Q: I get a blotchy rash on my chest and back in the summer that my doctor told me is something called “Tinea Versicolor.” What causes that and how can I treat it?
A: Tinea Versicolor (TV) is a common rash that affects up to 10 percent of all teenagers. The rash is usually most notable in areas where you sweat the most; typically, it may start on the back and spread slowly to your chest, abdomen, shoulders and neck. It usually gets noticed in the summer because the spots make your normal skin look “blotchy.”
TV is caused by a yeast-like organism called Malassezia that is part of your normal skin flora, and infection is limited to the uppermost portion of the skin. The name versicolor itself means “several colors,” a fact that is reflected in the range of colors (from white to red to brown) assumed by the organism on your skin.
TV occurs worldwide and is more frequently seen in areas with higher temperatures and higher relative humidity. It also tends to run in families. The exact number of people affected by TV is difficult to predict because many affected individuals might not seek medical attention. The rate of infection appears to be the same across all races and genders.
Your doctor might make the diagnosis of TV based on the characteristic rash. It might also help to look at some skin scrapings under the microscope, which may reveal a characteristic “ziti and meatballs” pattern, representing short fungal hyphae and big, round spores in clusters.
Treatment is straightforward, with education forming the keystone of any management plan. Patients need to understand that TV might recur and that skin pigment changes might take months to revert to normal; sun avoidance/protection is the best way to minimize contrast between affected and normal skin.
Over-the-counter topical preparations are usually very effective. Selenium sulfide shampoos or lotions (like Selsun Blue or Extra-Strength Head and Shoulders) are inexpensive and readily available. Typically, they are applied to affected areas of the skin for about 5 to 10 minutes and then washed off completely; this process is repeated once a day for about 2 weeks. To keep the rash from coming back, repeat this process every other week or during the first week of each month. For more difficult cases, your doctor may choose to use prescription strength medications.
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