Introduction:
Tinea versicolor is one of the superficial fungal infections and it is caused by the yeast Malassezia. Malassezia species include Malassezia furfur and Malassezia globosa. This organism is a normal commensal of the body and it becomes manifest in humid weather, during stress or when there are immnocompromised states such as diabetes mellitus, malnutrition, pregnancy, cancers or HIV/AIDS. I found out that a lot of Nigerians refer to this condition as ‘eczema’. This is incorrect as eczema is a different disease entity in dermatology.
Epidemiology:
Though it can occur at any age, it is commonly seen among young adults. One of the reasons will be increased sebaceous activity in them. No sex predilections.
Signs and Symptoms:
It is usually asymptomatic, rather, areas of hypopigmented macules (light discoloration of the skin) and if they coalesce, patches are seen which sometimes are extensive. The lesions might appear slightly scaly. It usually involves the scalp, face, back and trunk. Other areas include the pubis and the intertriginous areas.
Laboratory Investigations:
Skin scrapings done for microscopy will show the fungal hyphae with a lot of spores hence the name ‘spaghetti and meat balls’ appearance. Wood’s lamp can also be used where it gives characteristic yellow/orange fluorescence. Other investigations will be as indicated, based on possible predisposing condition.
Differential Diagnosis:
There are other conditions that can give whitish to brownish discoloration of the skin and this must be ruled out. Good clinical acumen is of essence. They include seborrheic dermatitis, vitiligo, Hansen’s disease, secondary syphilis and pityriasis rosea.
Management:
Patient education is an essential aspect of management. For him/her to know it can be aggravated in humid conditions and with stress. Also, following treatment, it takes a while for the skin to return to its initial colour. Repigmentation can be aided by exposure to sunlight. Use of steroid containing creams must be avoided by the patient as this can also aggravate the condition and make it less responsive to treatment. Drugs of choice include:
1. 2.5% selenium sulphide shampoo. This is applied for about 10 minutes on involved areas and washed off. Frequency of use will be as prescribed by the dermatologist.
2. 2% ketoconazole shampoo. This is applied in similar way as the first.
3. Topical antifungals that can be used include clotrimazole, miconazole and ketoconazole.
4. Oral antifungals are indicated when there is extensive involvement or if patient is not responding to topical creams. These include itraconazole and fluconazole tablets.
Conclusion:
In conclusion, Tinea versicolor is a common fungal infection especially among young adults. It is not ‘eczema’ or necessarily due to poor hygiene as widely thought in the environment. Rather, our humid condition causes proliferation of the Mallasezia species which is ordinarily a normal commensal of the body. Following treatment, clinical evidence might not be seen for another 3 - 4 weeks. And lastly, maintenance therapy is usually indicated to prevent recurrence.
Reference
References:
Prawer S, et al., Superficial Fungal Infections, in Clinical Dermatology, 1st ed, Mc Graw Hill Education, 2013, p.83.