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any of several skin disorders characterized by shedding dry flakes of skin

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/10/09 22:19:53」(JST)

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Tinea versicolor (also known as Dermatomycosis furfuracea,^[1] Pityriasis versicolor,^[1] and Tinea flava)^[1] is a condition characterized by a rash on the trunk and proximal extremities.^[1] Recent research has shown that the majority of Tinea versicolor is caused by the Malassezia globosa fungus, although Malassezia furfur is responsible for a small number of cases.^[2]^[3] These yeasts are normally found on the human skin and only become troublesome under certain circumstances, such as a warm and humid environment, although the exact conditions that cause initiation of the disease process are poorly understood.^[2]^[4]

The condition pityriasis versicolor was first identified in 1846.^[5] Versicolor comes from the Latin, from versāre to turn + color.^[6]

Symptoms

The symptoms of this condition include:

Occasional fine scaling of the skin producing a very superficial ash-like scale
Pale, dark tan, or pink in color, with a reddish undertone that can darken when the patient is overheated, such as in a hot shower or during/after exercise. Tanning typically makes the affected areas contrast more starkly with the surrounding skin.^[7]
Sharp border ^[8]
Pityriasis versicolor is more common in hot, humid climates or in those who sweat heavily, so it may recur each summer.^[8]
Sometimes severe "pin-prick" itching in the affected areas; usually when the person's body temperature is elevated by exercise or a hot/warm environment, but the person hasn't started sweating yet. Once sweating begins the "pin-prick" itching subsides.^{[citation needed]}

The yeasts can often be seen under the microscope within the lesions and typically have a so-called "spaghetti and meat ball appearance"^[9] as the round yeasts produce filaments.

In people with dark skin tones, pigmentary changes such as hypopigmentation (loss of color) are common, while in those with lighter skin color, hyperpigmentation (increase in skin color) are more common. These discolorations have led to the term "sun fungus".^[10]

Pityriasis versicolor commonly causes hypopigmentation in people with dark skin tones

Prevalence

This skin disease commonly affects adolescents and young adults, especially in warm and humid climates. It is thought that the yeast feeds on skin oils (lipids) as well as dead skin cells. Infections are more common in people who have seborrheic dermatitis, dandruff, and hyperhidrosis.^[4]

Diagnosis

Tinea Versicolor fluorescence under Wood's lamp

Tinea versicolor may be diagnosed by a potassium hydroxide (KOH) preparation and lesions may fluoresce copper-orange when exposed to Wood's lamp.^[11] The differential diagnosis for Tinea versicolor infection includes:

Pityriasis alba
Pityriasis rosea
Seborrheic dermatitis
Erythrasma
Vitiligo
Leprosy
Syphilis
Post-inflammatory hypopigmentation^[12]

Treatment

Malassezia furfur in skin scale from a patient with tinea versicolor

Treatments for tinea versicolor include:

Topical antifungal medications containing 2.5% selenium sulfide are often recommended.^[11] Ketoconazole (Nizoral ointment and shampoo) is another treatment. It is normally applied to dry skin and washed off after 10 minutes, repeated daily for 2 weeks. Ciclopirox (Ciclopirox olamine) is an alternative treatment to ketoconazole as it suppresses growth of the yeast Malassezia furfur. Initial results show similar efficacy to ketoconazole with a relative increase in subjective symptom relief due to its inherent anti-inflammatory properties.^[13] Other topical antifungal agents such as clotrimazole, miconazole or terbinafine can lessen symptoms in some patients^{[citation needed]}. Additionally, hydrogen peroxide has been known to lessen symptoms, and on certain occasions, remove the problem, although permanent scarring has occurred with this treatment in some sufferers.^{[citation needed]} Clotrimazole (1%) is also used combined with selenium sulfide (2.5%) (Candid-TV).

Oral antifungal prescription-only medications include 400 mg of ketoconazole or fluconazole in a single dose, or ketoconazole 200 mg daily for 7 days, or itraconazole^[14]^[15] 400 mg daily for 3–7 days. The single-dose regimens, or pulse therapy regimes, can be made more effective by having the patient exercise 1–2 hours after the dose, to induce sweating. The sweat is allowed to evaporate, and showering is delayed for a day, leaving a film of the medication on the skin.^[16]

Some success with Senna alata has been reported.^[17]

Recurrence is common and may be reduced by intermittent application of topical anti-fungal agents like tea tree oil^[18] or selenium sulfide.

References

^ ^a ^b ^c ^d Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St Louis: Mosby. pp. Chapter 76. ISBN 1-4160-2999-0.
^ ^a ^b Morishita N; Sei Y. (December 2006). "Microreview of Pityriasis versicolor and Malassezia species". Mycopathologia 162 (6): 373–76. doi:10.1007/s11046-006-0081-2.
^ Prohic A; Ozegovic L. (January 2007). "Malassezia species isolated from lesional and non-lesional skin in patients with pityriasis versicolor". Mycoses 50 (1): 58–63. doi:10.1111/j.1439-0507.2006.01310.x.
^ ^a ^b Weedon, D. (2002). Skin pathology (2nd edition ed.). Churchil Livingstone. ISBN 0-443-07069-5.
^ Inamadar AC, Palit A (2003). "The genus Malassezia and human disease". Indian J Dermatol Venereol Leprol 69 (4): 265–70. PMID 17642908.
^ "versicolor". Collins English Dictionary — Complete & Unabridged 10th Edition. HarperCollins Publishers. Retrieved March 2, 2013.
^ "What to Avoid While Treating Tinea Versicolor". Retrieved 2013-01-05.
^ ^a ^b http://www.dermnetnz.org/fungal/pityriasis-versicolor.html
^ "Adolescent Health Curriculum - Medical Problems - Dermatology - Papulosquamous Lesions (B4)". Retrieved 2008-12-10.
^ "Tioconazole (Topical Route) - MayoClinic.com". Retrieved 2008-12-10.
^ ^a ^b Likness, LP (June 2011). "Common dermatologic infections in athletes and return-to-play guidelines.". The Journal of the American Osteopathic Association 111 (6): 373–379. PMID 21771922.
^ http://dermind.tripod.com/tv.htm
^ Ratnavel RC, Squire RA, Boorman GC (2007). "Clinical efficacies of shampoos containing ciclopirox olamine (1.5%) and ketoconazole (2.0%) in the treatment of seborrhoeic dermatitis". J Dermatolog Treat 18 (2): 88–96. doi:10.1080/16537150601092944. PMID 17520465.
^ Faergemann J, Gupta AK, Al Mofadi A, Abanami A, Shareaah AA, Marynissen G (January 2002). "Efficacy of itraconazole in the prophylactic treatment of pityriasis (tinea) versicolor". Arch Dermatol 138 (1): 69–73. doi:10.1001/archderm.138.1.69. PMID 11790169.
^ Mohanty J, Sethi J, Sharma MK (2001). "Efficacy of itraconazole in the treatment of tinea versicolor". Indian J Dermatol Venereol Leprol 67 (5): 240–1. PMID 17664760.
^ Ketoconazole
^ Damodaran S, Venkataraman S (March 1994). "A study on the therapeutic efficacy of Cassia alata, Linn. leaf extract against Pityriasis versicolor". J Ethnopharmacol 42 (1): 19–23. doi:10.1016/0378-8741(94)90018-3. PMID 8046939.
^ http://www.drugs.com/npp/tea-tree-oil.html

External links

Wikimedia Commons has media related to Tinea versicolor.

Health in Plain English - Tinea versicolor
Tinea versicolor is harmless but can recur

UpToDate Contents

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1. 癜風 tinea versicolor pityriasis versicolor
2. 斑状の皮膚病変を有する患者へのアプローチ approach to the patient with macular skin lesions
3. 紅色陰癬 erythrasma
4. マラセチア感染症 malassezia infection
5. 疣贅状表皮発育異常症 epidermodysplasia verruciformis

English Journal

Differential Expression of Extracellular Lipase and Protease Activities of Mycelial and Yeast Forms in Malassezia furfur.

Juntachai W1, Kajiwara S.
Mycopathologia.Mycopathologia.2015 Jul 15. [Epub ahead of print]
Malassezia furfur is a dimorphic yeast that is part of the human skin microflora. This fungus is a pathogen of a certain skin diseases, such as pityriasis versicolor, and in rare cases causes systemic infection in neonates. However, the role of dimorphism in the pathogenicity remains unclear. A modi
PMID 26173769

Malassezia Pneumonia: A Rare Complication of Parenteral Nutrition Therapy.

Baker RM1, Stegink RJ2, Manaloor JJ3, Schmitt BH4, Stevens JC5, Christenson JC3.
JPEN. Journal of parenteral and enteral nutrition.JPEN J Parenter Enteral Nutr.2015 Jul 6. pii: 0148607115595224. [Epub ahead of print]
Malassezia species (formerly known as Pityrosporum) are part of normal human skin flora and have been associated with benign dermatologic conditions, such as seborrheic dermatitis and tinea versicolor. In rare cases, however, Malassezia has been associated with systemic disease in immunocompromised
PMID 26150410

[Tropical and travel-related dermatomycoses : Part 2: cutaneous infections due to yeasts, moulds, and dimorphic fungi].

Nenoff P1, Reinel D, Krüger C, Grob H, Mugisha P, Süß A, Mayser P.
Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete.Hautarzt.2015 Jul;66(7):522-32. doi: 10.1007/s00105-015-3635-8.
Besides dermatophytoses, a broad range of cutaneous infections due to yeasts and moulds may occur in subtropical and tropical countries where they can affect travellers. Not to be forgotten are endemic occurring dimorphic or biphasic fungi in countries with hot climate, which cause systemic and seco
PMID 25924703