Tinea versicolor (TV), a superficial yeast infection of the skin, is caused by Pityrosporon orbiculare, a normal scalp organism. Obesity, pregnancy, and a warm, moist environment may predispose a person to this infection.
The disease may show up as white, tan, or brown spots on the skin. The back, chest, and upper arms are most frequently involved, but other areas may be affected. Frequently, it is first noticed after the skin is tanned, because the color difference is then obvious. The yeast may interfere with the normal tanning process and therefore, the skin may look pale in the affected areas. Usually there are no symptoms or only mild itching.
Untreated, TV may persist for many years. Thorough scrubbing of the skin followed by a mild fungicide will usually control the infection, but the skin may not return to its normal color for a number of months. Sun exposure will eventually retan the affected skin. In addition, most patients who have tinea versicolor will experience relapses.
There are various therapies for TV, and no one of them is perfect for all patients.
- Selenium sulfide suspension (Selsun, not Selsun Blue) has been the standard therapy for years. It should be massaged into the skin from the neck down covering all areas, allowed to dry, and remain on for 10-15 minutes, after which is washed off in a shower. Some people clear after as little as two weeks of treatment. After the first two weeks, Selsun may be reapplied weekly or every other week in a similar fashion.
- Imidazole creams and lotions (Miconazole, Clotrimazole, Econazole, and Ketoconazole, and others) are effective when reasonably small area are involved. They should be rubbed in once or twice daily to the affected areas for three to four weeks.
- In patients with very intense disease, oral Ketoconazole is quite effective in eradicating the infection. This is not for every patient, because of possible serious, but very infrequent, side effects. An informed patient may decide to use this drug after appropriate blood tests are done. Recurrences are the rule, however.