Tinea Versicolor Fungal Infection

The non-contagious fungal rash of tinea versicolor is a chronic, asymptomatic superficial infection characterized by light scaly, macular patches. These patches range in color from light pink to deep tan to a darker brown. Although the name suggests a variety of colors, the hue of all patches is about the same on each individual.

The areas involved are usually restricted to between the chin and the waist, on the trunk and arms, sometimes to the wrist. Facial involvement is rare, except on darker skin. The rash may be mildly itchy, especially when perspiring, but most people are bothered most by its unsightliness. Involved untreated areas are usually hypopigmented patches that appear significantly lighter than the surrounding skin, especially where perspiration occurs first and most often, i.e. the upper back and chest. A simple wood’s light exam performed in a dark room on uncleansed skin will show intensified pigmentary changes and allow the extent and margins to be easily observed. Infected areas usually appear yellowish gold to greenish yellow-gold in fluorescence.

Tinea versicolor is caused by the organism pityrosporum orbicular (Malassezia). It is seen mostly in young adults living in temperate climates and accounts for about five percent of all fungal infections. The fine scales of tinea versicolor are teeming with “hype” and “spores”.

Factors predisposing a clinical infection:

• Pregnancy
• Genetic predisposition
• Underlying disease
• Patients taking systemic corticosteroids
• Hot and humid climate
• An active lifestyle that includes exercise, perspiration and occlusive workout wear

Tinea versicolor can infect people for years because of inconsistent treatment and re-infection. Tinea versicolor is unique because it produces hypopigmented lesions that lack skin color. The fungus produces an enzymatic reaction that interferes with melanin production in the affected areas. Sun exposure makes it look worse.

Tinea versicolor may be treated in a variety of ways, some of which may prove successful if used diligently for a prolonged period of time. The problem is that most topical methods are messy, tedious, frustrating and time-consuming. People often give up, and choose to “live with it” rather than undergo the often-unsuccessful standard treatment protocols.

In the past, application of of anti-fungal preparations or dandruff shampoos were prescribed follow an exfoliating bath. Though infection sometimes cleared up, re-infection was common, and pigmentary changes took months to resolve.

Medically-prescribed Treatments for Tinea Versicolor

• Dandruff preparations: Zinc pyrithione, selenium sulfide suspension, sodium hyposulfite 25%, or Tinver Lotion (25% sodium thiosulfate, 1% salicylic acid, 10% alcohol) applied to lesions twice a day for fourteen days.
• Anti-fungal creams: Lamisil® (terbinafine), Lotrimin® (clotrimazole), Monistat-Derm® (miconazole), Halotex® (holoprogin), Tinactin® (tolnaftate) and topical prescription Nizoral® (ketoconazole) preparations applied to lesions 2 to 3 a day for fourteen days.
• Topical retinoids: Applied twice a day for two weeks, retinoids can exfoliate tinea versicolor spores and help to resolve the pigmentary changes, but is prohibitively expensive since many insurance companies will not cover the use of Retin-A® and generic retinoid topicals for this purpose.
• Oral anti-fungal meds: Systemic anti-fungal drugs (Lamisil® and Nizoral®) promise up to a 90 percent “temporary” cure rate. These potent broad-spectrum anti-fungal agents are useful in the treatment of a stubborn fungal infections. However, intermittent use of oral anti-fungal medications to control a chronic fungal infection is extremely dangerous because it can lead to liver toxicity. Because of this risk, they should be utilized as a one-time last resort in the most serious, treatment-resistant cases only. And even then, re-infection often occurs.

Alternative Approach for Tinea Versicolor

1. Cleansing twice daily and immediately after perspiring with an exfoliant like a mandelic acid wash or sulfur soap (both of which are anti-fungal ingredients) and a net sponge to exfoliate the uppermost fungus-infected epidermal cells.
2. Applying an over-the-counter anti-fungal topical (Lamisil Gel®, terbinafine, etc.)
3. Applying an alpha hydroxy acid (mandelic, lactic and/or glycolic) body product to the entire affected area (and massage all the way in) 10 minutes after the topical anti-fungal is applied. This will help (a) the anti-fungal product penetrate into the deeper cell layers and (b) soften and exfoliate fungus-infected skin cells.

This routine must be performed consistently to achieve results and prevent recurrence. Don’t wear occlusive clothing like spandex, nylon jogging suits, and clothing made from silk, polyester and synthetic materials. If you can’t shower immediately after perspiring, change into a clean cotton T-shirt laundered in fragrance-free detergent without fabric softener. Results take time and diligence, but are safe and effective.

©2016 Kathryn Khadija Leverette and katleverette.com

The material on this website is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment.