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The non-contagious fungal rash of tinea versicolor is a chronic, asymptomatic superficial infection characterized by light scaly, macular patches. These patches range in color from light pink to deep tan to a darker brown. Although the name suggests a variety of colors, the hue of all patches is about the same in any one individual.
The areas involved are usually restricted to between the chin and the waist, on the trunk and arms, sometimes to the wrist. Facial involvement is rare except in blacks. The rash may be mildly itchy, especially when perspiring, but most people are bothered most by its unsightliness. Involved untreated areas are usually hypopigmented patches that appear significantly lighter than the surrounding skin, especially where perspiration occurs first and most often, i.e. the upper back and chest. A simple wood’s light exam performed in a dark room on uncleansed skin will show intensified pigmentary changes and allow the extent and margins to be easily observed. Infected areas usually appear yellowish gold to greenish yellow-gold in fluorescence.
Tinea versicolor is caused by the organism Pityrosporum orbicular. It is seen mostly in young adults living in temperate climates and accounts for about five percent of all fungal infections. The fine scales of tinea versicolor are teeming with “hype” and “spores”.
Factors predisposing a clinical infection:
- Pregnancy
- Genetic predisposition
- Underlying disease
- Patients taking systemic steroids
- Hot and humid climate
- An active lifestyle that includes exercise, perspiration and occlusive workout wear
Tinea versicolor can infect people for years because of inconsistent treatment and re-infection. Tinea versicolor is unique because it produces hypopigmented lesions that lack skin color. The fungus produces an enzymatic reaction that interferes with melanin production in the affected areas.
Tinea versicolor may be treated in a variety of ways, some of which will be successful if used diligently for a prolonged period of time and continued after clearing is achieved. Topical treatment methods can be messy, tedious, frustrating and time-consuming. People often give up, and choose to “live with it” rather than undergo daily treatment protocols. Though these infections sometimes clear up, re-infection is common, and pigmentary changes can take weeks or months to resolve.
Common medically-prescribed treatment methods:
- Dandruff preparations: Zinc pyrithione, selenium sulfide suspension, sodium hyposulfite 25%, or Tinver Lotion (25% sodium thiosulfate, 1% salicylic acid, 10% alcohol) applied to lesions twice a day for fourteen days.
- Anti-fungal creams: Lamisil® (terbinafine), Lotrimin® (clotrimazole), Monistat-Derm® (miconazole), Halotex® (holoprogin), Tinactin® (tolnaftate) and topical prescription Nizoral® (ketoconazole) preparations applied to lesions 2 to 3 a day for fourteen or more days.
- Topical retinoids: Applied twice a day for two weeks, retinoids help exfoliate tinea versicolor spores and help to resolve the pigmentary changes, but are prohibitively expensive since most insurance companies won’t cover them for this purpose.
- Oral anti-fungals: Systemic anti-fungal drugs (Lamisil® and Nizoral®) promise up to a 90 percent “temporary” cure rate. These potent broad-spectrum anti-fungal agents are useful in the treatment of most stubborn fungal infections. However, intermittent use of oral anti-fungals to control a chronic fungal infection is dangerous because it can lead to liver toxicity. Because of this risk, they should be utilized as a one-time last resort in the most serious, treatment-resistant cases only. Even then, re-infection often occurs.
Alternative approach:
- Cleansing twice daily and immediately after perspiring with a sulfur soap and a net sponge to exfoliate the uppermost fungus-infected epidermal cells
- Applying a natural anti-fungal body spray after cleansing and sweating
- Applying an over-the-counter anti-fungal topical (Lamisil Gel® or the generic terbinafine work best)
- Applying an alpha hydroxy acid (mandelic, lactic and/or glycolic acid, with or without brighteners) body product to the entire affected area (and massage all the way in) 10 minutes after the topical anti-fungal is applied. This will help (a) the anti-fungal product penetrate into the deeper cell layers, (b) soften and exfoliate fungus-infected skin cells and (c) help brighten any hyperpigmented (darker) areas.
This routine must be performed consistently to achieve results and prevent or slow down recurrence. Avoid wearing occlusive clothing like spandex, nylon jogging suits, and clothing made from silk, polyester and synthetic materials. If you can’t shower immediately after perspiring, apply a coat of anti-fungal cream or gel, then change into a clean cotton T-shirt laundered in fragrance-free products. Results take a lot of time, diligence and patience.
Individual results may vary and require compliance to corrective home care products, diligent sun protection, professional treatments, and important lifestyle changes, all of which must be monitored and maintained on a longterm basis.
©2013-2016 Kathryn Khadija Leverette. Reprinted with permission.
The material on this website is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment.
