Tinea Versicolor in 30-Year-Old Woman

Although tinea versicolor is fairly common, its appearance on the face and neck is unusual, notes Robert P. Blereau, MD of Morgan City, La. His patient, a 30-year-old woman, exhibits the pale, rounded, fine-scaled lesions typically found on tanned or dark-skinned persons.

The eruption is dark brown on the white skin of a 21-year-old man, the patient of Drs Eric J. Lewis and Charles E. Crutchfield III of Minneapolis, but it may also appear as a lighter or pinkish brown on light skin-thus, the term "versicolor." The superficial infection is caused by a yeastlike fungus, Pityrosporum orbiculare or Pityrosporum ovale (previously known as Malassezia furfur and Malassezia ovalis, respectively). The diagnosis can be confirmed by examining a potassium hydroxide preparation of skin scrapings. The classic microscopic appearance of hyphae and grapelike clusters of spores is known as the "spaghetti and meatballs" pattern.

Tinea versicolor is generally asymptomatic but may be mildly pruritic. It most often occurs on the central chest and back, although the entire trunk and the arms may be involved. The many topical medications used include a 2.5% suspension of selenium sulfide, 25% sodium thiosulfate, zinc pyrithione shampoo, and antifungal creams (eg, miconazole, clotrimazole, econazole, ciclopirox, and ketoconazole). Oral treatments include ketoconazole (a single 400-mg dose, repeated in 1 week, or 200 mg daily for 5 to 10 days), itraconazole (200 mg daily for 5 days), and fluconazole (a single 400-mg dose).