Varied Presentations of Tinea Versicolor: Case 3 Papulosquamous Tinea Versicolor

A palpable papulosquamous, arciform chronic eruptionhad been present in a 70-year-old man for many years.The asymptomatic rash was in a "mantle" distribution--across the upper shoulders, neck, and back.A potassium hydroxide (KOH) preparation demonstratedthe short, clustered hyphae and spores ofMalassezia furfur. The condition responded to topicaleconazole.It is uncommon for tinea versicolor to be palpablyand overtly scaly. However, given the eruption's distribution,the presence of spores as well as hyphae on theKOH evaluation, the positive therapeutic response to appropriatetreatment, and the prevalence of this yeast infection,the diagnosis of tinea versicolor was undoubtedlycorrect.The differential diagnosis included epidermal nevusand tinea corporis. Epidermal nevus has a significant intradermalcomponent and is congenital, whereas tineaversicolor is epidermal and acquired. Tinea corporis istypically acute in onset and more inflammatory, but it canbe chronic.

(Case and photograph courtesy of Joe Monroe, PA-C.)