Varied Presentations of Tinea Versicolor: Case 2 Truncal Tinea Versicolor
Large, reddish tan, asymptomatic patches recently developed
on the trunk of a 36-year-old man. Five years earlier,
a similar outbreak had resolved after a 10-day course of
oral ketoconazole(; this episode was the first recurrence.
Tinea versicolor is a superficial skin infection caused
by Pityrosporum orbiculare and Pityrosporum ovale, also
known as Malassezia furfur. The diagnosis is easily made
by the clinical appearance and can be confirmed by a potassium
hydroxide preparation that shows hyphae—short,
rod-shaped fragments intermixed with round spores and
grapelike clusters—in what is referred to as the “spaghetti
and meatballs” pattern. Recurrences are common and
occur most often in the spring and summer.
Topical treatments include selenium sulfide suspension
2.5%, sodium thiosulfate( 25%, ketoconazole, miconazole, clotrimazole(, econazole, ciclopirox, sulfosalicylic
acid shampoo, and zinc pyrithione shampoo. Oral therapies
include ketoconazole, itraconazole(, and fluconazole(. Griseofulvin( is ineffective.
A 10-day course of oral ketoconazole was prescribed
because of its previous effectiveness in this patient.
(Case and photographs courtesy of Dr Robert P. Blereau.)