Lawrence Charles Parish, M. D.
Q Our 16-year-old son just returned from five days at the beach and his back and chest look like a road map. There are light and dark areas that make him look funny. What happened?
A He has tinea versicolor, a superficial fungal infection. It's caused by Malassezia furfur, a yeast that represents the fungal form of two yeasts, Pityrosporon ovale and Pityrosporon orbiculari. Both are normally found on the skin and usually cause no problems. Because the yeast needs warm, moist areas in order to thrive, it often grows better in the summer. In addition, it likes the fatty content of the skin. For reasons that aren't yet understood, people who have lots of earwax are more prone to this nuisance condition. Also, why some people get tinea versicolor and others don't is not understood.
Tinea versicolor, sometimes called pityriasis versicolor, is just what it name means: yeast (tinea) or scaling (pityriasis) with many colors (versicolor). The scaling causes minimal itching, but it does prevent the covered area from being suntanned. With sun exposure, the non-scaly areas may tan. Areas covered by scale are protected from the sun's tanning rays and so remain light. This accentuates the color differences between the scaly and non-scaley areas. Hence, multicolored or versicolor. Occasionally, there is a little irritation, so that redness develops.
Tinea versicolor can be confused with a medicine reaction (drug eruption), a sunburn, or eczema (atopic dermatitis). It can also mimic vitiligo, a condition occurring when areas of pigment cells become lazy and stop making melanin, the substance that gives all skin it's color.
Treatment is quite easy. The best is the oral anti-fungal medicine Sporanox, a medicine available only by prescription. It's taken twice a day for a week. If the involved areas are small, antifungal creams can be used, but remember that five to ten grams of the cream are needed daily for three to four weeks. Other regimens include using selenium sulfide shampoo (Selsun) nightly for a few weeks to peel the skin. With treatment, the scale is gone in a few weeks, but the multi-colored look takes about three months to return to normal.
If your child isn't treated, the skin changes most likely will eventually go away on their own. The good news is that tinea versicolor doesn't cause any permanent skin damage.
Although this nuisance skin condition is readily conquered, it can recur annually for a decade or two. Remember that this common skin condition is treated very nicely but not cured.
Lawrence Charles Parish, M.D., is a clinical professor of Dermatology and Cutaneous Biology and director of the Jefferson Center for International Dermatology, Jefferson Medical College, Philadelphia, PA. Please send your questions and comments to him care of Pediatrics for Parents, P.O. Box 63716, Philadelphia, PA 19147.
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