Pityriasis versicolor (overview) B36.0

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Pityriasis versicolor flava; Tinea versicolor

History
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Eichstedt 1846

Definition
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Frequent, non-inflammatory superficial mycosis (also known as tinea versicolor; note: the term "tinea" should, however, be reserved for dermaphytoses) occurring seasonally in the warm season and not transmissible from person to person, caused by lipophilic yeasts of the genus Malassezia. Remark: versicolor means "polychromy" and means the difference in colour in summer due to the lack of browning of the flock (see also Pityriasis versicolor alba).

Pathogen
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Malassezia species (14 Malassezia species have been identified); the prevalence of the different species varies from country to country. species. In India, for example, Malassezia globosa was the preferred species (> 90%), followed by Malassezia sympodialis, Malassezia furfur, Malassezia obtusa and Malassezia restricta. In Argentina, Malassezia sympodialis was found preferentially. Malassezia furfur is able to form pigments and fluorochromes with tryptophane (see wood light as detection method). Substances with UV-protective effect are formed, especially pityriacitrin. Explanation why sunburn rarely occurs in the pityriasis versicolor alba foci (in contrast to vitiligo).

Occurrence/Epidemiology
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In tropical zones 30-40% of adults are affected, in temperate zones about 1-4%.

Etiopathogenesis
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Contactivity is considered low to non-existent. Predisposing factors besides a tropical humid macroclimate are individual factors like hyperhidrosis oleosa, seborrhoea and impaired skin evaporation. Development of Malassezia species in a warm and humid environment rich in lipids. Individual factors are discussed.

Manifestation
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Occurs in adolescents, post-pubertal as well as younger adults (rather rare in older age).

Localization
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Mainly in the middle of the chest and back, spreading to the lateral parts of the trunk, also: navel region, inner sides of the thighs, inner sides of the upper arms.

Clinical features
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Overall variable image with partly large, figured, partly also small heart-shaped tinsel like yellow, yellow-brown or also grey or white, discreetly scaled, not itching (occasionally somewhat exciting) spots or thin plaques.

In summer, the foci appear lighter ( pityriasis versicolor alba) compared to the surrounding tanned skin, in winter darker.

An initially already clearly hyperpigmented form can be described as "pityriasis versicolor chromians". This form shows circumscribed to cent-sized, later confluent, dirty yellow to brownish, bran-like scaling foci.

Itching rarely occurs in pityriasis versicolor. S.a. shaving phenomenon.

Special forms:

Diagnostics
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Clinical picture is already diagnostic for the experienced person.

Fungus detection in the native adhesive tape preparation: A transparent strip of adhesive tape is firmly pressed onto suspicious skin changes and removed again. Adhering skin scales and fungal elements can be stained according to Parker after sticking the strip on (apply equal amounts of blue ink and caustic potash solution to the preparation) or examined directly under a microscope. Remark: Cultivation of the pathogens (yeasts of the genus Malassezia) is not recommended, as they only grow on special nutrient media. The pathogens are particularly suitable for a native examination. In contrast to dermatophytes and other yeast fungi, Malassezia spp. take up the ink immediately and stand out clearly marked in blue against the background.

Wood-light: Reddish or (greenish) yellow fluorescence (this is not regularly observed!).

Remark: A differentiation of the different types of wood. A differentiation of the different species is not necessary because of a lack of clinical relevance in everyday clinical use.

Histology
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In the PAS staining, detection of intracorneal spores and hyphae.

Differential diagnosis
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Vitiligo (mostly prominent, large white spots on the skin)

Pityriasis rosea (typical, usually prominent, exanthematic small lesions)

Tinea corporis (borderline, circulatory, scaly plaques)

Pseudoleukoderm (condition following preceding huaterosis, e.g. psoriasis)

Erythrasma (intertriginous localization; flat, homogeneous, non-edged, symptomless yellowish-red spot)

seborrhoeic eczematide (localized in the area of the seborrhoeic zones, circulatory plaques, edge accentuation possible; native detection in the Sellotape Abort Test negative)

External therapy
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In uncomplicated cases antimycotic alcoholic solutions.

Econazole: A solution containing Econazole(Epi-Pevaryl P.v. solution) has proved to be a good ready-to-use drug. This solution is rubbed onto the wet body for 3-5 minutes on 3 consecutive evenings after showering. Rinse off in the morning after overnight exposure.

Important: An antifungal therapy of the capillitium is recommended at the same time: A shampoo containing ketoconazole(e.g. Terzolin) is particularly suitable; shampoo for 5 minutes.

Alternative: Ciclopirox: Effective is a combination of 2 different shampoos. Active ingredients e.g. Ciclopirox and zinc pyrithione (e.g. Kelual DS -Shampoo® 2 bottles of 100 ml: shampoo the breast, head and back and let it work for 5 minutes. At the beginning of the therapy, daily applications for 5 days, then 1 x per week).

Alternatively: 2.5% selenium disulphide (Selsun Shampoo®), lather the whole integument including capillitium, leave to act for 5 minutes, rinse off. Followed by an antimycotic cream.

Alternative: Among the own recipes 20% propylene glycol as well as a 2-5% salicylic acid skin spirit R218 (as prophylactic) have proven to be effective.

Internal therapy
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  • In case of frequent recurrences or in case of resistance to the usual procedures, an internal therapy should be used.
  • Itraconazole (e.g. Sempera) 200 mg/day p.o. for 5-7 days or once a month 400 mg p.o.
  • Alternatively: Ketoconazole (e.g. Nizoral) 1 time per day 200 mg p.o. for 10 days or 1 time per month 400 mg p.o.
  • Alternative: Fluconazole once/day 50 mg p.o. for 14 days p.o. for 2-4 weeks.
  • Note: Systemic Terbinafine is not effective!

Progression/forecast
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Chronic course. Exacerbation and remission are possible at any time.

Prophylaxis
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For prevention: Itraconazole 2 times/day 200 mg p.o. 1 time per month for 6 months.

Note(s)
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Pregnancy: Still problematic; only the polyene antifungal drug Nystatin, which is approved for pregnancy and lactation, is suitable for local therapy. Clotrimazole should not be applied in early pregnancy. However, it can be used for local therapy after the 1st trimester.

Also the papillomatosis confluens et reticularis is treated by various doctors. Also the papillomatosis confluens et reticularis is considered by various authors as a clinical variant of pityriasis versicolor.

In atopic dermatitis a trigger effect by Malassezia-species is assumed. Especially the atopical dermatitis in the face, neck and neck area (head-neck dermatitis) may benefit from an antimycotic external therapy.

The term "tinea versicolor" should be reserved for dermatophytoses.

Literature
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  1. Brasch J (2012) News on diagnostics and therapy of mycoses. Dermatologist 63: 390-395
  2. Crespo Erchiga V et al (2000) Malassezia globosa as the causative agent of pityriasis versicolor. Br J Dermatol 143: 799-803
  3. Eichstedt E (1846) Mushroom formation in the pityriasis versicolor. Frorip New notes from the field of natural medicine Heilkinde 39: 270
  4. Gaitanis G et al (2006) Distribution of Malassezia species in pityriasis versicolor and seborrhoic dermatitis in Greece. Typing of the major pityriasis versicolor isolate M. globosa. Br J Dermatol 154: 854-859
  5. Gupta AK et al (2003) Pityriasis versicolor. Dermatol Clin 21: 413-429
  6. Gupta AK (2002) Pityriasis versicolor. J Eur Acad Dermatol Venereol 16: 19-33
  7. Hu SW et al (2010) Pityriasis versicolor: a systematic review of interventions. Arch Dermatol 146: 1132-1140
  8. Ljubojevic S et al (2002) The role of Malassezia furfur in dermatology. Clin Dermatol 20: 179-182
  9. Nenoff P et al (2001) The yeast fungus Malassezia: pathogen, pathogenesis and therapy. dermatologist 52: 73-86
  10. Vander Straten MR et al (2003) Cutaneous infections dermatophytosis, onychomycosis, and tinea versicolor. Infect Dis Clin North Am 17: 87-112

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Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020