek: Multiple hypopigmented macules (dry white spots)
noted.

DEVELOPMENTAL LEVEL
Erik Erickson’s Theory of Psychosocial Development
Stage/Age Period Psychosocial Stage Nursing Implications

Early Adulthood (19 - 40 Intimacy vs. Isolation. During
y/o) this stage, individuals form deep,
meaningful relationships and
connections with others. Failure to
do so may lead to feelings of
isolation and loneliness.
Intimacy refers to the ability to
form close, meaningful
relationships with others. It
involves sharing one's true self,
feelings, and experiences with
others, fostering emotional
connections and a sense of
belonging. On the contrary,
isolation signifies a failure to
establish deep connections and
relationships. It involves a sense of
loneliness, detachment, and a lack
of meaningful engagement with
others.
As people enter their early
adulthood phase of Intimacy vs.
Isolation, they can incline
towards either of these two
polar behavior models, which
can affect their social life and
psychological state.
Thus, assist early adults in
fostering meaningful
connections. Guide individuals
in developing communication
skills, educate on healthy
relationships, and encourage
social engagement to prevent
feelings of isolation.

Status: The client, despite facing the challenges of Tinea Versicolor,

continues to actively engage in social activities such as playing
Intimacy basketball, going to the gym, and spending time with friends. This
demonstrates a healthy pursuit of meaningful relationships and
connections, aligning with the psychosocial stage of Intimacy in early
adulthood.

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 OVERVIEW OF THE DISEASE

DEFINITION:

Tinea versicolor is a common, benign, superficial fungal infection of the skin that causes small,
discolored patches. Tinea versicolor is also called pityriasis versicolor. It’s caused by an
overgrowth of a type of yeast that naturally lives on your skin. Clinical features of tinea
versicolor include either hyperpigmented or hypopigmented finely scaled macules. It commonly
affects trunks, back, neck and shoulders. Tinea versicolor isn’t contagious, and most people
recover fully after treatment.

Some patches or spots can become scaly and dry. Over time, the patches get larger and start to
connect, covering larger areas of your skin. People with tinea versicolor develop white, yellow,
red, pink or brown spots. Hot weather, humidity and sun exposure can make tinea versicolor
worse.

Pityriasis versicolor occurs more frequently in adolescents and young adults probably due to the
increase of sebum production by the sebaceous glands which allow for a more lipid-rich
environment in which Malassezia can grow. Pityriasis versicolor affects men and
women equally and no specific ethnic predominance has been noted

reference: Tinea Versicolor: Symptoms, Causes & Treatments (clevelandclinic.org)

Tinea versicolor - Wikipedia

ETIOLOGY:

Tinea versicolor belongs to Malassezia-related diseases. The majority of tinea versicolor is

caused by the fungus Malassezia globosa although Malassezia furfur is responsible for a small
number of cases. Pityriasis versicolor is caused by Malassezia, a dimorphic lipophilic fungus,
also known as Pityrosporum. It is a component of normal skin flora.

SIGNS AND SYMPTOMS:

1. Patches of skin discoloration.

2. Spots that do not tan the way the rest of the skin does.
3. Mild itching.

4. Occasional fine scaling of the skin producing a very superficial ash-like scale.

5. Pale, dark tan, or pink in color, with a reddish undertone that can darken when the patient is
overheated, such as in a hot shower or during/after exercise. Tanning typically makes the affected
areas contrast severe with the surrounding skin.

STATISTICS & INCIDENCE

Global

- Tinea versicolor is a common disease, affecting nearly 1% of the general population. In the
authors' clinic, 1.4% of new patients are seen for tinea versicolor.

- It is more prevalent in tropical and humid climates, where it can affect up to 40% of people.
In mild or moderate climates, it affects about 1% of people.

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- Pityriasis versicolor has been reported worldwide, but it is more common in warm and humid
conditions. The prevalence is as high as 50% in tropical countries and as low as 1.1% in cold
climates such as Sweden

Reference: Tinea Versicolor - StatPearls - NCBI Bookshelf (nih.gov)

incidence of tinea versicolor globally - Search (bing.com)

Local

- Tinea versicolor is rampant among Filipinos. The true incidence of the condition is much
greater than the 2.1% incidence reported by SIMUANGCO 2 inasmuch as Filipinos, particularly
those belonging to the lower socio-economic classes, ignore this mild, superficial disorder and
do not seek medical help.

- Pityriasis versicolor has a worldwide distribution, but it is more common in tropical countries,
with prevalence ranging from 2.3% in the Philippines (Romero 1999) to 16.3% to 17.8% in
Malawi (Msyamboza 2012; Ponnighaus 1996)

- According to a study in Davao City, Philippines, tinea versicolor was the most common fungal
infection, with a prevalence of 25.34% among patients who consulted for skin problems

Reference: Interventions for the treatment of pityriasis versicolor - PMC (nih.gov)

Complications

- No permanent complication of tinea is seen

- Main complication is the skin discoloration: The fungus interferes with the normal skin
pigmentation, resulting in small and discolored patches. The main complication is the skin
discoloration that can persist for weeks after treatment because the melanocytes (skin color-
producing cells) require time to recover and properly pigment the skin.

- Tinea versicolor doesn’t cause any long-term complications or disorders

Reference: complications of tinea versicolor - Search (bing.com)

Risk factors of acquiring tinea versicolor:

Some risk factors for tinea versicolor include:

1. Hot and humid weather

2. Exposure to sunlight
2. Oily skin
3. Immunosuppression
4. Hormonal changes in the body; (most common in adolescent and early adulthood stage)

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 ANATOMY AND PHYSIOLOGY OF INTEGUMENTARY SYSTEM
The integumentary system is the largest organ of the body that forms a physical barrier between
the external environment and the internal environment that it serves to protect and maintain. (Kim,
J., & Dao, H. (2023). Physiology, Integumentary. StatPearls. Treasure Island (FL): StatPearls
Publishing.)

The major functions of the integumentary system:

1. Protection. The skin is the covering of the body. Though exposed to the external environment,
the skin’s structure reduces the negative and harmful effects of ultraviolet light. Acting as a barrier,
the skin also keeps microorganisms from entering the body and prevents dehydration by reducing
water loss.
2. Sensation. The integumentary system has sensory receptors that can detect heat, cold, touch,
pressure, and pain.
3. Temperature regulation. The skin plays a major role in regulating body temperature through
the modulation of blood flow through the skin and the activity of sweat glands; conserving or
releasing heat and helps maintain the body’s water and homeostatic balance.
4. Endocrine activity. The skin initiates the biochemical processes involved in Vitamin D
production. When exposed to ultraviolet light, the skin produces a molecule that can be
transformed into the hormonal form of vitamin D, an important regulator of calcium homeostasis.
5. Excretion. Small amounts of waste products are excreted through the skin and glands such as:
water, urea, and ammonia. Skin also releases products like sebum, sweat, and pheromones and
exerts important immunologic functions by secreting bioactive substances such as cytokines.

The integumentary system includes the skin and accessory structures, such as hair, nails, and
glands.
Skin: The skin, besides being the largest, is also the heaviest organ in the body. It weighs about
six pounds (or more) and is approximately 2 millimeters thick — thinner on sensitive areas like
eyelids, and thicker on surfaces that take more stress, like the soles of your feet. One inch of the
skin contains nearly 19 million cells. (Clevelandclinic.org (2022).)

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The skin is primarily made up of three layers. The upper layer is the epidermis, the layer below
the epidermis is the dermis, and the third and deepest layer is the subcutaneous tissue
(hypodermis).
Epidermis: The superficial layer of the skin, consisting of stratified squamous epithelial tissue
that further break down into four to five layers on thick skin like the palms and soles (stratum
basale, stratum spinosum, stratum granulosum, stratum lucidum, and stratum corneum, while in
other places, the epidermis only has four layers, lacking the stratum lucidum). The multiple cell
layers of the epidermis protects against the potential damage from abrasion on the skin’s surface.
In addition, the epidermis reduces water loss through the skin. (Lopez-Ojeda, W., Amarendra, P.,
Alhajj, M., Oakley, A.M. (2022). Anatomy, Skin (Integument). StatPearls [Internet]. Treasure
Island (FL): StatPearls Publishing)

Cells of Epidermis:
Melanocytes: Derived from neural crest cells and primarily produce melanin, which is responsible
for the pigment of the skin. UVB light stimulates melanin secretion which is protective against UV
radiation, acting as a built-in sunscreen. Melanin transferred to neighboring keratinocytes by
“pigment donation”; involves phagocytosis of tips of melanocyte processes by keratinocytes.
(Yousef, H., Alhajj, M., & Sharma, S. (2022). Anatomy, Skin (Integument), Epidermis.)
Keratinocytes: The predominant cell type of epidermis and originate in the basal layer, produce
keratin, and are responsible for the formation of the epidermal water barrier by making and
secreting lipids. Keratinocytes also regulate calcium absorption by the activation of cholesterol
precursors by UVB light to form vitamin D. (Yousef, H., Alhajj, M., & Sharma, S. (2022).
Anatomy, Skin (Integument), Epidermis.)

Langerhans’ cells: are the skins first line defenders and play a significant role in antigen
presentation. (Yousef, H., Alhajj, M., & Sharma, S. (2022). Anatomy, Skin (Integument),
Epidermis.)

Merkel’s cell: are oval-shaped modified epidermal cells found in stratum basale, directly above
the basement membrane. These cells serve a sensory function as mechanoreceptors for light touch,

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and are most populous in fingertips, though also found in the palms, soles, oral, and genital
mucosa. (Yousef, H., Alhajj, M., & Sharma, S. (2022). Anatomy, Skin (Integument), Epidermis.)

Dermis: A layer of connective tissue. The structure of the dermis is responsible for most of the
strength of the skin. It is also divided into two layers, the papillary dermis (the upper layer) and
the reticular dermis (the lower layer). (Lopez-Ojeda, W., Amarendra, P., Alhajj, M., Oakley, A.M.
(2022). Anatomy, Skin (Integument). StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing)

Accessory structures (hair, nails, and glands)

Hair: found everywhere on the skin except the palms, the soles, the lips, the nipples, parts of the
external genitalia, and the distal segments of the fingers and toes.

Nails: a thin plate consisting of layers of dead stratum corneum cells that contain a very hard type
of keratin.

Associated Glands: has several types of glands that secrete materials onto its surface; however,
not all are functional in all individuals. The major glands of the skin are the sebaceous glands and
the sweat glands.

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 INDEPENDENT NURSING MANAGEMENT

NURSING RATIONALE DONE

RESPONSIBILITIES

To build relationship and gain trust

Establish rapport to the client.
Explain the condition to the
client and provide assurance for
the non-contagious nature of the
condition.
Advise the client on the importance
Educated the client about
hygiene practices emphasizing
perspiration management.
Educated the client on how to
use the Dr. S. Wong’s sulfur
soap with moisturizer which is a
fungicide and Bioderm
Ointment, a topical medication
designed specifically for
hypopigmentation, and reducing the
managing hypopigmentation
conditions, provided by the
DepEd Nurse.
✓
of the client.
Emphasize the importance of
understanding the non-
transmissible aspect to alleviate
✓
concerns and fears and to
encourage participation in
addressing the problem.
of regular bathing and thorough
✓
drying to minimize the risk of
infections.
To maximize its therapeutic
benefits, promoting optimal skin
hygiene and medication's
✓
effectiveness in managing
fungal load on the skin.

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S

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 REFERENCES:

Brief Overview:
• https://www.ncbi.nlm.nih.gov/books/NBK441916/#:~:text=A%20%20%2C%20hysis%2
C%20weightfrom%20the%20primary%20progressive%20disease.
• https://www.ncbi.nlm.nih.gov/books/NBK567737/

Definition of Terms:
• httpshttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538277/ ://www.merriam
webster.com/dictionary
• VanPutte, C. L., & Seeley, R. R. (2014). Seeley's anatomy & physiology. New York, NY:
McGrawHill

Developmental Level:
• https://www.verywellmind.com/erik-eriksons-stages-of-psychosocial-development-
2795740
• Kozier & Erb’s Fundamentals of Nursing (11th ed., Vol. 1). (2022). Audrey Berman,
Shirlee Snyder, Geralyn Frandsen.

Anatomy and Physiology of The Affected System:

• VanPutte, C. L., & Seeley, R. R. (2014). Seeley's anatomy & physiology. New York, NY:
McGrawHill
• Kim, J., & Dao, H. (2023). Physiology, Integumentary. StatPearls. Treasure Island (FL):
StatPearls Publishing.
• Lopez-Ojeda, W., Amarendra, P., Alhajj, M., Oakley, A.M. (2022). Anatomy, Skin
(Integument). StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing
• Yousef, H., Alhajj, M., & Sharma, S. (2022). Anatomy, Skin (Integument), Epidermis

Overview of the Disease:

• Tinea Versicolor: Symptoms, Causes & Treatments (clevelandclinic.org)
Tinea versicolor - Wikipedia
• Tinea Versicolor - StatPearls - NCBI Bookshelf (nih.gov)
incidence of tinea versicolor globally - Search (bing.com)
• Interventions for the treatment of pityriasis versicolor - PMC (nih.gov)
• complications of tinea versicolor - Search (bing.com)

Pathophysiology
• https://www.researchgate.net/publication/42610384_Pathogenesis_of_dermatophytosis_a
nd_tinea_versicolor?fbclid=IwAR0CepAYc-Ein-2s49vqwOMh-
CJX0xlqaliZe8i4QHKmgMCIGELCAMRRuRs
• https://www.ncbi.nlm.nih.gov/books/NBK482500/
• https://my.clevelandclinic.org/health/diseases/17719-tinea-versicolor
• VanPutte, C. L., & Seeley, R. R. (2014). Seeley's anatomy & physiology. New York, NY:
McGrawHill
• Corwin, Elizabeth J. (2008) Handbook of Pathophysiology.
Nursing Management:

Nursing Care Plan:

• Kozier & Erb’s Fundamentals of Nursing (11th ed., Vol. 1). (2022). Audrey Berman,
Shirlee Snyder, Geralyn Frandsen.

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