Tinea versicolor is a fungal infection of the topmost layer of the skin causing scaly, discolored patches.
The infection, caused by the yeast Malassezia furfur, is quite common, especially among young adults. Malassezia furfur is typically a harmless yeast that normally lives on the skin but in some people causes tinea versicolor. Most affected people are healthy. Some people may be genetically predisposed to overgrowth of this yeast. Other risk factors for tinea versicolor include heat and humidity and an immune system weakened by corticosteroid use, pregnancy, undernutrition, diabetes, or other disorders.
Tinea versicolor usually does not cause any symptoms but sometimes causes itching. However, it does cause many tan, brown, salmon, or white scaly patches to appear on the trunk, neck, abdomen, and occasionally the face. The patches may join to form larger patches. The patches do not tan, so in summer, when the surrounding skin tans, the patches may become obvious. People with naturally dark skin may notice lighter patches. People with naturally fair skin may get darker or lighter patches. Tinea versicolor is a mild infection and is not considered contagious.
Doctors can often diagnose tinea versicolor by its appearance. Doctors may use an ultraviolet light to show the infection more clearly and usually examine scrapings from the infected area under a microscope to confirm the diagnosis.
The skin may not regain its normal pigmentation for many months or years after the infection is gone. Tinea versicolor commonly comes back after successful treatment because the yeast that causes it normally lives on the skin.
Antifungal creams applied directly to the affected areas (topical), such as ketoconazole or terbinafine cream, may be used, as well as terbinafine solution spray. Prescription-strength selenium sulfide lotion is effective if applied to the affected areas (including the scalp) for 10 minutes a day for 2 weeks. Prescription ketoconazole shampoo is also effective. It is applied and washed off in 5 minutes. It is used as a single application or daily for 3 days. Other treatments include applying topical ketoconazole daily for 2 weeks and bathing with zinc pyrithione soap or sulfur-salicylic shampoo for 1 to 2 weeks.
Antifungal drugs taken by mouth, such as ketoconazole or fluconazole, are sometimes used to treat a widespread infection (see see Table: Drugs for Serious Fungal Infections). In addition, some people prefer the convenience of a drug taken by mouth. However, because these drugs may cause unwanted side effects and because tinea versicolor is a mild infection, topical drugs are usually preferred. Drugs taken by mouth do not prevent recurrence.
To lower the chance of recurrence, many doctors recommend practicing meticulous hygiene and using zinc pyrithione soap regularly or one of the other topical treatments monthly.
Last full review/revision June 2013 by Denise M Aaron, MD