Tinea Versicolor

What causes tinea versicolor

Malassezia yeasts live on almost everyone's skin, especially in oily areas. Tinea versicolor is one of several types of fungal skin infection, but unlike ringworm it comes from your own skin yeast. Under certain conditions they switch from a harmless yeast form to a hyphal (thread-like) form and multiply. The overgrowth:

• produces a substance (azelaic acid) that interferes with pigment production, causing lighter spots, or
• causes mild inflammation and thickening that leads to darker or pinker spots.

Because the yeast is already part of normal skin, tinea versicolor is not contagious and is not caused by poor hygiene.

Risk factors

• Hot, humid weather and tropical climates
• Heavy sweating and tight, non-breathable clothing
• Oily skin and oily skin products
• Adolescence and young adulthood, when oil glands are most active
• Weakened immunity, steroid use, and pregnancy (less commonly)
• Family tendency

Symptoms and appearance

• Small, round or oval spots that join to form larger irregular patches
• Colors range from white or pale to pink, salmon, tan or brown; on a single person they are usually all one tone
• Fine, powdery scale, more visible when the skin is stretched or scratched
• Mild itch, often worse when hot
• Usual sites: upper back, chest, shoulders, neck and upper arms; in children, sometimes the face
• Spots become more obvious after sun exposure, because the surrounding skin tans and the patches do not. That is why it is nicknamed "sun fungus"

Tinea versicolor vs similar conditions

Diagnosis

A doctor can often diagnose tinea versicolor by looking at it. Quick tests confirm it:

• KOH test: scraping a few scales onto a slide shows yeasts and short threads, often described as a "spaghetti and meatballs" pattern.
• Wood's lamp: under ultraviolet light, affected skin may glow yellow-green or copper-orange.
• Tape test: clear tape pressed on the skin collects scales for the microscope.

How to get rid of tinea versicolor

Antifungal shampoos and washes (first choice for most people)

Use as a body wash on the affected area and a few inches around it:

• Ketoconazole 2% shampoo: lather on, leave for 5 minutes, rinse; daily for 1 to 3 days or as directed
• Selenium sulfide 2.5% shampoo: leave on for about 10 minutes, rinse; daily for 1 to 2 weeks
• Zinc pyrithione soaps or shampoos as a milder option

Follow the product label or your doctor's directions for exact timing.

Antifungal creams

For small areas: clotrimazole, miconazole, ketoconazole or terbinafine cream, applied once or twice daily for 2 to 4 weeks.

Oral antifungal tablets

For widespread, stubborn or frequently recurring cases, a doctor may prescribe fluconazole or itraconazole for a short course. Oral terbinafine does not work for tinea versicolor. Tablets can interact with other medicines and are not used in pregnancy.

Why the spots stay after treatment

Treatment kills the yeast quickly, and scaling and itch usually go within 2 to 4 weeks. Color changes take longer: pale spots need sun exposure and time for pigment cells to recover, often 1 to 3 months or more. Dark spots also fade slowly. Lingering color without scale does not mean treatment failed.

Preventing recurrence

Tinea versicolor returns in many people, often each summer, because the yeast never fully leaves the skin.

• Use an antifungal shampoo as a body wash once or twice a month during warm months, or before a trip to a hot climate.
• Shower soon after exercise or heavy sweating.
• Wear loose, breathable cotton or moisture-wicking clothing.
• Avoid oily sunscreens and body lotions on affected areas; choose oil-free products.
• For frequent recurrences, a doctor may prescribe a once-monthly oral antifungal dose.

Outlook

Tinea versicolor is harmless and does not scar or spread to other people. It responds well to treatment but often recurs. The main bother is cosmetic, especially the uneven skin color, which improves over months.

Frequently asked questions

Is tinea versicolor contagious?

No. The yeast that causes it lives on everyone's skin. Tinea versicolor develops when that yeast overgrows on your own skin because of heat, humidity, sweating or oily skin. You cannot catch it from or pass it to other people through touch, towels or sexual contact.

How long does it take to get rid of tinea versicolor?

The yeast usually clears within 1 to 4 weeks of antifungal treatment, and scaling and itching stop. Skin color can take 1 to 3 months or longer to return to normal, especially for light spots, which need sun exposure to repigment.

What is the fastest way to get rid of tinea versicolor?

For widespread spots, antifungal shampoos such as ketoconazole or selenium sulfide used as a body wash work within days to weeks. For stubborn or extensive cases, a doctor may prescribe a short course of oral fluconazole or itraconazole. Expect skin color to take longer to recover.

Why does tinea versicolor keep coming back?

The Malassezia yeast is a permanent part of the skin, so when conditions such as heat, humidity and sweating return, it can overgrow again. Recurrences are common. Using an antifungal wash once or twice a month in warm weather significantly reduces flare-ups.

What is the difference between tinea versicolor and vitiligo?

Tinea versicolor spots are slightly scaly, off-white, pink or tan, and mostly on the trunk. Vitiligo patches are pure chalk-white, smooth, without scale, and often on the hands, face, and around the eyes and mouth. Vitiligo is an autoimmune loss of pigment cells, not a yeast infection.