EpistemisPityriasis versicolor
Specialty: Skin.
Why it occurs
- Proliferation of lipophilic yeasts of the genus *Malassezia* (mainly *Malassezia globosa* and *Malassezia furfur*) that are part of the normal skin flora and change to their pathogenic mycelial phase under predisposing conditions
- Hot and humid climates that favor sweating and sebum production
- Production of azelaic acid by yeast, which competitively inhibits melanocyte tyrosinase, giving rise to hypopigmented macules
- Chronic use of body oils or systemic corticosteroids that alter local skin immunity.
Initial workup
Clinical diagnosis supported by the visualization of fine peeling on scraping (fingernail sign). Wood light examination reveals yellow-orange or pale gold fluorescence characteristic of active lesions. Direct KOH examination showing the typical “spaghetti and meatballs” image (short hyphae and clustered round spores).
red flags
Presence of severe generalized peeling that is difficult to control and does not respond to multiple cycles of topical and systemic antifungals in a patient with suspected underlying immunodeficiency or decompensated diabetes mellitus.
Standard management
- Selenium sulfide 2.5% in shampoo — applied to affected areas for 10-15 minutes before showering for 7-10 days
- Ketoconazole 2% in bath gel — topical application with similar method for 5 consecutive days
- Fluconazole — systemic antifungal indicated for extensive or recurrent forms, dose of 300 mg once a week orally for 2 to 3 weeks
- Itraconazole (systemic alternative, dose of 200 mg orally daily for 5 to 7 days).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Skin
- Listed causes
- 4
- Treatment options
- 4