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Varied Presentations of Tinea Versicolor: Case 2 Truncal Tinea Versicolor

Varied Presentations of Tinea Versicolor: Case 2 Truncal Tinea Versicolor

Large, reddish tan, asymptomatic patches recently developed on the trunk of a 36-year-old man. Five years earlier, a similar outbreak had resolved after a 10-day course of oral ketoconazole; this episode was the first recurrence. Tinea versicolor is a superficial skin infection caused by Pityrosporum orbiculare and Pityrosporum ovale, also known as Malassezia furfur. The diagnosis is easily made by the clinical appearance and can be confirmed by a potassium hydroxide preparation that shows hyphae--short, rod-shaped fragments intermixed with round spores and grapelike clusters--in what is referred to as the "spaghetti and meatballs" pattern. Recurrences are common and occur most often in the spring and summer. Topical treatments include selenium sulfide suspension 2.5%, sodium thiosulfate 25%, ketoconazole, miconazole, clotrimazole, econazole, ciclopirox, sulfosalicylic acid shampoo, and zinc pyrithione shampoo. Oral therapies include ketoconazole, itraconazole, and fluconazole. Griseofulvin is ineffective. A 10-day course of oral ketoconazole was prescribed because of its previous effectiveness in this patient.

(Case and photographs courtesy of Dr Robert P. Blereau.)

 
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