Пітіріазіс Вершиколор (МКХ-10: B36) ⚠️

Pityriasis Versicolor: A Persistent, Superficial Fungal Skin Infection

What Is It?

Pityriasis versicolor, also called tinea versicolor, is a long-lasting, recurring fungal infection that affects the surface of the skin. It’s caused by yeast-like fungi from the Malassezia family, most often Malassezia furfur. These fungi naturally live on our skin, especially in oily areas. The infection happens when Malassezia changes from its harmless yeast form into a harmful, thread-like form.

This condition shows up as patches or spots on the skin that are either lighter or darker than the surrounding area and often flaky. These usually appear on the chest, back, and upper arms. Most people don’t experience symptoms, but some might notice mild itching. While it’s not dangerous, pityriasis versicolor can cause concern about appearance and affect confidence, especially because it’s visible on exposed skin.

How Does It Develop and What Triggers It?

The change of Malassezia from a harmless yeast to a harmful form happens when certain internal or environmental factors upset the skin’s natural balance. These include:

• Hot and humid weather: Increases sweating and oil production, creating a perfect environment for the fungus to grow;
• Excessive sweating (hyperhidrosis): Common in athletes or during seasonal changes;
• Hormonal changes: Such as those caused by taking the pill, natural hormone fluctuations, or conditions like Cushing’s syndrome;
• Weakened immune system: Due to illnesses like HIV/AIDS, cancer, or long-term steroid use;
• Family history: Some people seem more prone to it;
• Poor nutrition and hygiene: These can weaken the skin’s barrier and allow the fungus to grow more easily.

Once active, the fungus gets into the outer layer of the skin (stratum corneum) and produces substances like azelaic acid and other acids that block melanin production, leading to changes in skin colour after inflammation.

What Does It Look Like?

The main sign of pityriasis versicolor is clearly outlined, flaky patches on the skin that can be pink, tan, light brown, or even pale white—especially noticeable on darker skin. At first, these spots are usually small, round or oval, up to 1 cm across, but they often join together to form larger patches over time.

Typical features include:

• Colour: Depends on your natural skin tone and the stage of the infection—can look like “coffee with milk,” salmon-pink, yellow-brown, or lighter than the surrounding skin;
• Flaking: Fine, bran-like flakes are often visible if you scratch the area (known as a positive “scratch sign”);
• Edges: Well-defined and may spread outwards;
• Symptoms: Usually no symptoms or just mild itching, especially when sweating.

Where Does It Usually Appear?

Pityriasis versicolor mainly affects warm, oily parts of the body. Common spots include:

• Chest and upper back;
• Stomach area;
• Neck and shoulders;
• Upper arms and thighs;
• Less often: Face, scalp, groin, and genital areas, usually in more severe or recurring cases.

After sun exposure, the affected skin may stay lighter than usual for a while, creating a patchy look called “post-inflammatory leukoderma.” This happens because melanin production is temporarily blocked but usually improves with time and treatment.

The Follicular Form of Pityriasis Versicolor

Besides the common patchy form, pityriasis versicolor can also appear as a follicular type, which is less common and can look like bacterial folliculitis (inflammation of hair follicles).

Key points about this form:

• Where it appears: Usually on the chest, back, shoulders, and sometimes upper arms and thighs;
• What it looks like: Many small, red or skin-coloured bumps or pustules around hair follicles;
• Symptoms: Itching, burning or irritation that’s often stronger than in the usual form;
• Diagnosis: It’s important to tell this apart from bacterial folliculitis—only a microscope test or culture can confirm the fungal cause.

How Is Pityriasis Versicolor Diagnosed?

Doctors usually diagnose it by looking at the skin, supported by simple and quick tests to confirm it’s fungal:

• Wood’s lamp test: Under ultraviolet light, the patches glow yellow-gold or orange, especially with Malassezia furfur;
• Microscope test (KOH prep): A skin scraping treated with potassium hydroxide shows a classic “spaghetti and meatballs” pattern—short, curved fungal threads and round spores;
• Culture: The fungus can sometimes be grown on special oily media, but this is rarely needed;
• PCR testing: Used in tricky or recurring cases to identify the exact Malassezia species.

Treating Pityriasis Versicolor

Treatment depends on how bad the infection is, how much skin is affected, and whether it keeps coming back. Both creams and tablets work well, but creams are usually enough for smaller areas.

Topical Treatments (Best for Mild to Moderate Cases):

• Ketoconazole 2% shampoo or cream: Applied once or twice daily for 2 to 4 weeks;
• Clotrimazole, terbinafine, or miconazole creams: Used twice daily until the skin clears;
• Selenium sulfide 2.5% lotion: Put on the affected area and washed off after 10 minutes (used every other day);
• Zinc pyrithione or sulphur soaps: Helpful for ongoing care or to prevent flare-ups.

Oral Treatments (For More Severe or Recurring Cases):

• Itraconazole: 100 mg twice a day for 7 to 14 days;
• Fluconazole: 150–300 mg once a week for 2 to 4 weeks (or 50 mg daily for 2 weeks as an alternative);
• Oral ketoconazole: 200 mg twice daily for up to 14 days (used less often due to risk to the liver and requires monitoring).

It’s important to follow the full course of treatment and keep up good skin hygiene to avoid the infection coming back. For stubborn or widespread cases, a combination of tablets and creams may be needed.

How to Prevent Pityriasis Versicolor

Because pityriasis versicolor often returns—especially in warm climates or if you’re prone to it—taking steps to prevent it is key:

• Use antifungal shampoos regularly: Such as ketoconazole or selenium sulfide once or twice a week, especially in hot weather;
• Keep skin clean: Shower daily, avoid tight clothes, and change out of sweaty clothes quickly;
• Manage sweating: Use antiperspirants and wear breathable fabrics to keep skin dry;
• Avoid too much sun: Especially when your skin is healing, to prevent pale patches from standing out;
• Treat any underlying health issues: Like immune problems, poor nutrition, or hormone imbalances.

In Summary

Pityriasis versicolor is a common, surface-level fungal infection caused by the overgrowth of Malassezia on the skin. It’s not harmful medically, but its appearance and tendency to come back can cause worry. Early diagnosis, the right treatment, and ongoing prevention are important to keep it under control and reduce flare-ups.

With a mix of topical and oral treatments, good hygiene, and managing your environment, most people get good results. Understanding how it behaves and how to maintain clear skin plays a big part in managing this condition well.