Pityriasis Versicolor

Bipin Poudel
 Pityriasis versicolor
• Also known as Tinea versicolor

• A common, benign, superficial cutaneous fungal infection

• Usually characterized by hypo/hyper pigmented macules and patches on

neck,chest and back

• Infection is localized to the stratum corneum

 Etiology
• Causative Agent: Malassezia furfur and Malassezia globosa

• Lipophillic, dimorphic fungus

• Formerly known as Pityrosporum ovale

• Commensals of normal skin in areas rich in sebaceous glands

• In clinical stage found in both yeast(spore) and filamentous(hyphae) stage

 Risk factors

• Genetic predisposition
• High temperature, humid environment
• Immunocompromised state
• Malnutrition
• Application of oily preparation
• Corticosteroids usage
• Cushing disease
 Pathogenesis

Malassezia furfur

Transform into mycelial form in hot & humid

condition

Releases azelaic acid

Inhibits melanin production

Hypopigmented macules
 Clinical Features

• Hypopigmented (less commonly erythematous or hyperpigmented)

scaly perifollicular macules

• Frequently coalesce; perifollicular character of lesions retained at the

periphery
 Pityriasis Versicolor

A. Perifollicular, hypopigmented macules with branny scales. Lesions have coalesced in center, but discrete and
distinct prefollicular at periphery. C. Perifollicular lesions
 Clinical Features

• Surmounted with branny

scales which can be
accentuated, by scratching
lesion gently with help of a
glass slide
Sites of Predilection

• Upper trunk, often

spreading to neck and
upper arm
 Other Manifestations of M. furfur

• Malassezia folliculitis
• Adolescents and young adults
• Characterized by follicular papules often surmounted by pustules
• On trunk and chest
 Investigations
• KOH mount
• Mixture of short,
branched hyphae and
spores described as

“spaghetti and meat

ball” appearance
• Wood’s lamp
• Yellow fluorescence
 Diagnosis

• Hypopigmented (sometimes hyperpigmented), perifollicular macules

that become confluent. Lesions appear to be sitting on the skin.

• Branny scales, accentuated by scratching with glass slide.

• Upper trunk and neck.

• KOH mount confirmatory

 Differential Diagnosis

• Vitiligo

• Leprosy

• Pityriasis rosea
 Treatment

• Though the fungal infection is controlled easily, the hypopigmentation

often persists

• Topical agents
• Systemic agents
 Topical Agents

• Azole antifungals
• Ketoconazole, 2% applied daily for 1-4 weeks

• Selenium sulphide
• 2.5% lotion in a detergent base, used weekly for 4 weeks
• Can cause irritation (so used diluted 1:1 with water)
 Systemic Agents

• Needed in extensive lesions or when recurrences are frequent

• Fluconazole 300 mg once weekly for 2 weeks

• Itraconazole 200 mg once daily for 5 days

• Ketoconazole 400 mg SOS

 Prevention

• Maintenance therapy
• Weekly with topical agents
• Monthly with systemic agents
 Reference

• Illustrated synopsis of Dermatology and Sexually Transmitted Diseases, Neena Khanna, 6th Edition

• Clinical Dermatology by Thomas Habif, 6th Edition

• FitzPatrick’s Color Atlas and Synopsis of Clinical Dermatology, 7th Edition

• ABC of Dermatology, 6th Edition