Pityriasis versicolor

This is a chronic yeast infection which is often asymptomatic. It is seen in adolescents and adults but not younger children. It is characterised by pigmentary changes, often on the trunk and proximal parts of the limbs. Brown or pinkish oval or round scaly patches are seen (Gawkrodger, 2003) (Figure 12.11). In tanned or pigmented skin, the lesions may be hypopigmented. It is caused by overgrowth of a yeast called Pityrosporum orbiculare. It is common in young adults.

Management

1. Topical imidazole antifungal, e.g. Canesten or Daktarin, or alternatively selenium sulphide shampoo (Selsun) or ketaconazole shampoo should be applied and showered off after 5–10 minutes three times a week for 2 weeks. The best way to do this may be to lather the shampoo on the scalp and then allow the lather to sit on the skin. While redness and scaling rapidly improves, colour disturbances can take months to recover.
2. Recurrence is common, so patients need to be made aware of the difference between prolonged repigmentation and recurrence of the active condition.
3. For resistant cases, Itraconazole 200 mg daily for 7 days may be given.