Tinea versicolor symptoms and signs often appears as lots of small spots of color that seem to run into each other and form large patches. The colors can vary from white to light brown, dark brown, gray-black or pinkish red. There can also be a mix of colors.
Tinea versicolor usually shows up on the back, chest, or upper arms . It can also happen on the face or in places where the skin rubs together, such as the armpit.
People often notice this problem more in the summer when affected areas of the skin stand out because they don’t get tan from the sun.
Tinea versicolor symptoms clinical features
The term “versicolor” refers to the variable changes in cutaneous pigmentation that may occur in this disorder. The macules, patches, and thin plaques of tinea versicolor can be hypopigmented, hyperpigmented, or mildly erythematous . In light-skinned individuals, hyperpigmented tinea versicolor is often light brown. Hyperpigmented tinea versicolor may present as dark brown to gray-black macules and patches in those with dark skin.
The color of affected areas can vary between individuals with similar skin color, and occasionally, between areas of involvement on one person. Although the reasons for pigmentary variation are unconfirmed, a few theories have been proposed. Patients with hypopigmented tinea versicolor often notice that the disorder is most prominent during the summer, when the affected areas fail to tan after sun exposure. Inhibitory or damaging effects on melanocytes by azelaic acid (a dicarboxylic acid produced by Malassezia) may play a role in the development of hypopigmentation . Hyperpigmented and erythematous lesions may be a consequence of an inflammatory reaction to the yeast .
A fine scale is often present on affected skin, which becomes more apparent when the lesion is scraped for microscopy. Individual lesions are typically small, but frequently coalesce into larger patches. In adolescents and adults, tinea versicolor is most commonly found on the upper trunk and proximal upper extremities, and less often on the face and intertriginous areas. In contrast, when tinea versicolor occurs in children, it is likely to involve the face.
Tinea Versicolor Diagnosis
A diagnosis of tinea versicolor should be suspected when a patient presents with hypopigmented or hyperpigmented macules coalescing into patches on the upper trunk, proximal extremities, neck, or face. The variable clinical features of tinea versicolor and the existence of other skin disorders with similar findings make it preferable to confirm the diagnosis with a potassium hydroxide (KOH) preparation. Both hyphae and yeast cells are evident in a pattern that is often described as “spaghetti and meatballs” . Additionally, in approximately one-third of cases, examination with a Wood’s lamp will reveal yellow to yellow-green fluorescence . (See “Office-based dermatologic diagnostic procedures”, section on ‘Potassium hydroxide preparation’.)