Patients often come in with small white (hypo-pigmented) patches on their upper arms wondering what to do about it. Ask for help, because you will need to see your doctor for diagnosis and treatment—most treatment options are prescription only. It’s easy to get rid of though, so here you go.
What is it?
Tinea versicolor is a common skin fungal infection. The white/hypopigmented areas occur most commonly on the upper arms and trunk. The organism that causes it is different from athlete’s foot or nail fungus, it is a lipid (fat) dependent yeast called Malassezia. Malassezia is normally found on skin and only causes a problem (tinea versicolor) when it transforms from a yeast form to a mycelial form (the vegetative or branching part of a fungus).
Why do some people get it?
We don’t really know. The use of oils on the skin, hot and humid weather and sweating are risk factors.
Is it contagious?
No. Tinea versicolor is not contagious.
What does it look like?
This may seem strange, but it can cause lighter areas (hypo-pigmented white areas) or darker areas. In light skinned people it can cause white or light brown small patches, in dark skinned folks it can be white, dark brown or gray-black. The most common appearance is lighter or white patches on the upper arms. In kids, for some reason, it most commonly involves the face.
Why the upper arms?
This is a cool and kind of gross fact at the same time. Malassezia is lipid (fat) dependent. There are more sebaceous glands on the upper arms—these glands secrete sebum (an oily substance that helps lubricate our skin) and the Malassezia likes that. Ewww.
Does it itch?
Nope, usually you feel no symptoms you will just notice the differently colored patches. In the summer when you are tan, you will notice them more because the affected patches will not tan, making them look more distinct.
What else could it be?
You will need to see your doctor for treatment so he or she can ensure it is tinea versicolor and not seborrheic dermatitis, vitiligo, or pityriasis rosea, among other things.
Can you treat it?
Yes, treatments work well, but recurrence is common. Remember that even when infection is treated it takes a couple months for the pigment to return to normal. Some folks need long-term maintenance therapy to prevent it from coming back.
So what might you be prescribed to treat tinea versicolor?
- The “Azole” antifungal creams. Clotrimazole 1%, ketoconazole 2%, econazole 1%, and miconazole 2% are examples that work well when used once or twice daily for one to four weeks. After an average of two weeks, 84% of people have been cured. Pick one of these based on price, as these are all generics and should be reasonable, though econazole can still be expensive.
- Ketoconazole 2% shampoo works better with a shorter duration of therapy. The shampoo applied to the areas affected is left on for 5 minutes once daily for 3 days cures 80% of people.
- Terbinafine (Lamisil) 1% cream or gel is used twice daily for one week.
- Ciclopirox 0.77% cream is effective when used twice a day for 14 days. It’s generic and reasonably priced.
- Selenium sulfide shampoo 2.5% works well when used as one 10 minute application daily for one week. Of note, the over the counter 1% shampoo has not been studied so we don’t know if it works for treatment.
- Zinc pyrithione 1% or 2% shampoo is used on areas affected every day for 2 weeks and you leave it on for 5 minutes.
Pills—used only when the topicals don’t work. Two anti-fungal pills have been shown to be effective:
- Fluconazole (Diflucan) 300 mg once a week for two weeks cures 87% of people.
- Itraconazole (Spectazole) 200 mg per day for 5 days also works well.
Hope this helps