How to Diagnose and Treat Tinea Versicolor

Published September 17th, 2021 by Chris Riley
Fact Checked by
Jacqueline Hensler
Medically Reviewed:
Dr. Angel Rivera

What is tinea versicolor? | Causes | Diagnosis | Treatment | Prevent

Tinea versicolor is a common skin infection that causes red, scaly patches on the chest, back, or neck. You may also see flaky white spots in these areas. There are many possible causes for this condition including poor hygiene such as wearing dirty clothing, excessive sweating such as from exercise, or even from an allergic reaction. The good news is there are treatments available for tinea versicolor, even if you have sensitive skin. We’ll discuss what tinea versicolor is and how to diagnose and treat it. 

What is tinea versicolor?

Tinea versicolor, also called pityriasis versicolor, is a fungal infection that causes discoloration of the skin. The most common symptom of tinea versicolor is discoloration of skin color to white or light brown scaly patches on the body, but it can also cause darkening and thickening of the affected areas as well as itching, scaling, redness, and inflammation. It will often look like a spotty rash on your body. 

Fungi are usually the main culprits for tinea versicolor, in particular, Malassezia globosa and  Malassezia restricta, which are both a type of yeast. These fungi are naturally found on the skin in moderate numbers, but they grow rapidly when conditions, such as overhydration and excessive moisture, become favorable.

What causes tinea versicolor?

The main cause of tinea versicolor is an overgrowth of these yeast fungi that get trapped inside pores and hair follicles clogged with sebum, sweat, and keratin debris. When this happens underneath areas where clothing touches the body, like armpits or groin, or folds like between toes, the heat can make these yeasts multiply even further. The fungus feeds off of dead skin cells and oil secretions from your body which leads to red patches all around affected areas rather than just a solid patch somewhere else on the body.

There are several factors that contribute to contracting tinea versicolor including excess heat and humidity, sweating, oily skin, an impaired immune system caused by certain medications like birth control pills or anti-seizure drugs. There may be a genetic predisposition as the condition often runs in families, although there is very little information regarding the hereditary aspect of it. This condition affects people who have darker complexions more than those with lighter coloration. It is most commonly found on the back, chest, and neck.

How do you diagnose tinea versicolor?   

You can check for tinea versicolor by looking at your skin under light and checking if it has the telltale signs: whitish patches on dark skin, yellow or brownish patches on pale skin, and red spots around affected areas. The scales of this infection usually look like tiny flakes that are dry and flaky, but they sometimes feel greasy to touch as well. If any other symptoms appear with these patchy changes such as itching or discomfort then you should go see a doctor right away. 

Tinea versicolor can be diagnosed by a physical examination during a potassium hydroxide test which causes tinea versicolor to turn white. Or it can be diagnosed through other laboratory tests done to confirm an infection of the skin. Doctors can also take samples of skin cells from affected areas to test against antifungal agents which reveals whether or not they're yeast fungi that may cause tinea versicolor in particular. Another method of diagnosing this infection includes examining scrapings under a microscope because their shape resembles grains of sand more so than other types of fungal infections. If these tests come back negative for yeast fungi and tinea versicolor then you should be tested for ringworm as well.

If the yeast fungi are present in high numbers then there may be some accompanying itching too, which tends to be more severe during nighttime hours when humidity levels are high. The fungi can also affect areas of the skin which are in contact with clothing, like underarms or groin area, and this is another reason why it's important to see a health professional if you notice any symptoms.

How do you treat tinea versicolor?

After your diagnosis, you’ll want to treat the condition. Tinea versicolor is treated topically by applying antifungals directly to the skin, either in a cream or lotion form. Oral forms, such as pills, may also be used for treatment. The most common topical treatments are selenium sulfide shampoo which can be purchased over-the-counter at pharmacies or ketoconazole solution applied twice daily for one week. It usually takes two weeks of treatment before symptoms of tinea versicolor begin improving. If tinea versicolor recurs frequently despite standard therapy, oral terbinafine or other medications may be used instead because it has greater efficacy than other treatments. These treatments work best when they are applied to all areas of the body where tinea versicolor lesions appear, including in and around nails and scalp hair. If you have diabetes, HIV/AIDS, kidney disease, or cancer treatment, anti-fungal medication will not work as well for treating tinea versicolor because it's harder for your body to absorb those medications so they may need to prescribe something stronger like Sporanox, another antifungal medication. 

Please consult your healthcare professional about which treatments will work best for you. 

How can you prevent tinea versicolor?

The best prevention strategy recommended is to maintain good hygiene and keep the affected area as dry as possible, especially after bathing. People with tinea versicolor are also advised to wear loose clothing made of natural fibers such as cotton. Synthetic materials like nylon trap moisture against the skin which can worsen symptoms. Wearing a hat when going outside in summer may reduce sun exposure on areas where scales have formed and also help prevent outbreaks from occurring again. Be mindful to prevent sweat accumulation under hats and helmets as it can lead to irritation of the scalp and spread of infection. It is important for those experiencing frequent recurrence to avoid triggers such as heat stress, sweating excessively, alcohol consumption, hormonal changes during puberty and menstruation, or pregnancy because these factors can exacerbate the condition. If you experience tinea versicolor frequently or before puberty, consult your healthcare professional about whether long-term preventative treatment with oral antifungals may be appropriate.

Summary

Tinea versicolor is a fungal infection that causes light brown, scaly patches on the skin with areas of hypopigmentation, or white discoloration. Tinea versicolor is caused by a yeast fungus that is normally on the skin but can cause problems under the right conditions; namely, with excess moisture and humid weather. Treatment for tinea versicolor includes topical antifungals such as selenium sulfide shampoo that are purchased over-the-counter at pharmacies or ketoconazole solution applied twice daily for one week to reduce symptoms associated with the infection. Oral terbinafine medication may also be prescribed if standard treatment does not work because it has greater efficacy than other treatments. Prevention of tinea versicolor includes maintaining good hygiene and keeping the affected area as dry as possible especially after bathing and wearing loose clothing made from natural fibers such as cotton to reduce the risk of recurrence. Should you have any further questions about tinea versicolor, please contact your physician or dermatologist to learn which treatments are best for you.

Sources: 

Mayo Clinic – Symptoms and causes

American Academy of Dermatology Association – Tinea versicolor: Diagnosis and Treatment 

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