WHAT IS PITYRIASIS VERSICOLOR?

Pityriasis versicolor is an innocent skin condition including light scaling areas on the body that have a different color than the environment. Typically, the areas with pityriasis versicolor are lighter in color than the surrounding skin, but it likewise takes place that they are darker.

This is where the name originates from, due to the fact that the term pityriasis is used in dermatology for all sorts of gently scaling skin illness, and versicolor means opposite color. The color changes are triggered by yeasts of the Malassezia typewho reside on the skin These yeasts prevail on regular skin, however they can trigger skin sores under certain conditions. Pityriasis versicolor is mainly caused by Malassezia globosa and Malassezia sympodialis. The infection is seen particularly in young people. The conditions that promote the advancement of the condition are a high degree of humidity, normally in mix with a high ambient temperature level and a greasy (many-rich) skin.

WHAT ARE THE PHENOMENA?

In people with light skin color, pityriasis versicolor may appear like light brown or reddish-brown spots with a fine scaling. These spots look darker than the surrounding white skin. The color difference is in some cases barely visible in the winter season. When the skin is extended, flakes begin to blow up, this is a sign that the yeast infection is still active. In the summer, the sun can turn color through ‘suns’: the surrounding skin turns brown, the affected areas are left behind in color. At that moment the condition becomes more visible. In people with dark skin color, the spots are lighter in color than the surrounding typical skin.

The areas can differ in size from a few millimeters to tens of centimeters. They are generally seen on the trunk and arms. They can likewise overlap and coagulate over large areas of the skin, with expansion to the lower arms, backs of the hands, thighs and even to the knees. Especially in tropical environments sometimes the face and the hairy head are likewise impacted. The condition is cosmetically troubling, but causes no further grievances, in some cases a little itch.

WHAT IS THE CAUSE OF PITYRIASIS VERSICOLOR?

Pityriasis versicolor is triggered by a superficial infection of the skin by a yeast of the species Malassezia (previously likewise called Pityrosporum ovale). There are various variations of this yeast. Pityriasis versicolor is primarily triggered by the types Malassezia globosa and Malassezia sympodialis. A yeast is a little single cell organism that can multiply by budding. On the typical, healthy skin there are always yeasts of the species Malassezia. These yeasts live off the fat layer that exists on the skin. The largest number of yeasts are discovered on the hairy head, on the top of the trunk, and in the body folds. Under particular situations, particularly under damp and warm conditions, the number of yeasts can increase and trigger problems. Also with certain conditions such as (excessive) sweating, diabetes, pregnancy, and with a lowered resistance more yeasts can be present on the skin. The Malassezia yeasts can not just cause pityriasis versicolor, however also dandruff and a kind of eczema called seborrhoeic eczema.

Pityriasis versicolor is generally seen in warm and damp countries. 40% of the population might struggle with this. On the pigmented skin, pityriasis versicolor is likewise more noticeable because the color difference is greater. In the Netherlands pityriasis versicolor is much less typical, in about 1% of the population. In the Netherlands it is mainly present in the summer season. Here, too, the phenomenon takes place that the condition becomes more visible as soon as one goes sunbathing in the summer season: the surrounding skin turns brown, however the affected areas remain behind in color. The yeasts produce a substance that prevents the production of pigment by the pigment cells. This triggers the color differences.

HOW IS THE DIAGNOSIS PROPOSED?

The skin lesions are so common that it can generally be recognized by eye. In some cases some flakes are removed the skin and analyzed under the microscope to see if there are any yeast spheres. You can also use blue ultraviolet light to see if there is a yellow-green color (some Mallasezia yeast lights yellow-green under ultraviolet light). This is only visible if it is totally dark in the consulting room. After treatment with an anti-yeast agent, the yeast balls can not be found.

HOW IS PITYRIASIS VERSICOLOR TREATED?

Treatment with creams and creams for the skin.

If the location to be treated is not very substantial, it can be used with an antifungal cream such as ketoconazole cream or ciclopirox cream. Lubricate the afflicted location once a day for 2 weeks.

Likewise treat the hairy head two times a week with ketoconazole head gel, since the hairy head is the perfect location for the yeast to survive. From the hairy head they can spread out again over the remainder of the body. Those who regularly struggle with repeating pityriasis versicolor ought to continue to deal with the head frequently (eg when a week) with ketoconazole gel. The gel should be applied to the scalp after cleaning in the shower, then permitted to soak and rinse for 5 minutes. See below under dandruff.

For bigger surface areas, an anti-dandruff hair shampoo such as Selsun (selenium disulfide) or Nizoral head gel (ketoconazole gel) can be applied over the whole body.

Selsun:

Water down the Selsun anti-dandruff shampoo with a little water and spread it over the entire body with a washcloth. Not on the face, not on the genitals and not on damaged skin (wounds), however in the hair. Let the shampoo soak for 10 minutes and then rinse completely. Do this once a day for 7 successive days.

The old guideline for making use of Selsun in pityriasis versicolor was: apply the shampoo pure over the body, put on an old Tee shirts or pajamas and let it work overnight. Rinse next early morning. This just needs to occur once, which is a lot more useful. But due to the fact that Selsun is just a soap, it is sticky and annoying for some patients, hence the above rather milder recommendations from the provider. Those who can handle it can likewise apply the undiluted one-night method.

Ketoconazole head gel or shampoo:

Ketoconazole hair shampoo can be used in the same method as Selsun: wash the hair (potentially with an anti-dandruff shampoo) then leave ketoconazole headgel or hair shampoo for 5 minutes. Likewise spread out ketoconazole hair shampoo over the whole body and leave it for 5 minutes. Then rinse. Repeat this every day for 5 days.

Treatment with tablets:

In extremely comprehensive pityriasis versicolor the yeast infection can likewise be managed by swallowing anti-fungal tablets. This kills the yeast from the within, and all places on the body are reached.

After that the infection can still come back, because due to the fact that the yeast occurs all over in our environment, reinfection quickly occurs. Even then, it makes sense to apply maintenance treatment with a ketoconazole hair shampoo.

WHAT CAN YOU DO YOURSELF?

You can try to prevent conditions that intensify (warm ambient temperature level, humid conditions, excessive sweating). Other pointers are: after showering, always let the skin dry properly, do not walk in a sweaty garment, sleep in a cool bed room. Nonetheless, the condition can constantly return, and one is more susceptible to it than the other. If the condition has come back a number of times, ketoconazole head gel can be used preventively during the summertime.

WHAT ARE THE POTENTIAL CUSTOMERS?

After the healing of pityriasis versicolor the light spots can continue to exist for a longer amount of time. This is due to the fact that the yeast cells secrete a compound that has a (often long-term) inhibitory impact on pigment development. This sometimes confuses: the yeast is well managed and killed, but the skin problem is still just as visible and does not seem to be over. In basic, the pale areas will vanish spontaneously in the course of the summer season or after about half a year. If the white areas still remain noticeable, a tanning bed can sometimes be effective in returning the pigment to the white spots. This can be a routine sunbed remedy in a tanning center.

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