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Pityriasis Versicolor

Pityriasis versicolor is a common fungal infection of the skin caused by Malassezia furfur and M. globosa yeasts. It presents as hypopigmented or hyperpigmented macules on the upper trunk that become scaly. Diagnosis is made clinically but can be confirmed with KOH mount showing spaghetti and meatball appearance or positive wood's lamp fluorescence. Treatment involves topical or oral antifungal agents like ketoconazole or selenium sulfide. Recurrences are common in hot humid climates so maintenance therapy may be needed.

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Rahul Srivastava
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349 views21 pages

Pityriasis Versicolor

Pityriasis versicolor is a common fungal infection of the skin caused by Malassezia furfur and M. globosa yeasts. It presents as hypopigmented or hyperpigmented macules on the upper trunk that become scaly. Diagnosis is made clinically but can be confirmed with KOH mount showing spaghetti and meatball appearance or positive wood's lamp fluorescence. Treatment involves topical or oral antifungal agents like ketoconazole or selenium sulfide. Recurrences are common in hot humid climates so maintenance therapy may be needed.

Uploaded by

Rahul Srivastava
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd

Pityriasis Versicolor

Bipin Poudel
Pityriasis versicolor
• Also known as Tinea versicolor

• A common, benign, superficial cutaneous fungal infection

• Usually characterized by hypo/hyper pigmented macules and patches on


neck,chest and back

• Infection is localized to the stratum corneum


Etiology
• Causative Agent: Malassezia furfur and Malassezia globosa

• Lipophillic, dimorphic fungus

• Formerly known as Pityrosporum ovale

• Commensals of normal skin in areas rich in sebaceous glands

• In clinical stage found in both yeast(spore) and filamentous(hyphae) stage


Risk factors

• Genetic predisposition
• High temperature, humid environment
• Immunocompromised state
• Malnutrition
• Application of oily preparation
• Corticosteroids usage
• Cushing disease
Pathogenesis

Malassezia furfur

Transform into mycelial form in hot & humid


condition

Releases azelaic acid

Inhibits melanin production

Hypopigmented macules
Clinical Features

• Hypopigmented (less commonly erythematous or hyperpigmented)


scaly perifollicular macules

• Frequently coalesce; perifollicular character of lesions retained at the


periphery
Pityriasis Versicolor

A. Perifollicular, hypopigmented macules with branny scales. Lesions have coalesced in center, but discrete and
distinct prefollicular at periphery. C. Perifollicular lesions
Clinical Features

• Surmounted with branny


scales which can be
accentuated, by scratching
lesion gently with help of a
glass slide
Sites of Predilection

• Upper trunk, often


spreading to neck and
upper arm
Other Manifestations of M. furfur

• Malassezia folliculitis
• Adolescents and young adults
• Characterized by follicular papules often surmounted by pustules
• On trunk and chest
Investigations
• KOH mount
• Mixture of short,
branched hyphae and
spores described as

“spaghetti and meat


ball” appearance
• Wood’s lamp
• Yellow fluorescence
Diagnosis

• Hypopigmented (sometimes hyperpigmented), perifollicular macules


that become confluent. Lesions appear to be sitting on the skin.

• Branny scales, accentuated by scratching with glass slide.

• Upper trunk and neck.

• KOH mount confirmatory


Differential Diagnosis

• Vitiligo

• Leprosy

• Pityriasis rosea
Treatment

• Though the fungal infection is controlled easily, the hypopigmentation


often persists

• Topical agents
• Systemic agents
Topical Agents

• Azole antifungals
• Ketoconazole, 2% applied daily for 1-4 weeks

• Selenium sulphide
• 2.5% lotion in a detergent base, used weekly for 4 weeks
• Can cause irritation (so used diluted 1:1 with water)
Systemic Agents

• Needed in extensive lesions or when recurrences are frequent

• Fluconazole 300 mg once weekly for 2 weeks

• Itraconazole 200 mg once daily for 5 days

• Ketoconazole 400 mg SOS


Prevention

• Maintenance therapy
• Weekly with topical agents
• Monthly with systemic agents
Reference

• Illustrated synopsis of Dermatology and Sexually Transmitted Diseases, Neena Khanna, 6th Edition

• Clinical Dermatology by Thomas Habif, 6th Edition

• FitzPatrick’s Color Atlas and Synopsis of Clinical Dermatology, 7th Edition

• ABC of Dermatology, 6th Edition

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