Tinea versicolor is one of the most common skin conditions in tropical countries — affecting up to 8% of the Indian population — and one of the most consistently confused with other causes of skin discolouration. Patients present having tried multiple pigmentation treatments for what they believe is a melanin-based problem, unaware that the patchy discolouration on their chest and back is caused by a fungal overgrowth that requires antifungal treatment, not depigmentation.

What Causes It

Tinea versicolor is caused by Malassezia furfur (and related species), a lipophilic yeast that is a normal component of the skin microbiome. Under certain conditions — heat, humidity, excessive sweating, oily skin, immunosuppression, or hormonal changes — Malassezia proliferates excessively and produces azelaic acid as a metabolic byproduct. This azelaic acid inhibits tyrosinase, the melanin-producing enzyme, in the affected skin cells. The result: areas of lighter (hypopigmented) skin on a background of normal or sun-darkened surrounding skin. In some cases, particularly in lighter skin or during active infection, hyperpigmented patches appear instead.

How to Identify It

Tinea versicolor typically presents as well-defined, scaling patches on the chest, upper back, shoulders, and upper arms — occasionally the face in severe cases. The patches fail to tan with sun exposure, making them more noticeable in summer. Under Wood’s lamp examination, they show a characteristic yellow-green fluorescence. The fine scale — visible when the skin is gently scratched — is a clinical hallmark.

Treatment and Prevention

Topical ketoconazole 2% shampoo or cream, applied to affected areas for 10-15 minutes before rinsing, daily for 2-3 weeks, is highly effective. Selenium sulphide shampoo is an alternative. Oral itraconazole (200mg daily for 5-7 days) is used for widespread, resistant, or frequently recurring disease. The critical patient communication: pigmentation normalises slowly after successful antifungal treatment — it can take 3-6 months for the skin tone to even out, even after the infection is completely cleared. This is not treatment failure; it is the natural timeline of melanin recovery.

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— Dr. Nishita Ranka | Consultant Dermatologist | Dr. Nishita’s Clinic for Skin, Hair & Aesthetics, Hyderabad