Figure 14-8. Tinea versicolor on the chest. The dark areas of the skin are infected with the fungus. (K.U.M.C.; Sandoz Pharmaceuticals)
Tinea versicolor is a moderately common skin eruption with characteristics of tannish-colored, irregularly shaped scaly patches causing no discomfort that are usually located on the upper chest and back. It is caused by a lipophilic yeast (see Chap, 19). Dry scaling can be revealed-by stroking the skin with a fingernail
PRIMARY LESIONS. Papulosquamous or maculosquamous, tan, and irregularly shaped lesions occur.
SECONDARY LESIONS. Relative depigmentation results because the involved skin does not tan when exposed to sunlight. This cosmetic defect, obvious in the summer, often brings the patient to the office.
DISTRIBUTION. The upper part of the chest and the back, neck, and arms are affected. Rarely are the lesions on the face or generalized. COURSE. The eruption can persist for years unnoticed. Correct treatment is readily effective, but the tinea usually recurs. CAUSE. The causative agent is a lipophilic yeast, Pityrosporum orbiculare, which has a hyphae form called Pityrosporum or Malassezia furfur. CONTAGIOUSNESS. The disease is not contagious and is not related to poor hygiene.
LABORATORY FINDINGS. A scraping of the scale placed on a microscopic slide, covered with a 20% solution of potassium hydroxide and a coverslip, shows the hyphae. Under the low-power lens of the microscope, very thin, short, mycelial filaments are seen. Diagnostic grape-like clusters of spores are seen best with the high-power lens. The appearance of spores and hyphae is referred to as "spaghetti and meatballs." The dimorphic organism does not grow on routine culture media.
Pityriasis rosea: Acute onset; lesions oval with collarette of fine adherent dry scale (see earlier in this chapter)
Seborrheic dermatitis: Greasy scales in hairy areas, mainly (see Chap 13)
Mild psoriasis: Thicker scaly lesions on trunk and elsewhere (see earlier in this chapter)
Vitiligo: Because tinea versicolor commonly manifests with depigmentation of the skin, many cases have been called vitiligo. This is indeed unfortunate because tinea versicolor is quite easy to treat and has a much better prognosis than vitiligo (see Chap.,2,4)
Secondary syphilis: Lesions are more widely distributed and present on palms and soles (see Chap 16)
Selenium (Selsun or Head and Shoulders Intensive Treatment) suspension 120.0
Sig: Bathe and dry completely. Then apply medicine as a lotion to all the involved areas, usually from neck down to pubic area. Let it dry. Bathe again in 24 hours and wash off the medicine. Repeat procedure again at weekly intervals for four treatments.
Comment: Recurrences are rather common and can be easily retreated. May be irritating.
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