What is tinea versicolor

Pityriasis versicolorIndicationsInfectious diseasesPityriasis versicolor is a common, benign, and chronically recurring skin disease caused by fungi of the genus Malassezia is triggered. Hyper- or hypopigmented spots appear on sebum-rich skin regions such as the back. Antifungal or keratolytic drugs are used for treatment.

synonymous: tinea versicolor, bran lichen, bran fungus


Pityriasis versicolor is a skin disease that occurs mainly in areas with high sebum production such as the back, chest, upper arms, shoulders, armpits, neck, face and the base of the scalp. Round to oval hyper- or hypopigmented spots appear. The skin is slightly thickened, flaky, and sometimes slightly itchy. The spots can be colored, for example pink, salmon, brown, red or black. If they are hypo- or depigmented, it is also referred to as pityriasis versicolor alba.


The cause of the disease is a superficial fungal infection of the stratum corneum with yeasts of the genus Malassezia, especially with Malassezia globosa. These unicellular and lipophilic fungi are a normal part of the skin flora in all people, but only in some do they lead to clinical symptoms due to endogenous and exogenous factors.

Risk factors

Fungal growth is favored by a warm, moist and lipid-rich environment. Adolescents and younger adults are more often affected because they produce more sebum, and the disease is more common in countries with a tropical climate. Sweating is also thought to promote the condition, and heredity is likely to play an important role (often in first-degree relatives). Other factors such as immunosuppression are discussed.


The diagnosis can usually be made by an experienced dermatologist on the basis of the clinical picture. In addition, a microscopic test is carried out. Skin flakes are dissolved with potassium hydroxide (KOH) and a little heat and colored with methylene blue, for example. Under the microscope, the round spores and the thread-like pseudohyphae are visible (also known as “spaghetti with meatballs” in jargon, corresponding images can be found in the specialist literature). In some of the patients, the lesions fluoresce under UV radiation (Wood light, 365 nm or in the disco).


The diagnosis is made under medical treatment. Other pigmentation disorders such as vitiligo can be used as differential diagnoses, but these mainly occur on the hands and face. Other skin diseases such as chloasma, tinea corporis, seborrheic dermatitis, pityriasis rosea, erythrasma or syphilis must be excluded in the diagnosis.


Topical antifungal drugs:

Systemic antifungal drugs:

  • Internally, fluconazole, itraconazole or ketoconazole are used. These drugs must be prescribed by a doctor and can cause more adverse effects than topical therapy. It should also be noted that it is not suitable for all patients. One advantage, on the other hand, is that it is easier to use.

Topical Keratolytics:

  • such as selenium disulfide, zinc pyrithione, sulfur or salicylic acid are corneal dissolving agents that can also affect sebum production and are partially antimicrobial. They are used in the form of shampoos or as a suspension.

It should be noted that the spots can persist for weeks to months even after successful treatment, especially if they are de- or hypopigmented.


Since relapses are common, antifungal and keratolytic drugs are also used preventively. For example, the literature suggests using selenium disulfide on the first three days of the month. Prophylaxis is also possible with internal or external antimycotics.

see also

Antifungals, Azole Antifungals, Terbinafine, Ciclopirox, Keratolytics

  • Altmeyer P., Bacharach-Buhles M. Dermatology, Allergology, Environmental Medicine. Berlin, Heidelberg: Springer-Verlag, 2008
  • Medicinal product information (CH)
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Conflicts of Interest: None / Independent. The author has no relationships with the manufacturers and is not involved in the sale of the products mentioned.

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