Pityriasis Versicolor

What is Pityriasis Versicolor?

Pityriasis versicolor, also referred to as tinea versicolor, is a common fungal (a yeast) skin infection that affects the skin surface. It appears as distinct areas of finely scaly discoloured skin, varying from white/pink to red/brown. The condition generally requires treatment. Changes in skin colour usually take weeks to months to clear, and commonly it recurs despite effective treatment. Pityriasis versicolor is not contagious.

Can I get treatment online?

The Online Clinic can prescribe treatment for pityriasis versicolor online following short consultation. Please complete the consultation form to begin.

Who gets Pityriasis Versicolor?

Pityriasis versicolor more commonly occurs in hot and humid climates of the world, and in summer in Europe’s temperate climate. Prevalence varies widely from less than 1% of the population in temperate countries to 40% in tropical countries. The condition affects both men and women of all ethnicities, most of whom are healthy. It especially affects adolescents and young adults, since during that age period the skin’s sebaceous glands increase production of oily sebum on to the skin.

What causes Pityriasis Versicolor?

Pityriasis versicolor is caused by a yeast (a type of fungus) known as Malassezia, that normally lives on the human skin. Malassezia lives on the lipids (fats) provided in the sebum secreted by the skin’s sebaceous glands. It usually does not cause problems, but some conditions allow Malassezia to change its form and grow.

Who is at risk of Pityriasis Versicolor?

Several factors increase the risk of pityriasis versicolor, including:

• Age, with adolescents and young adults mostly affected (young children and adults aged over 65 years are less commonly affected)
• Oily skin
• Hot/warm and humid climates
• Excessive sweating
• Hormone changes in the body
• A weakened immune system due to certain conditions (e.g., diabetes) or immunosuppressant medicines (e.g., corticosteroids)
• Malnutrition

What are the signs and symptoms of Pityriasis Versicolor?

Pityriasis versicolor presents as discoloured, oval patches on the skin. These can range in colour from white/pink to red/brown, and can be lighter or darker than the normal skin colour. Patches on naturally lighter skin tend to be more obvious in summer as they do not tan. The patches have subtle scales and are usually itchy. They can also merge, and cover large areas of the body. However, patches are usually without symptoms and do not cause permanent scarring. Pityriasis versicolor tends to occur on the upper body, (areas rich in sebaceous glands), often spreads to the neck, upper arms, and abdomen, and can affect other areas such as scalp, face (children), arm pits, groin, and upper legs.

How is Pityriasis Versicolor diagnosed?

Usually, a diagnosis of pityriasis versicolor is made on examination of the skin only, based on the changes in skin colour and fine scales of the affected areas. Occasionally, when the diagnosis is unclear, it is confirmed by a skin scraping of the patches. The skin scraping is pretreated with potassium hydroxide and examined under a microscope. Groups of yeast cells and their branches (hyphae) can be seen. The hyphae and yeast cell groups are sometimes referred to as having a ‘spaghetti and meatballs’ appearance. The skin may also be examined under ultraviolet light using a Wood lamp, where pityriasis versicolor is seen as a yellow-orange fluorescence.

Other conditions that have similar clinical features to pityriasis versicolor include vitiligo, other forms of pityriasis (tinea), guttate psoriasis, and seborrheic dermatitis.

How is Pityriasis Versicolor treated?

Pityriasis versicolor usually requires treatment. Treatment is effective, but it may take two to three months for the skin pigmentation to return to normal once the yeast has been eradicated. The condition can recur, particularly when the climate is hot or warm and humid.

Topical antifungal medicines that are applied to the skins surface are used initially for pityriasis versicolor. These antifungal treatments can either:

• Remove dead skin and stop further yeast invasion of the skin, such as selenium sulphide 2.5% and pyrithione zinc, or
• Kill the yeast, such as an imidazole (ketoconazole 2%, clotrimazole, and econazole) and terbinafine 1%

When a large area of the body is affected, an antifungal shampoo is generally used for up to a week. These are lathered and left on the skin for several minutes before rinsing off well. If a small area of skin is affected, then creams (used for two to three weeks) may be preferred. The most common treatment used is ketoconazole that can be applied as a foaming shampoo or a cream.

Pityriasis versicolor often comes back. To prevent recurrence, ketoconazole shampoo can be used for up to six months. When recurrence occurs in hot/warm humid climates, ketoconazole shampoo can be used for a few days before exposure as a preventative measure.

When the first topical antifungal treatment fails to resolve pityriasis versicolor, the diagnosis may be confirmed by a skin scraping and a second topical antifungal agent used. Oral antifungal medicines may be offered when pityriasis versicolor is difficult to treat and recurs. Oral treatments include a short course of itraconazole or fluconazole.

How can a person with Pityriasis Versicolor help themselves?

As pityriasis versicolor naturally occurs on the skin, it may be difficult to prevent overgrowth of the yeast from first occurring or from coming back. Measures that may help if you have or have been effectively treated for pityriasis versicolor, include:

• Avoiding over-heating, sweating and sun exposure by wearing loose cool clothing
• Avoiding tanning by limiting skin exposure to the sun (cover up), wearing a non-oily, high protection factor sunscreen, and by not using sun lamps
• Not using oily skin care products
• Using an anti-dandruff shampoo containing selenium

References

American Academy of Dermatology. Tinea Versicolor. 2023.
Available from: https://www.aad.org/public/diseases/a-z/tinea-versicolor-overview.

BMJ Best Practice. Pityriasis versicolor. Last reviewed 20 September 2023.
Available from: https://bestpractice.bmj.com/topics/en-gb/861.

Hudson A, Sturgeon A, Peiris A. Tinea Versicolor. JAMA. 2018;320(13):1396. doi:10.1001/jama.2018.12429

Karray M, McKinney WP. Tinea Versicolor. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
Available from: https://www.ncbi.nlm.nih.gov/books/NBK482500/.

National Institute for Health and Care Excellence. Pityriasis versicolor. Last revised July 2022.
Available from: https://cks.nice.org.uk/topics/pityriasis-versicolor/.