Varied Presentations of Tinea Versicolor: Case 2 Truncal Tinea Versicolor

Large, reddish tan, asymptomatic patches recently developedon the trunk of a 36-year-old man. Five years earlier,a similar outbreak had resolved after a 10-day course oforal ketoconazole; this episode was the first recurrence.Tinea versicolor is a superficial skin infection causedby Pityrosporum orbiculare and Pityrosporum ovale, alsoknown as Malassezia furfur. The diagnosis is easily madeby the clinical appearance and can be confirmed by a potassiumhydroxide preparation that shows hyphae--short,rod-shaped fragments intermixed with round spores andgrapelike clusters--in what is referred to as the "spaghettiand meatballs" pattern. Recurrences are common andoccur most often in the spring and summer.Topical treatments include selenium sulfide suspension2.5%, sodium thiosulfate 25%, ketoconazole, miconazole,clotrimazole, econazole, ciclopirox, sulfosalicylicacid shampoo, and zinc pyrithione shampoo. Oral therapiesinclude ketoconazole, itraconazole, and fluconazole.Griseofulvin is ineffective.A 10-day course of oral ketoconazole was prescribedbecause of its previous effectiveness in this patient.

(Case and photographs courtesy of Dr Robert P. Blereau.)