Tinea versicolor

Last updated: December 13, 2022

Summarytoggle arrow icon

Tinea versicolor (pityriasis versicolor) is a benign superficial skin infection that occurs most often in young adults during hot and humid weather and is most commonly caused by the fungi Malassezia globosa and Malassezia furfur. The infection is characterized by finely scaling, hypopigmented or hyperpigmented macules on the trunk and/or chest. Patients often become aware of the disease after sun exposure because the lesions do not tan and become more visible against the recently tanned surrounding skin. Diagnosis is commonly made clinically but can be confirmed with the spaghetti-and-meatballs pattern of the hyphae and spores on KOH preparation of skin scrapings. Antifungal topical medications such as selenium sulfide and ketoconazole are considered first-line treatment. Oral fluconazole and itraconazole may be considered for those with severe, widespread, or refractory disease. Lesions will resolve completely over time, but recurrences are common.

Tinea versicolor, despite its name, is not caused by dermatophytes. See dermatophyte infections for more information.

Epidemiologytoggle arrow icon

  • Occurs worldwide, with a higher incidence in tropical climates
  • More prevalent in healthy individuals 21–30 years of age [1]

Epidemiological data refers to the US, unless otherwise specified.

Etiologytoggle arrow icon

Pathophysiologytoggle arrow icon

Clinical featurestoggle arrow icon

  • Round, well-demarcated macules that reveal a fine, subtle scale with gentle scraping that can coalesce into patches (which may have irregular shapes)
  • Colors vary (hypopigmented, hyperpigmented, or erythematous skin lesions)
  • Lesions do not tan in the sunlight, because of which they are more commonly noticed in the summer.
  • Milder pruritus (compared to dermatophyte infections)
  • Common sites are the trunk and chest, but the neck, abdomen, upper arms, and thighs may also be affected.

Patients often become more aware of the lesions after exposure to sunlight because the surrounding skin tans while the lesions do not.

Diagnosticstoggle arrow icon

Differential diagnosestoggle arrow icon

The differential diagnoses listed here are not exhaustive.

Treatmenttoggle arrow icon

See “Treatment of tinea versicolor” for agents and dosages.

Prognosistoggle arrow icon

  • The lesions will resolve without any permanent changes within 1–2 months of therapy.
  • Recurrences are common and treatment may need to be repeated intermittently.

Referencestoggle arrow icon

  1. M M Selim, K Kubec. Pityriasis Versicolor--Epidemiological and Therapeutical Study. Mycoses. 1989.
  2. Marks JG Jr, Miller JJ . Lookingbill and Marks' Principles of Dermatology. Saunders Elsevier ; 2013
  3. Vimal Prajapati, P. Régine Mydlarski. Answer: Can you identify this condition?. Canadian Family Physician. 2008.
  4. James WD, Berger T, Elston D. Andrews' Diseases of the Skin: Clinical Dermatology. Elsevier Health Sciences ; 2015
  5. Tinea versicolor. Updated: October 31, 2016. Accessed: May 3, 2017.

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