Pityriasis versicolor, also called Tinea versicolor, is a fungal infection common in our environment. It is caused by an organism called Pityrosporum ovale. Commonly picked up from swimming pools and from sharing of clothing, it may even develop from fungus living on ones own body.
Pityriasis versicolor presents as light brown flat areas of discoloration with branny scales, found most commonly on the chest and upper back. Occasionally, the entire back may be involved and rarely, the face. Individual lesions may be a few mm in diameter upto about a centimeter. Coalescence of the lesions to form sheets of discoloration on the upper back is quite common.
The diagnosis of Pityriasis versicoloured is confirmed by demonstrating fungal elements (hyphae and spores) which have the appearance of spaghetti (hyphae) and meatballs (spores) under the microscope.
Pityriasis Versicolor is a curable condition and numerous medications are available, some of which are applied on the body while others are taken orally. Although easy to treat, it must be remembered that this infection is just as easy to pick up again.
1. Lamisil Spray Solution
A convenient method of treatment by spraying the involved area daily for two weeks.
2. Pevaryl Foaming Solution
Applied each day after a bath throughout the body for three consecutive days. The medication is allowed to dry on the body without wiping it with a towel.
3. Selsun Shampoo
One application throughout the body is usually sufficient although various methods of application are used in different centres.
4. Sodium Hyposulphite
This is applied twice daily for two weeks on the body.
1. Nizoral Tablets
Two tablets on Day 1 and 2 on day 7 taken with meals. Four tablets in total. For recurrent infection, two tablets are taken on the first day of each month for six months.
2. Sporanox Tablets
Two tablets twice a day taken for 7 days. To prevent recurrences, 2 capsules are taken twice a day on one day each month for six months ie. 4 capsules a month for 6 months.
Recent clinical studies have shown that 2 capsules of Sporanox taken just once is actually sufficient to treat the infection.
How to determine if treatment has been successful.
Active infection is demonstrated by the presence of scales on scratching the surface of infected skin. When the fungus is killed, the skin no longer scales. However, the skin often remains light in colour in comparison with surrounding skin. Tanning may not occur on this area for several months.
Reason for loss of colour.
The organism, Pityrosporum ovale, secretes a chemical called Azaleic Acid which kills the colour cells (melanocytes) in the skin. During treatment, the fungus is destroyed but the damage it produces while it is alive is still evident long after the fungus has been killed. New melanocytes have to move into the area in order to produce normal colour.
How does one get colour back?
The best way is to expose the involved skin to sunlight for about half an hour every day. With this technique, it is not unusual for normal skin colour to take about three months to return.
An alternative is to expose the body to narrow band UVB light.