Editing Tinea versicolor

{{Short description|Skin disease}}
{{Distinguish|pityriasis rosea}}
{{Infobox medical condition (new)
| name            = Tinea versicolor
| synonyms        = Dermatomycosis furfuracea,<ref name="Bolognia" /> pityriasis versicolor,<ref name="Bolognia" /> tinea flava,<ref name="Bolognia">{{cite book |author=Rapini, Ronald P |author2=Bolognia, Jean L. |author3=Jorizzo, Joseph L |title=Dermatology: 2-Volume Set |publisher=Mosby |location=St Louis |year=2007 |pages=Chapter 76 |isbn=978-1-4160-2999-1 }}</ref> lota
| image           = Tinea versicolor1.jpg
| width           = 255
| caption         =
| pronounce       =
| field           = [[Dermatology]]
| symptoms        =
| complications   =
| onset           =
| duration        =
| types           =
| causes          = Malassezia globosa, Malassezia furfur
| risks           =
| diagnosis       =
| differential    =
| prevention      =
| treatment       =
| medication      =
| prognosis       =
| frequency       =
| deaths          =
}}
'''Tinea versicolor''' (also '''pityriasis versicolor''') is a condition characterized by a skin eruption on the trunk and proximal extremities.<ref name="Bolognia" />  The majority of tinea versicolor is caused by the fungus ''[[Malassezia globosa]]'', although ''[[Malassezia furfur]]'' is responsible for a small number of cases.<ref name="ReferenceA">{{cite journal |author=Morishita N |author2=Sei Y. |title=Microreview of pityriasis versicolor and ''Malassezia'' species |journal=Mycopathologia |date=December 2006 |volume=162 |issue=6 |pages=373–76 |doi=10.1007/s11046-006-0081-2|pmid=17146580 |s2cid=30397515 }}</ref><ref>{{cite journal |author=Prohic A |author2=Ozegovic L. |title=''Malassezia'' species isolated from lesional and non-lesional skin in patients with pityriasis versicolor |journal=Mycoses |date=January 2007 |volume=50 |issue=1 |pages=58–63 |doi=10.1111/j.1439-0507.2006.01310.x|pmid=17302750 |s2cid=25493290 }}</ref> These [[yeasts]] are normally found on the [[human skin]] and become troublesome only under certain conditions, such as a warm and humid environment, although the exact conditions that cause initiation of the disease process are poorly understood.<ref name="ReferenceA"/><ref name="Weedon, D 2002">{{cite book |author=Weedon, D. |year=2002 |title=Skin pathology |edition=2nd |publisher=Churchill Livingstone |isbn=0-443-07069-5 }}</ref>

The condition pityriasis versicolor was first identified in 1846.<ref name="pmid17642908">{{cite journal |vauthors=Inamadar AC, Palit A |title=The genus ''Malassezia'' and human disease |journal=Indian J Dermatol Venereol Leprol |volume=69 |issue=4 |pages=265–70 |year=2003 |pmid=17642908 |url=http://www.ijdvl.com/text.asp?2003/69/4/265/4990 |access-date=2013-12-26 |archive-date=2024-02-24 |archive-url=https://web.archive.org/web/20240224181528/https://ijdvl.com/issue/2003-69-4/ |url-status=live }}</ref>  Versicolor comes from the Latin ''{{lang|la|versāre}}'' 'to turn' + ''color''.<ref>{{cite encyclopedia |title=versicolor |encyclopedia=Collins English Dictionary — Complete & Unabridged 10th Edition |publisher=HarperCollins Publishers |url=http://dictionary.reference.com/browse/versicolor |access-date=March 2, 2013 |archive-date=October 18, 2012 |archive-url=https://web.archive.org/web/20121018034222/http://dictionary.reference.com/browse/versicolor |url-status=live }}</ref>

It is commonly referred to as Peter Elam's disease in many parts of South Asia.<ref name="PMC4030364">{{cite journal |vauthors=Kaushik A, Pinto HP, Bhat RM, Sukumar D, Srinath MK |title=A study of the prevalence and precipitating factors of pruritus in pityriasis versicolor |journal=Indian Dermatology Online Journal |volume=5 |issue=2 |pages=223–224 |year=2014 |doi=10.4103/2229-5178.131141 |pmid=24860771 |pmc=4030364 |doi-access=free }}</ref>

==Signs and symptoms==
[[File:Pityriasis versicolor frontal retouche.jpg|thumb|right|Pityriasis versicolor commonly causes [[hypopigmentation]], visible in people with dark skin tones.]]
[[File:Malassezia spores 2.jpg|thumb|upright=1.2|Pityriasis versicolor in a man and electron micrograph of his skin showing round ''[[Malassezia]]'' spores (S)<ref>{{cite book |doi=10.5772/61850 |isbn=978-953-51-2252-4 |chapter=Observation of Fungi, Bacteria, and Parasites in Clinical Skin Samples Using Scanning Electron Microscopy |author=Ran Yuping |title=Modern Electron Microscopy in Physical and Life Sciences |editor=Janecek, Milos |editor2=Kral, Robert |publisher=InTech |year=2016|s2cid=53472683 }}</ref><!-- This is content from a predatory publisher (intechopen.com); recommend finding an alternative source for a comparable image, but I hesitate to remove the image at this time. -->]]
The signs of this condition include:
* Occasional fine scaling of the skin producing a very superficial ash-like scale
* 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 more starkly with the surrounding skin.<ref>{{cite web|url=http://tineaversicolor.us/whattoavoid.html|archive-url=https://web.archive.org/web/20130727011050/http://tineaversicolor.us/whattoavoid.html|title=What to Avoid While Treating Tinea Versicolor|access-date=2013-01-05|archive-date=2013-07-27|url-status=dead}}</ref>
* Sharp border<ref name="dermnetnz.org">[http://www.dermnetnz.org/fungal/pityriasis-versicolor.html Pityriasis versicolor | DermNet New Zealand] {{Webarchive|url=https://web.archive.org/web/20160718170132/http://www.dermnetnz.org/fungal/pityriasis-versicolor.html |date=2016-07-18 }}. Dermnetnz.org. Retrieved on 2016-10-14.</ref>

Pityriasis versicolor is more common in hot, humid climates or in those who sweat heavily, so it may recur each summer.<ref name="dermnetnz.org"/>  <!-- Sometimes severe "pin-prick" itching in the affected areas; usually when the person's body temperature is elevated by exercise or a hot/warm environment, but the person hasn't started sweating yet. Once sweating begins the "pin-prick" itching subsides.{{Citation needed|date=June 2008}} – dubious, ?OR - needs good 2nd source citation else remove  -->

The yeasts can often be seen under the microscope within the lesions and typically have a so-called "spaghetti and meatball appearance"<ref name="urlAdolescent Health Curriculum - Medical Problems - Dermatology - Papulosquamous Lesions (B4)">{{cite web |url=http://www.usc.edu/student-affairs/Health_Center/adolhealth/content/b4derm4.html |title=Adolescent Health Curriculum – Medical Problems – Dermatology – Papulosquamous Lesions (B4) |access-date=2008-12-10 |archive-date=2008-11-28 |archive-url=https://web.archive.org/web/20081128071221/http://www.usc.edu/student-affairs/Health_Center/adolhealth/content/b4derm4.html |url-status=dead }}</ref> as the round yeasts produce filaments.

In people with dark skin tones, pigmentary changes such as [[hypopigmentation]] (loss of color) are common, while in those with lighter skin color, [[hyperpigmentation]] (increase in skin color) is more common. Because infected skin tans less than uninfected skin, resulting in uneven tanning, the term "sun fungus" is sometimes used.<ref name="urlTioconazole (Topical Route) - MayoClinic.com">{{cite web |url=http://www.mayoclinic.com/health/drug-information/DR601345 |title=Tioconazole (Topical Route) – MayoClinic.com |access-date=2008-12-10 |archive-date=2014-01-01 |archive-url=https://web.archive.org/web/20140101201307/http://www.mayoclinic.com/health/drug-information/DR601345 |url-status=live }}</ref><ref>{{Cite web |last=Lehrer |first=Michael |access-date=2024-05-15 |title=Tinea Versicolor (Pityriasis Versicolor) |url=https://www.cedars-sinai.org/health-library/diseases-and-conditions/t/tinea-versicolor-pityriasis-versicolor.html |website=Cedars Sinai Health Library}}</ref>

==Pathophysiology==
In cases of tinea versicolor caused by the fungus ''[[Malassezia furfur]]'', [[Hypopigmentation|lightening]] of the skin occurs due to the fungus's production of [[azelaic acid]], which has a slight bleaching effect.<ref name=Vary2015>{{cite journal|author=Vary JC Jr|title=Selected Disorders of Skin Appendages – Acne, Alopecia, Hyperhidrosis|journal=The Medical Clinics of North America|volume=99|issue=6|pages=1195–1211|date=November 2015|pmid=26476248|doi=10.1016/j.mcna.2015.07.003}}</ref>

==Diagnosis==
[[File:Tinea Versicolor (Wood's Lamp).JPG|thumb|right|Tinea versicolor fluorescence under [[Black light|Wood's lamp]]]]
Tinea versicolor may be diagnosed by a [[potassium hydroxide]] (KOH) preparation and lesions may fluoresce copper-orange when exposed to [[Wood's lamp]] (UV-A light).<ref name="Athlete">{{cite journal|last1=Likness|first1=LP|title=Common dermatologic infections in athletes and return-to-play guidelines.|journal=The Journal of the American Osteopathic Association|date=June 2011|volume=111|issue=6|pages=373–379|pmid=21771922|doi=10.7556/jaoa.2011.111.6.373|doi-access=free}}</ref>
The [[differential diagnosis]] for tinea versicolor infection includes:{{citation needed|date=June 2017}}
* [[Progressive macular hypomelanosis]]
* [[Pityriasis alba]]
* [[Pityriasis rosea]]
* [[Seborrheic dermatitis]]
* [[Erythrasma]]
* [[Vitiligo]]
* [[Leprosy]]
* [[Syphilis]]
* Post-inflammatory hypopigmentation

==Treatment==
Treatments for tinea versicolor include:
* [[Topical]] [[Antifungal drug|antifungal medications]] containing [[Selenium disulfide|selenium sulfide]] are often recommended.<ref name="Athlete"/> [[Ketoconazole]] ([[Nizoral]] ointment and shampoo) is another treatment.  It is normally applied to dry skin and washed off after 20 minutes, repeated daily for two weeks.{{citation needed|date=May 2020}} [[Ciclopirox]] (ciclopirox olamine) is an alternative treatment to ketoconazole, as it suppresses growth of the yeast ''Malassezia furfur''. Initial results show similar efficacy to ketoconazole with a relative increase in subjective symptom relief due to its inherent anti-inflammatory properties.<ref>{{cite journal |vauthors=Ratnavel RC, Squire RA, Boorman GC |title=Clinical efficacies of shampoos containing ciclopirox olamine (1.5%) and ketoconazole (2.0%) in the treatment of seborrhoeic dermatitis |journal=J Dermatolog Treat |volume=18 |issue=2 |pages=88–96 |year=2007 |pmid=17520465 |doi=10.1080/16537150601092944|s2cid=34852507 }}</ref> Other topical antifungal agents such as [[clotrimazole]], [[miconazole]], [[terbinafine]], or [[zinc pyrithione]] can lessen symptoms in some patients.<ref>{{cite journal|title = Management of Seborrheic Dermatitis and Pityriasis Versicolor|last = Faergemann|first = Jan|journal = [[Am. J. Clin. Dermatol.]]|year = 2000|volume = 1|issue = 2|pages = 75–80|pmid = 11702314|doi = 10.2165/00128071-200001020-00001|s2cid = 43516330}}</ref> Additionally, [[hydrogen peroxide]] has been known to lessen symptoms and, on certain occasions, remove the problem, although permanent scarring has occurred with this treatment in some people.{{Citation needed|date=June 2009}} Clotrimazole is also used combined with selenium sulfide.{{citation needed|date=February 2023}}
* Oral medications are viewed as a second-line of treatment for pityriasis versicolor in the event of widespread, severe, recalcitrant or recurrent cases. Systemic therapies include [[itraconazole]] (200&nbsp;mg daily for seven days) and [[fluconazole]] (150 to 300&nbsp;mg weekly dose for 2 to 4 weeks) that are preferred to oral ketoconazole which is no longer approved due to its potential hepatotoxic side effects.<ref name="Karray McKinney 2021 p. ">{{citation | last1=Karray | first1=M | last2=McKinney | first2=WP | title=Tinea Versicolor | chapter=article-30211 | publisher=StatPearls Publishing | publication-place=Treasure Island (FL) | year=2021 | pmid=29494106 | url=http://www.ncbi.nlm.nih.gov/books/NBK482500/ | access-date=2021-08-07 | page= | archive-date=2021-10-17 | archive-url=https://web.archive.org/web/20211017171015/https://www.ncbi.nlm.nih.gov/books/NBK482500/ | url-status=live }}[[File:CC-BY icon.svg|50px]] Text was copied from this source, which is available under a [https://creativecommons.org/licenses/by/4.0/ Creative Commons Attribution 4.0 International License] {{Webarchive|url=https://web.archive.org/web/20171016050101/https://creativecommons.org/licenses/by/4.0/ |date=2017-10-16 }}.</ref> The single-dose regimens and [http://medical-dictionary.thefreedictionary.com/pulse+therapy pulse therapy] regimens can be made more effective by having the patient exercise 1–2 hours after the dose, to induce sweating. The sweat is allowed to evaporate, and showering is delayed for a day, leaving a film of the medication on the skin.<ref>[http://www.fpnotebook.com/ID/Pharm/Ktcnzl.htm Ketoconazole] {{Webarchive|url=https://web.archive.org/web/20210128022806/https://fpnotebook.com/ID/Pharm/Ktcnzl.htm |date=2021-01-28 }}. Fpnotebook.com. Retrieved on 2016-10-14.</ref>

==Epidemiology==
This skin disease commonly affects [[adolescent]]s and young adults, especially in warm and humid climates. The yeast is thought to feed on skin oils ([[lipid]]s), as well as dead skin cells. Infections are more common in people who have [[Seborrhoeic dermatitis|seborrheic dermatitis]], [[dandruff]], and [[hyperhidrosis]].<ref name="Weedon, D 2002"/>

== References ==
{{Reflist}}

== External links ==
* {{Commons category-inline|Tinea versicolor}}

{{Diseases of the skin and appendages by morphology}}
{{Mycoses}}
{{Medical resources
|  DiseasesDB     = 10071
|  ICD10          = {{ICD10|B|36|0|b|35}}
|  ICD9           = {{ICD9|111.0}}
|  ICDO           =
|  OMIM           =
|  MedlinePlus    = 001465
|  eMedicineSubj  = derm
|  eMedicineTopic = 423
|  MeshID         = D014010
}}
{{Authority control}}

{{DEFAULTSORT:Tinea Versicolor}}
[[Category:Mycosis-related cutaneous conditions]]
[[Category:Animal fungal diseases]]
[[Category:Papulosquamous disorders]]