Tinea Versicolor

Topic Overview

What is tinea versicolor?

Tinea versicolor (say “TIH-nee-uh VER-sih-kuh-ler”) is a fungal infection that causes many small, flat spots on the skin. The spots can be flaky or mildly itchy. The many small spots may blend into large patchy areas, usually on the oily parts of the upper body like the chest and back. The spots can be either lighter or darker than the skin around them.

See a picture of tinea versicolor.

What causes tinea versicolor?

Tinea versicolor is caused by a fungus. This fungus lives all around us, including on the skin. Normally, everyday washing and showering removes dead skin and fungi (more than one fungus). But in hot and humid weather, such as during the summer or in tropical areas, fungi may grow more rapidly. As these fungi grow in number, their natural balance on the skin is affected, the normal color of the skin changes, and spots appear.

People with oily skin, especially teens and young adults, are more likely to get tinea versicolor. It does not spread from person to person.

Other things that increase your chance of getting tinea versicolor include:

• Having an impaired immune system, which can occur during pregnancy or from some illnesses.
• Using certain medicines, such as corticosteroids, antibiotics, or birth control pills.

Tinea versicolor usually is less likely to occur as you age, when the skin becomes less oily.

What are the symptoms?

Symptoms of tinea versicolor include small, flat, round or oval spots that may, over time, form patches. The spots occur on oily areas of skin on the upper chest, back, or upper arms or, less often, on the upper thighs, neck, or face.

The spots can be lighter or darker than the skin around them. During the summer in mild climates, the spots may be very noticeable because they don't tan with the rest of your skin. During the winter, the spots may seem to go away as your tan fades and they become less obvious.

The spots are flat and may be white, pink, red, tan, or brown, depending on your skin color. Each person's spots are usually just one color. The spotted skin may be scaly. Although it’s not common, your skin may be itchy, especially when you are hot.

How is tinea versicolor diagnosed?

Your doctor often can tell if you have tinea versicolor by looking at the spots. He or she may look at a sample (scraping) of the infected skin under a microscope.

How is it treated?

The infection is easily treated with skin creams, shampoos, or solutions. But not everyone chooses to get treatment.

If the infection is severe or if it covers large areas of your body, returns often, or does not get better with skin care, your doctor may prescribe antifungal pills. Antifungal pills cannot be taken by some people, especially those with liver or heart problems. You may have blood tests so your doctor can check to make sure your kidneys and liver are working okay.

Treatment kills the fungi quickly. But it can take months for the spots to disappear and for your skin color to return to normal.

This infection is easily treated. But it often returns in 1 to 2 years.

Can tinea versicolor be prevented?

To prevent tinea versicolor from returning, use skin creams, shampoos, or solutions at least once a month. Ask your doctor if you should use them more often.

Tanning will make the condition more obvious. If you avoid tanning, the change in skin color will be less noticeable.

Prescribed antifungal pills can be used once a month to prevent the infection from returning. But they are usually not needed.

Some doctors believe fungi that remain in clothing may cause the infection to return. Normal washing and cleaning is usually effective in removing fungi from clothes. But for persistent tinea versicolor, you may need to dry-clean your clothes or wash them in the hottest possible water.

Frequently Asked Questions

Symptoms

Symptoms of tinea versicolor include:

• A rash of small circular or oval spots that may eventually form patches. The spots are flat and may be white, pink, red, tan, or brown.
• Itching, especially when you are hot. But itching isn't always present.

Most people are more distressed by the appearance of their skin than by the itching.

The rash occurs on oily areas of skin, commonly on the upper chest and back, and less commonly on the upper thighs, upper arms, or neck. Rashes on the face are rare but may appear in children.

The spots of the rash usually appear lighter than the rest of your skin because they don't tan. In untanned individuals and in African Americans, the spots may appear darker than the surrounding skin (hyperpigmented). The spotted skin may be scaly, especially if it is lightly scratched.

During the summer in mild climates, the spots may be very noticeable because they don't change color even if the rest of your skin changes from being out in the sun. During the winter, the color of the spots may be less obvious.

In tropical climates with high heat and humidity, the appearance of the spots may not change throughout the year.

Tinea versicolor usually gets better or disappears as you age and your skin becomes less oily.

Tinea versicolor is sometimes confused with other conditions with similar symptoms, such as vitiligo or pityriasis rosea.

Exams and Tests

Your doctor may be able to diagnose tinea versicolor based on how it looks or may refer you to a dermatologist, who specializes in skin conditions. The diagnosis of tinea versicolor is confirmed through a skin test in which a sample (scraping) of the infected skin is evaluated.

The test used most often for tinea versicolor is the KOH (potassium hydroxide) preparation, which can show whether the skin condition is caused by a fungus. This painless, noninvasive test can usually be done in a clinic or a doctor's office.

Other tests for tinea versicolor include a Wood's light exam and, in rare cases, a skin culture or biopsy.

Treatment Overview

Products applied to the skin (topical)—creams, shampoos, or solutions—are effective treatments against the fungus that causes tinea versicolor. But if the rash is severe, covers large areas of your body, returns often, or does not get better with topical treatment, you may need antifungal pills. Treatment kills the fungi quickly, but the spots may take months to disappear. Your skin color will also need time to return to normal.

Treatment is usually needed to prevent the rash from spreading and to improve the appearance of your skin. But not everyone chooses to get treatment. If it is not treated, tinea versicolor may linger until you are 50 or 60 years old, when the skin becomes less oily.

In general, creams, shampoos, and solutions are thought to be safer than antifungal pills, because they mostly affect only your skin. But topical treatments:

• Can be inconvenient and messy.
• May sting and smell bad.
• May be just as expensive as pills.
• Can take a long time to apply, especially if the rash covers a large area of your body.

For these reasons, people may not complete an entire course of treatment, and the rash may return.

Antifungal pills are often given because they are easier to use than the other products. They may also be more effective at curing the rash than topical products.

Healing continues after you have finished all the medicine. But it can take up to 6 months to know how your skin color will look after it heals.

Tinea versicolor is easily treated. But it often returns within 1 to 2 years. This may happen because of things you cannot change, such as your tendency to get the rash. If you tend to get tinea versicolor often, take measures to prevent it from coming back.

• Apply an antifungal product to your skin at least once a month. Your dermatologist may recommend using an antifungal as often as once a week.
• Take a prescribed antifungal pill once a month.

Treatment choices

Topical products such as antifungal creams, shampoos, or solutions are effective treatments for tinea versicolor. But if the rash is severe, covers large areas of your body, returns often, or does not get better with topical treatment, antifungal pills may be prescribed.¹

How many times each topical product must be applied and how long it is left on varies. Make sure to closely follow your doctor's instructions.

Shampoos

Antifungal shampoos are usually easier to apply than some antifungal creams and may cost less when applied to a large area of skin. Antifungal shampoos can be applied to your body as well as to your head.

An antifungal shampoo containing selenium sulfide (2.5%) is available by prescription. Selenium sulfide shampoos (example, Selsun Blue, Head and Shoulders) are also available without a prescription. But nonprescription shampoos may be less effective, because they contain only 1% selenium sulfide. Selenium sulfide may irritate your skin.

Antifungal shampoo containing selenium sulfide should be applied once a day over most of your body from the ears to the knees, including the back. It can be rinsed off after 10 minutes. The shampoo should be used daily for 7 to 14 days or longer.

An antifungal shampoo containing ketoconazole (Nizoral) is available in different strengths with or without a prescription. Nonprescription shampoos may be less effective than prescription shampoos.

Other topical products

Antifungal creams and foam solutions are available with or without a prescription. These products can be applied to the body or face once or twice a day for 2 weeks. Examples include:

• Selenium sulfide (such as Selsun), available with or without a prescription in different strengths.
• Ketoconazole (Nizoral), available with a prescription.
• Clotrimazole (such as Lotrimin), available with or without a prescription in different strengths.
• Terbinafine (Lamisil), available with or without a prescription in different strengths.
• Butenafine (Mentax), available with a prescription.
• Naftifine (Naftin), available with a prescription. Naftifine also comes in a gel.
• Ciclopirox olamine (Loprox), available with a prescription as a cream, gel, or lotion. But it is fairly expensive. And you will need to apply large amounts to affected areas.

Terbinafine (Lamisil) 1% solution can also be used to treat tinea versicolor. Terbinafine is available with a prescription and comes in a pump spray.

Antifungal pills

Antifungal pills may be taken in a single dose or once a day for 5 to 10 days to treat tinea versicolor. The medicine in some antifungal pills comes to the surface of your skin through sweat. So you'll get the best results if you take an antifungal pill, exercise briskly and long enough to sweat, and then wait about 12 hours before you shower.

Antifungal pills available with a prescription include:

• Ketoconazole (Nizoral).
• Fluconazole (Diflucan).
• Itraconazole (Sporanox).

Griseofulvin, an antifungal used to treat other fungal skin infections, is not used to treat tinea versicolor.

Home Treatment

Tinea versicolor can be treated at home with topical products such as antifungal creams, shampoos, and solutions. After treatment is started, it can take months for the spots to disappear and for your skin color to return to normal. Although tinea versicolor can usually be treated successfully with medicines, the rash may return in 1 or 2 years.

When using creams, shampoos, or solutions, follow the directions closely. You usually need to use these products for 1 to 2 weeks. If your skin becomes irritated, stop using the product.

To prevent tinea versicolor from coming back, use a topical product at least once a month. Talk to your dermatologist about how often to use the product. Antifungal pills prescribed by your doctor can be used once a month to prevent the rash from returning, but they are usually not needed. The medicine in antifungal pills comes to the surface of your skin through sweat. So you'll get the best results if you take an antifungal pill, exercise briskly and long enough to sweat, and then wait about 12 hours before you shower.

Tanning will make the condition more obvious, so avoid tanning to keep the change in skin color less noticeable.

For more information on the medicines used to treat tinea versicolor, see the Treatment Overview section of this topic.

Some doctors believe fungi that remain in clothing may cause the rash to return. Normal washing and cleaning are usually effective in removing fungi from clothes. But for persistent tinea versicolor, you may need to dry-clean your clothes or wash them in the hottest possible water.

Other Places To Get Help

Organization

Related Information

• Athlete's Foot
• Fungal Nail Infections
• Ringworm of the Scalp or Beard
• Ringworm of the Skin

References

Citations

1. Habif TP (2004). Tinea versicolor section of Superficial fungal infections. Clinical Dermatology: A Color Guide to Diagnosis and Therapy, 4th ed., pp. 451–454. Philadelphia: Mosby.

Other Works Consulted

• Janik MP, Heffernan MP (2008). Yeast infections: Candidiasis and tinea (pityriasis) versicolor. In K Wolff et al., eds., Fitzpatrick's Dermatology in General Medicine, 7th ed., vol. 2, pp. 1822–1830. New York: McGraw-Hill.
• Berger TG (2008). Tinea versicolor (pityriasis versicolor) section of Dermatologic disorders. In SJ McPhee et al., eds., Current Medical Diagnosis and Treatment 2008, 47th ed., pp. 100–101. New York: McGraw-Hill.
• Faergemann J, Nazarian R (2006). Tinea versicolor (pityriasis versicolor). In MG Lebwohl et al., eds., Treatment of Skin Disease: Comprehensive Therapeutic Strategies, 2nd ed., pp. 654–656. Philadelphia: Mosby Elsevier.
• Habif TP, et al. (2005). Tinea versicolor. Skin Disease: Diagnosis and Treatment, 2nd ed., pp. 228–231. Philadelphia: Elsevier Mosby.
• Wolff K, Johnson RA (2009). Pityriasis versicolor (PV) section of Fungal infections of the skin and hair. In Fitzpatrick's Color Atlas and Synopsis of Clinical Dermatology, 6th ed., pp. 732–735. New York: McGraw-Hill.

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