Tinea Versicolor Fungal Infection
by Kathryn Khadija Leverette

           The non-contagious fungal rash of tinea versicolor is a chronic, asymptomatic superficial infection characterized by light scaly, macular patches. These patches range in color from light pink to deep tan. Although the name suggests a variety of colors, the hue of all patches is about the same in any one individual.

The areas involved are usually restricted to between the chin and the waist, on the trunk and arms, sometimes to the wrist. Facial involvement is rare except in blacks. The rash may be mildly itchy, especially during times of perspiration, but most people are bothered most by its unsightliness. Involved untreated areas are usually hypopigmented patches that appear significantly lighter than the surrounding skin. A simple wood's light exam intensifies pigmentary changes and allows the extent and margins to be readily observed, with the infected areas always appearing orange in fluorescence.

            Tinea versicolor is caused by the organism pityrosporum orbicular.  It is seen mostly in young adults living in temperate climates and accounts for about five percent of all fungal infections. The fine scales of tinea versicolor are teeming with "hype" and "spores".
            Factors predisposing a clinical infection include:

              a. pregnancy
              b. genetic predisposition
              c. underlying disease
              d. patients taking systemic steroids
              e. a warm and humid climate
               f. an active lifestyle that includes exercise, perspiration and occlusive workout wear

            Tinea versicolor can infect people for years because of inconsistent treatment and re-infection. Tinea versicolor is unique because it produces hypopigmented lesions that lack skin color. The fungus itself produces a form of azelaic acid, which may interfere with
            melanin production in the affected areas, and may be cytotoxic to the melanocytes that produce brown skin cells.

            Tinea versicolor may be treated in a variety of ways, some of which may prove successful if used diligently for a prolonged period of time. The problem is that most topical methods used in the past are messy, tedious, frustrating and time-consuming. People often give
            up, and choose to "live with it" rather than undergo the often unsuccessful, standard medical treatment.

            In the past, evening application of the following anti-fungal preparations have been prescribed follow an exfoliating bath. Though infection can be cleared up, re-infection is common, and pigmentary changes can sometimes take months to resolve.

The most common medically-prescribed treatment products include:

            A. Dandruff preparations: Zinc pyrithione, selenium sulfide suspension, sodium hyposulfite 25%, or Tinver Lotion (25% sodium thiosulfate, 1% salicylic acid, 10% alcohol) applied to lesions twice a day for fourteen days.
             
B .Anti-fungal creams: Lamisil (terbinafine), Lotrimin (clotrimazole), Monistat-Derm (miconazole), Halotex (holoprogin), Tinactin (tolnaftate) and Nizoral (ketoconazole) preparations applied to lesions twice a day for fourteen days.

            C. Topical retinoids: Applied twice a day for two weeks can exfoliate tinea versicolor
spores and help to resolve the pigmentary changes, but is prohibitively expensive since many  insurance companies will not cover the use of Retin-A® and similar topicals for this purpose..
                         
             D. Oral anti-fungals: Systemic anti-fungal drugs (Lamisil and Nizoral) promise up to a 90 percent “temporary” cure rate. These potent broad-spectrum anti-fungal agents are useful in the treatment of most stubborn fungal infections. However, intermittent use of oral anti-fungals to control a chronic fungal infection is potentially dangerous because it can lead to liver toxicity. Because of this risk, they should be utilized as a last resort in the most serious, treatment-resistant cases only. And even then, re-infection can occur.

            Effective alternative approach:
            Urban Skin Solutions recommends

            This routine should be performed twice daily and immediately after perspiring, longterm to prevent reoccurrence in those prone to tinea versicolor. Avoid wearing occlusive clothing like spandex, nylon jogging suits, and clothing made from silk and synthetic materials.