Tinea Versicolor: Simple to treat, hard to cure

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Tinea Versicolor: Simple to treat, hard to cure

By Dan Gold • June 10, 2008

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The skin discoloration is there year round, but its appearance is

variable. In dark-complexioned people it is a lighter area of skin.

In light-complexioned people the skin is darker. And in patients who

tan heavily in the summer and lose their tan in winter, the rash

reverses with the tan.

Ironically, the causative fungus lives on most people's skin

unnoticed. With infection it becomes symptomatic.

Besides discoloration, the skin may itch, and if scratched, might

flake. It typically is seen on the chest, back, neck and upper

extremities; however, people may also have it in the groin area.

Hot, humid weather with associated sweating causes spreading. The

infection leads to visits to the doctor mostly for cosmetic reasons.

Many people think it looks or insinuates that they are dirty.

Treatment can diminish or eradicate the rash, but it usually recurs.

Selenium, found in dandruff control shampoos such as Selsun Blue,

can be applied in the shower to the skin like a body shampoo.

After lathering, the shower water should be turned off and the suds

allowed to stand for five minutes before rinsing. Patients are

usually advised to use these preparations every shower the first

week, three times the second week, then once a week to keep the rash

at bay. It can be harder to control.

Prescription shampoo, cream, and lotion preparations may be more

effective. Oral antifungal meds such as Nizoral (ketoconazole) are

available in tablet form by prescription only. One week-long method

of therapy is to take the pill once a day, then wait two hours and

exercise until perspiring. The drug is thought to be released

through sweat and oil glands into the skin, enhancing eradication of

the fungus. Still, it might return, but why?

Most medicines that kill bacteria or fungi work by providing a

chemical to the target organism which is used as a building block in

cell wall construction or some other critical process of

reproduction. This building block does not work and causes cell

death. The medication has to be available to the target organisms

during cellular division.

Since fungi divide slowly or infrequently, many dormant cells may

remain on the skin after medications are washed off or metabolized.

Division occurs and the infection is re-established. This requires

re-treatment.

Fortunately, this skin infection, for those with normal immune

defenses, is not dangerous. Most primary care providers can

recognize Tinea Versicolor at first sight. If the cause is in doubt,

a simple scraping of cells placed upon a glass slide and treated

with a few drops of potassium hydroxide will show fungal elements

reminiscent of spaghetti and meatballs. The diagnosis is clinched

and accurate treatment can begin. Your doctor can help.

Dan Gold is medical director at Big Sandy Medical Center. The

Healer's Corner is a general information medical column and is not

intended for use in self-diagnosis and treatment of individual

medical problems. E-mail him at thehealerscorner@....