Tinea Versicolor

What is tinea versicolor?

Tinea versicolor (also known as pityriasis versicolor) is a fungal skin infection characterized by many small spots that usually appear on the oily parts of the upper body, typically the chest and back. The spotted skin is usually flaky or scaly, especially when lightly scratched. Health professionals often describe the rash as causing a spotty body.

See an illustration of tinea versicolor .

What causes tinea versicolor?

Tinea versicolor is caused by a yeast (Malassezia furfur), which is a type of fungus. This fungus is present everywhere in the environment, including on the surface of your skin. Normally, everyday washing and showering removes dead skin and fungi. However, when temperatures and humidity are high, such as during the summer or in tropical regions, fungi may grow more rapidly. As these fungi grow in number, their natural balance on your skin is upset, the normal color (pigmentation) of your skin changes, and spots appear.

While the yeast responsible for the condition is present on everyone's skin, some people are more susceptible than others to developing tinea versicolor. Tinea versicolor is not considered contagious.

What are the symptoms?

Symptoms of tinea versicolor include a rash of small circular or oval spots that may eventually form patches. The rash occurs on oily areas of skin on the upper chest, back, or upper arms, or less commonly on the upper thighs, neck, or face. The spots are flat and may be white, pink, red, tan, or brown, depending on your skin color. Each person's spots are usually the same color, either lighter or darker than the rest of the skin. The spotted skin may be scaly. Although not common, your skin may be itchy, especially when you are hot.

How is tinea versicolor diagnosed?

A health professional can often recognize tinea versicolor by looking at the rash. If the diagnosis is uncertain, a sample (scraping) of the infected skin is examined under a microscope.

How is it treated?

Usually, products applied to the skin—creams, shampoos, or solutions—are effective treatments. However, if the rash is severe, covers large areas of your body, returns often, or does not get better with topical treatment, antifungal pills may be prescribed. Tinea versicolor is easily treated, but it often returns within 1 to 2 years.

What increases my risk for tinea versicolor?

Tinea versicolor is most common in teenagers and young adults because their skin tends to be more oily, but it can occur at any age. Tinea versicolor is rare in small children and older adults.¹

Other factors that increase your risk of developing tinea versicolor include:

• Susceptibility to fungal infections.
• An impaired immune system, which can occur during pregnancy or from some illnesses.
• Excessive sweating.
• Oily skin.
• A warm, humid climate, especially if you wear tight, nonbreathable clothing.
• Use of some medications, such as corticosteroids, antibiotics, and birth control pills.

Tinea versicolor occurs worldwide, but it is most common in tropical areas where the heat and humidity cause sweating and promote fungal growth. Tinea versicolor is not common in cold, dry climates.

Frequently Asked Questions

Symptoms of tinea versicolor include:

• A rash of small circular or oval spots that may eventually form patches. The spots are flat and may be white, pink, red, tan, or brown.
• Itching, especially when you are hot. However, itching isn't always present.

Most people are more distressed by the appearance of their skin than by the itching.

The rash occurs on oily areas of skin, commonly on the upper chest and back, and less commonly on the upper thighs, upper arms, or neck. Rashes on the face are rare but may appear in children.

The spots of the rash usually appear lighter than the rest of your skin because they don't tan. In untanned individuals, the spots may also appear darker (hyperpigmented) than the surrounding skin, and are often darker in African Americans. The spotted skin may be scaly, especially if it is lightly scratched.

During the summer in mild climates, the spots may be very noticeable because they don't tan with the rest of your skin. During the winter, the spots may appear to go away as your tan fades, making the spots less obvious.

In tropical climates with high heat and humidity, the appearance of the spots may not change throughout the year.

Tinea versicolor usually gets better or disappears as you age and your skin becomes less oily.

Tinea versicolor is sometimes confused with other conditions with similar symptoms, such as vitiligo or pityriasis rosea.

Your health professional may be able to diagnose tinea versicolor based on its appearance or may refer you to a dermatologist, who specializes in skin conditions. The diagnosis of tinea versicolor is confirmed through a skin test in which a sample (scraping) of the infected skin is evaluated.

The test used most often for tinea versicolor is the KOH (potassium hydroxide) preparation, which can indicate whether the skin condition is caused by a fungus. This painless, noninvasive test can usually be done in a clinic or doctor's office.

Other tests for tinea versicolor include a Wood's light exam and, in rare cases, a skin culture or biopsy.

Products applied to the skin—creams, shampoos, or solutions—are effective treatments for the fungus that causes tinea versicolor. However, if the rash is severe, covers large areas of your body, returns often, or does not get better with topical treatment, antifungal pills may be prescribed. While treatment kills the fungi quickly, it can take months for the spots to disappear and your skin color to return to normal.

Treatment is usually needed to prevent the rash from spreading and to improve the appearance of your skin. If left untreated, tinea versicolor may linger until you are 50 or 60 years old, when the skin becomes less oily.

Generally, creams, shampoos, and solutions are thought to be safer than antifungal pills because they mostly affect only your skin. However, topical treatments:

• Can be inconvenient and messy.
• May sting and/or smell bad.
• May be just as expensive as pills.
• Can take a long time to apply, especially if the rash covers a large area of your body.

For these reasons, people may not complete an entire course of treatment, and the rash may return.

Antifungal pills are often given because they are easier to use than the other products. They may also be more effective at curing the rash than topical products. The risk of side effects may not be as great when these pills are used to treat tinea versicolor as they are when used to treat other fungal infections, because the pills are taken for such a short period of time.

While it can be easily treated, tinea versicolor often returns within 1 to 2 years. This may be due to factors that cannot be changed, such as your susceptibility. If you tend to get tinea versicolor often, take measures to prevent it from returning:

• Apply an antifungal topic product once a month.
• Take a prescribed antifungal pill once a month.

Treatment choices

Topical products such as antifungal creams, shampoos, or solutions are effective treatments for tinea versicolor. However, if the rash is severe, covers large areas of your body, returns often, or does not get better with topical treatment, antifungal pills may be prescribed.

How many times each topical product must be applied and how long it is left on varies. Therefore, it is important to closely follow your doctor's recommendations.

Shampoos

Antifungal shampoos are usually easier to apply than some antifungal creams and may cost less when applied to a large area of skin. Antifungal shampoos can be applied to your body as well as to your head.

An antifungal shampoo containing the medication selenium sulfide 2.5% is available by prescription. Selenium sulfide is also available in nonprescription antifungal shampoos (such as Selsun Blue or Head and Shoulders). However, nonprescription shampoos may be less effective since they contain only 1% selenium sulfide. Selenium sulfide may irritate your skin.

Antifungal shampoo containing selenium sulfide should be applied once a day over most of your body from the ears to the knees, including the back. It can be rinsed off after 10 minutes. The shampoo should be used daily for 7 to 14 days or longer.

An antifungal shampoo containing ketoconazole (Nizoral) is available with or without a prescription in different strengths. Nonprescription shampoos may be less effective than prescription shampoos.

Other topical products

Antifungal creams and foam solutions are available with or without a prescription. These products can be applied to the body or face once or twice a day for 2 weeks.

Examples include:

• Ketoconazole (Nizoral), available with a prescription.
• Clotrimazole (such as Lotrimin). Clotrimazole is available with or without a prescription in different strengths.
• Terbinafine (Lamisil). Terbinafine is available with or without a prescription in different strengths.
• Butenafine (Mentax), which is available with a prescription.
• Naftifine (Naftin), which is available with or without a prescription. Naftifine also comes in a gel.
• Ciclopirox olamine (Loprox). Ciclopirox olamine is available with a prescription as a cream, gel, or lotion; however, it is fairly expensive and you will need to apply large amounts to affected areas.

Terbinafine (Lamisil) 1% solution can also be used to treat tinea versicolor. Terbinafine is available with a prescription and comes in a pump spray.

Antifungal pills

Antifungal pills may be taken in a single dose or once a day for 5 to 10 days. Because the medication comes to the surface of your skin through sweat, you'll get the best results if it is not washed off too soon. Your doctor may recommend that, after taking your antifungal pill, you exercise briskly and long enough to sweat, and then wait 12 hours to shower.

Because these pills are taken for such a short period of time, the side effects or risks usually associated with long-term use are not as likely to occur. Some oral medications may not be appropriate for children.

Antifungal pills available with a prescription include:

• Ketoconazole (Nizoral).
• Fluconazole (Diflucan).
• Itraconazole (Sporanox).
• Terbinafine (Lamisil).

Griseofulvin, an antifungal used to treat other fungal skin infections, is not used to treat tinea versicolor.

Tinea versicolor can be treated at home with topical products such as antifungal creams, shampoos, and solutions. After treatment is started, it can take months for the spots to disappear and for your skin color to return to normal. Although tinea versicolor can usually be treated successfully with medications, the rash may return within 1 or 2 years.

When using creams, shampoos, or solutions, follow the directions closely. You usually need to use these products for 1 to 2 weeks. If your skin becomes irritated, stop using the product.

To prevent tinea versicolor from returning, use a topical product once a month. Prescribed antifungal pills can be used once a month to prevent the rash from returning but are usually not necessary.

Because the medication in antifungal pills comes to the surface of your skin through sweat, you'll get the best results if it is not washed off too soon. Your doctor may recommend that, after taking your antifungal pill, you exercise briskly and long enough to sweat, and then wait 12 hours to shower.

For more information on the medications used to treat tinea versicolor, see the Treatment Overview section of this topic.

Some health professionals believe fungi that remain in clothing may cause the rash to return. Normal washing and cleaning is usually effective in removing fungi from clothes, but for persistent tinea versicolor, you may need to dry clean your clothes or wash them in the hottest possible water.

Organization

• Athlete's Foot
• Fungal Nail Infections
• Ringworm of the Scalp or Beard
• Ringworm of the Skin

Citations

1. Klenk AS, et al. (2003). Yeast infections: Candidiasis, pityriasis (tinea) versicolor. In IM Freedberg et al., eds., Fitzpatrick's Dermatology in General Medicine, 6th ed., vol. 2, pp. 2006–2018. New York: McGraw-Hill.

Other Works Consulted

• Berger TG (2003). Tinea versicolor (Pityriasis versicolor) section of Skin, hair, and nails. In LM Tierney Jr et al., eds., Current Medical Diagnosis and Treatment, 42nd ed., pp. 99–100. New York: McGraw-Hill.

• Habif TP, et al. (2001). Tinea versicolor. In Skin Disease Diagnosis and Treatment, pp. 184–186. St. Louis: Mosby.

Author:	Kathleen M. Ariss, MS	Last Updated May 14, 2004
Medical Review:	Patrice Burgess, MD - Family Medicine Alexander H. Murray, MD, FRCPC - Dermatology
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