Last reviewed by Editorial Team on August 13th, 2018.
Pityriasis versicolor is an yeast infection that occurs at the level of the skin, leaning to the appearance of patches that are flaky and discolored (especially in the chest and back area). The patches can be of different colors, hence the versicolor addition to the pityriasis term (used to describe the patches). This condition is also presented as tinea versicolor, even though the term tinea is often restricted to the fungal infections caused by dermatophytes.
It should be noted that this condition is more common in young adults, affecting men in a larger percent than women. However, it can affect people of all ages, including children, teenagers and middle-aged adults. Studies have shown that this condition is more often encountered in climates that are rather hot and humid, the number of cases being reduced in climates that are cool and dry. It also affects those who have a predisposition to excessive sweating. The patches on the skin usually disappear in the winter, only to reappear in the summer. Several members of the same family can present this condition, even though it is not transmittable from one person to the other. It is estimated that one in ten people present this condition.
Pityriasis Versicolor Symptoms
These are the most common symptoms of pityriasis versicolor:
- Flaky patches appear on the trunk, neck and arms (other locations on the body are uncommon)
- The patches can have different colors – brown, copper, pink (sometimes they are paler than the surrounding skin) and also a sharp, well-defined border
- The patches that are paler in color commonly appear in dark-skinned individuals (condition known as pityriasis versicolor alba)
- The patches can evolve, changing their color from brown to white (they can also go from scaly to non-scaly, as they enter a new stage)
- The patches can also develop in a gradual manner, becoming adjoined and forming a larger patch with the passing of time
- Mild itchiness can be present in certain patients
- Even if the patient presents these patches on the skin (pale or dark, the color does not matter), this does not make the skin in the respective area more prone to sunburns
The main cause that leads to the appearance of pityriasis versicolor is a fungal infection, caused by the fungi from the Malassezia genus. These are microorganisms that are commonly found on the skin but, certain conditions such as excess humidity, can stimulate their overgrowth. Even though 14 different species of such fungi have been identified, it seems that only 3 are commonly involved in the appearance of the pityriasis versicolor: Malassezia globosa, Malassezia restricta and Malassezia sympodialis. A change in the metabolism might also be incriminated in the overgrowth of these fungi.
This condition might appear at the same time with seborrheic dermatitis, both being caused by microorganisms from the Malassezia genus. The risk for both pityriasis versicolor and seborrheic dermatitis is increased in those who have a natural oily skin. It is important to mention that this condition is not in any way caused by poor or inadequate hygiene. Also, it cannot be transmitted from one person to the other, as all people present these microorganisms on their skin.
These are the most common treatments recommended for patients diagnosed with pityriasis versicolor:
- For mild cases – topical antifungal agents
- Propylene glycol solution
- Selenium sulfide
- Sodium thiosulphate solution
- Topical azole – this is available either as cream or shampoo
- Variants – econazole, ketoconazole
- Ciclopirox – available as cream or solution
- Terbinafine – available as gel
- Antifungal shampoos
- Often the first treatment recommended for this condition
- Active ingredients – selenium sulfide or ketoconazole
- The odor of the shampoos might not be so pleasant
- Some people dilute the shampoo with water, so as to avoid the burning sensation
- It is recommended that you apply the shampoo directly to the scalp skin and leave it there for about 10 minutes, before rinsing it off with warm water
- The procedure should be repeated until you notice an improvement of the symptoms
- Antifungal creams
- These should be applied directly to the skin, as instructed by the doctor
- In rare cases, you might experience a burning sensation after applying the cream (talk to your doctor about such changes, as you may be experiencing an allergic reaction)
- It is recommended that the topical treatments are applied to the affected areas of the skin before going to bed, until the patient notices an improvement of the symptoms (usually, the treatment is applied for approximately two weeks)
- For the more severe cases or in patients who did not respond to the above-treatments, these are the recommended treatment choices:
- Oral antifungal agents
- Azole – itraconazole, fluconazole (variants)
- After taking the oral medication, you can perform intense physical exercise, which will induce sweating the medication at the level of the skin (higher chance of eradicating the fungus)
- You should not bathe immediately, as you will wash the medication off the skin
- The treatment can last between a couple of days and several months, depending on the severity of the infection
- If the infection recurs, the antifungal treatment might have to be repeated (oral or topical administration, as cream or shampoo)
- Oral antifungal medication might cause certain side-effects, such as rash on the skin, abdominal cramps, nausea or vomiting (talk to your doctor about the possibility of switching the medication with another one that does not present these side-effects)
- Oral antifungal agents
In conclusion, this is not a serious condition but it can cause some discomfort, especially from the aesthetic point of view. Both topical and oral treatments are recommended for pityriasis versicolor but it is remember that the treatment can extend for a couple of months. Plus, there is also the risk of the infection recurring, which means that the treatment will have to be repeated. The risk of recurrence might be reduced by using topical antifungal agents on a regular basis, including the ones containing selenium sulfide or those with natural ingredients, such as the tea tree oil.
Pityriasis Versicolor Pictures