A. Pityriasis versicolor (tinea versicolor) most commonly presents as small perifollicular, scaly, hypopigmented or hyperpigmented patches on the upper trunk in young adults. The perifollicular patches expand over time and become confluent.
B. In tinea versicolor, fungus does not grow in standard fungal culture media (eg, Sabouraud's dextrose), but KOH examination shows the abundant "spaghetti and meatballs" pattern of short hyphae and round spores. Pityrosporon ovale is part of the normal flora of skin in amounts that are not detectable on KOH examination. It is a yeast infection, and it is not a dermatophyte infection.
C. Effective topical treatment consists of selenium sulfide 2.5% lotion (Exsel, Selsun) applied overnight once a week for 3 weeks. Topical antifungal creams may also be used.
1. Miconazole (Micatin); apply to affected areas bid; 2% cream.
2. Clotrimazole (Lotrimin), apply to affected area bid for up to 4 wk; cream: 1% [15, 30, 45, 90 gm],1% lotion.
3. Ketoconazole (Nizoral) apply to affected area(s) qd-bid; 2% cream.
D. Effective systemic treatment consists of fluconazole (Diflucan), 400 mg, or ketoconazole (Nizoral), 400 mg, given as a single dose.
E. Relapses are very common. Prophylactic therapy, once weekly to monthly, with topical or oral agents should be encouraged if relapses occur.
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