Definition

Pityriasis versicolor (PV) or tinea versicolor, is a skin condition caused by the Malassezia fungi that affects the outer layer of the skin. This fungus typically does not pose health risks and exists in normal quantities on the skin's surface. Excessive growth of this fungus due to some factors could lead to skin discoloration.

PV is marked by small skin patches. Due to the fungus' metabolic processes, the patches may vary in color (white, reddish, or dark) on some skin parts. PV is commonly found in the torso and shoulder regions. Sunlight exposure may accentuate the visibility of the patches. PV is neither painful nor contagious, but it can have emotional impacts by reducing self-confidence and causing anxiety in those affected.

PV typically develops predominantly in hot and humid regions. In tropical countries, the incidence rate is approximately 50%, while in cold-temperature countries like Sweden, it is 1.1%. PV typically develops during adolescence and early adulthood. It is believed to result from increased sebum production by the sebaceous glands, creating a lipid-rich skin environment conducive to enhanced Malassezia growth and proliferation.

Causes

Pityriasis versicolor is caused by Malassezia fungal infection, a fungus that thrives on fats on the skin. Malassezia is a component of the skin's natural flora. The precise reason why this fungus can lead to pityriasis versicolor in specific individuals remains uncertain. Researchers have identified 14 species of Malassezia.  The leading causes of Pityriasis Versicolor identified are Malassezia furfur, Malassezia globosa, and Malassezia sympodialis.

Risk factor

Identifying many risk factors is crucial in the prevention and management of PV. Anyone is susceptible to developing PV, and some risk factors could influence the likelihood of experiencing it in the future.

Some of the risk factors include:

• Family history of PV
• High temperatures
• humid environment
• Having an oily skin type
• Certain hormonal fluctuations
• An immunocompromised state, particularly due to:
• Using specific drugs
• Organ transplant history
• Experiencing illnesses like HIV/AIDS or cancer
• Malnutrition
• Applying oily creams or moisturizers
• Pregnancy

Symptoms

If you have PV, you may notice the following symptoms:

• Discolored patches of skin may manifest as paler, redder, or darker lesions than the adjacent healthy skin
• Skin patches typically manifest on the back, chest, neck, and upper arm regions
• Skin issues may come with slight itchiness

Skin lesions will appear as white patches (hypopigmentation) on people with dark skin, while on people with light skin, the patches may appear darker (hyperpigmentation). Areas of skin affected by PV may have thin scales on the patches.

Diagnosis

Doctors usually diagnose tinea versicolor by conducting a detailed physical examination and medical interview with the patient. During the examination, the doctor will observe the characteristic patches on the skin affected by PV. In some cases, doctors may use additional diagnostic tests to assist them in diagnosing PV.

Several of these diagnostic tests consist of the following:

• Skin scrapings are used to evaluate tissue samples
• Using a special light (Wood's lamp) to examine the skin lesions
• Skin biopsy procedure

The diagnosis of PV is because it requires special treatment. If you or anybody in your family has ever had PV, you should let your doctor know. When the patient initially sees the doctor, details like the onset of symptoms will help the doctor diagnose and decide on the best course of action.

Management

Treating PV properly is essential. Treatment options for this condition include shampoos, ointments, creams, or antifungal medicines. Appropriate therapy may help the skin discoloration affected by PV revert to normal. It could take a few weeks to months for the treatment to effect and give the desired outcomes.

On PV, a variety of antifungal ointments can be used. First, wash the affected skin under running water and allow it to dry. Then, apply the topical medicine to the affected area 1-2 times daily for at least two weeks.

Doctors may prescribe oral medications if the skin lesions expand more widely and there are no notable changes after the first treatment. Fluconazole, itraconazole, or ketoconazole are a few antifungal medicines that doctors can prescribe to treat PV.

Furthermore, anti-dandruff shampoos with selenium sulfide or ketoconazole can be applied to the scalp, allowed to sit for ten minutes, and then rinsed under running water.

Complications

The primary complication of PV is skin hyperpigmentation in the affected area. The skin discoloration could take a significant amount of time post-treatment. Since melanocyte cells require time to resume functioning and produce the typical skin pigment, restoring skin color to its original state may take some time.

Patients with a normal immune system typically do not experience major complications, such as systemic invasions to certain organs. Patients with compromised immune systems may develop secondary folliculitis from mild scratching.

Prevention

Once you have found certain risk factors that you possess, the following step is to improve your modifiable risk factors. Here are the actions you can do:

• Choose garments with high sweat absorption
• Avoid heavy sweating, especially if you have a history of PV
• Avoid prolonged exposure to sunlight
• Avoid very heated air
• Utilize anti-dandruff shampoo every month to aid in the prevention of pityriasis versicolor, particularly on the scalp
• Avoid using skincare products with high oil content
• Remember to adhere to your prescribed medication treatment

If you have never consulted a doctor before, it is advisable to undergo a general check-up. If any health issues are identified that could raise your chances of having this condition, it is recommended to initiate treatment promptly to prevent it from worsening.

When to see a doctor?

If you have persistent symptoms on your skin that are spreading and the lesions are becoming bigger, it is advisable to consult a dermatologist. The doctor will conduct an interview that will ask you various questions, perform a physical examination, and certain diagnostic tests if needed, to identify the precise diagnosis and give suitable treatment to you.

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