Tinea versicolor, also known as pityriasis versicolor, is a common fungal skin infection caused by an overgrowth of Malassezia yeast, a type of fungus that’s normally present on the skin’s surface. While typically harmless, an overgrowth of this yeast can lead to discolored patches on the skin, most often found on the chest, shoulders, and back, preventing the skin from tanning evenly. This article explores the causes, symptoms, and treatment options for tinea versicolor, with a focus on dietary and lifestyle adjustments, as well as natural remedies to help manage and reduce skin discoloration.
Understanding Tinea Versicolor
Tinea versicolor is a fungal infection that affects the appearance of the skin, resulting in discolored patches that can be lighter (hypopigmentation) or darker (hyperpigmentation) than a person’s natural skin tone. These patches are typically lighter than the surrounding skin, a condition known as hypopigmentation. On lighter skin, tinea versicolor patches often present as pink or red hues, while on darker skin, they may appear as tan, white, or brown spots. These patches may scale slightly, but rarely itch or hurt.
What Causes Tinea Versicolor?
Tinea versicolor is caused by the uncontrolled growth of Malassezia yeast on the skin. Doctors are unclear on the specific catalyst for this yeast to grow out of control. However, certain environmental factors can expedite microbial growth. Several factors can contribute to this overgrowth, including:
- Hormonal fluctuations: Hormonal changes, particularly during adolescence and pregnancy, can trigger outbreaks.
- Weakened immune system: People with weakened immune systems are generally at a higher risk for developing fungal and bacterial infections. An imbalanced gut microbiome can compromise the body’s immune defenses, which can exacerbate fungal skin conditions, including tinea versicolor. If you have a suppressed immune system, for instance, if you are taking a corticosteroid medication such as prednisone for another health problem, tinea versicolor is more likely to occur.
- Gut dysbiosis: Gut dysbiosis, which is an imbalance of the microbiota in the gut microbiome, may also contribute to tinea versicolor by promoting the overgrowth of fungi and harmful bacteria in the gastrointestinal tract. Gut dysbiosis is often caused by a low-fiber diet high in ultra-processed foods and sugars. Antibiotic medications can also result in gut microflora disruption, which can impact the natural balance of beneficial bacteria and allow harmful microorganisms to proliferate.
- Environmental factors: High temperatures and humidity contribute to moist and warm skin, creating an ideal environment for yeast proliferation. Sun exposure, use of oils on the skin, naturally oily skin and sweating are all suspected to be triggers that can cause the round or oval yeast to convert to its hyphae form, resulting in the rash. This may explain why tinea versicolor is most common in those living in subtropical or tropical regions, especially in individuals with weakened immune systems. Excessive sweating, oily skin, and humid climates create the warm, moist environment where Malassezia thrives.
Symptoms of Tinea Versicolor
Tinea versicolor symptoms include noticeable patches on the skin. It is characterized by discolored round patches or spots on the skin. These discolored patches may be lighter or darker than a person’s natural skin tone. They may also be pink, tan, brown, or red, and they become more prominent with exposure to sunlight. Conversely, tinea versicolor patches may disappear in cool, dry weather. Most patients experience excessive dryness and/or itching, and a tinea versicolor rash can be uncomfortable. Usually, the only symptom of tinea versicolor is the white or light brown patches with well-defined borders. Patches may scale slightly, but rarely itch or hurt.
Differential Diagnosis
Tinea versicolor symptoms are similar to other skin conditions.
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- Vitiligo: People with darker skin may experience hypopigmentation with a tinea versicolor rash. This can often resemble vitiligo, which is a condition that affects the skin’s pigmentation. However, vitiligo does not affect the skin’s texture. This is an easy way to rule out the condition. Additionally, vitiligo does not often appear on the body’s trunk. Unlike tinea versicolor, vitiligo isn’t caused by infection but is linked to an autoimmune disease that results in large, white patches on the skin.
- Pityriasis Rosea: Certain tinea versicolor rashes may resemble the rash associated with pityriasis rosea. However, pityriasis rosacea is characterized by a larger “mother” or “herald” patch. Other red, scaly patches appear around this patch. While pityriasis rosacea is not dangerous, it is associated with higher rates of miscarriage and premature delivery in pregnant people.
- Psoriasis: Psoriasis is an autoimmune skin condition that causes scaly patches. If a case of tinea versicolor develops patches, it can have a similar appearance. However, psoriasis patches are often grey and silvery.
- Bed Bugs: In some cases, a tinea versicolor rash may resemble bed bug bites. However, older bed bug bites can result in fluid-filled blisters, a burning sensation, and bleeding.
If you have a new or developing rash, it’s important to see your primary care provider or dermatologist. While most rashes are benign, they can be uncomfortable. Only a doctor can provide a definitive diagnosis and make personalized treatment recommendations. If you’re unsure whether your skin discoloration is tinea versicolor or another condition like vitiligo or pityriasis rosea, professional diagnosis is vital for appropriate treatment.
Diagnosis and Treatment
Tinea versicolor is usually diagnosed based on a medical history and physical exam. The patches seen with this condition are unique, and usually allow the diagnosis to be made on physical exam. However, many doctors prefer to confirm a diagnosis by taking a sample. The doctor will examine the patches and surrounding skin. In addition, your healthcare provider may use an ultraviolet light, called a Woods Lamp, to see the patches more clearly. This involves scraping a blade across the skin to remove cells. It is not painful and does not cause a cut or blood. Once these cells are removed, they are observed under a microscope to see if the yeast is present. If the doctor suspects a different skin condition, they may run other tests. This can include blood tests or a skin biopsy. Some people can self-diagnose and self-treat tinea versicolor without the help of a doctor.
Treatment usually includes the use of an antifungal or dandruff shampoo on the skin, as prescribed by your healthcare provider. Most people can treat tinea versicolor with over-the-counter products. Medicated cleansers are also a common treatment. People with ongoing or severe cases of tinea versicolor may receive prescription medication from a doctor.
Conventional Treatments
Antifungal medications, such as topical antifungal creams or oral medications, are commonly used to treat tinea versicolor.
- Topical Treatments: Loprox, Nizoral, Extina, and Penlac are common topical prescription creams that can treat the rash. Medicated cleansing bars represent an effective over-the-counter option for patients with mild tinea versicolor infections. The medicated wash benefits include convenience of application during regular showering routines and gentle exfoliation that helps remove affected skin cells. Among cleansing bar types, those with 2% zinc pyrithione are most commonly available and suitable for daily use. Selenium sulfide shampoos stand as a primary over-the-counter treatment option for tinea versicolor, offering patients an accessible solution beyond cleansing bars. We recommend applying the shampoo to affected areas and leaving it on the skin for 10 minutes before rinsing thoroughly. Ideal dosage frequency involves daily application for seven consecutive days, followed by maintenance treatment once or twice monthly to prevent recurrence. For those with extensive or stubborn cases, we may suggest combining selenium sulfide shampoos with other treatments. For best results, apply these medicated shampoos to affected areas, including the scalp and body, leaving them on for 5-10 minutes before rinsing. The key shampoo ingredients work by disrupting fungal cell membranes and inhibiting yeast proliferation while maintaining scalp health.
- Oral Medications: Some patients may also receive prescriptions for oral medication. For persistent cases of tinea versicolor that don’t respond to over-the-counter solutions, we recommend prescription-strength oral antifungal medications such as fluconazole or itraconazole. When topical treatments prove insufficient for persistent or widespread tinea versicolor infections, oral antifungal medications may be prescribed by our dermatologists. Common oral antifungals we prescribe include fluconazole, itraconazole, and ketoconazole. These medications demonstrate excellent oral antifungal effectiveness, often clearing stubborn infections with just a few doses. We carefully evaluate each patient before prescribing these medications, as potential side effects may include liver enzyme elevation, nausea, or medication interactions.
If your rash and symptoms don’t resolve after a week of over-the-counter treatment, schedule an appointment with a physician.
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Tinea Versicolor Natural Remedies
Conventional tinea versicolor treatments can be harsh and may contribute to a long-term imbalance of the skin’s microbiome, increasing the risk of future flare-ups of tinea versicolor. Fortunately, certain home remedies may help manage fungal growth and offer a gentler alternative to certain pharmaceutical treatments, though individual results can vary.
- Essential Oils: Essential oils such as oregano and tea tree oil contain terpenoid phenols, a plant compound that has been studied for its potential fungicidal properties. Evidence published in the International Journal of Molecular Sciences found that “Tea tree oil is used medicinally as a topical antiseptic. It has a broad spectrum of antimicrobial activity against a wide range of bacteria, viruses, and fungi, including yeasts.” Thyme and grapefruit seed oil have also been shown to help manage fungal growth due to their high concentrations of carvacrol, thymol, and polymeric flavan-3-ols. These plant-derived compounds can damage microbial cell walls, disrupting their energy production and helping to inhibit the growth of the fungi responsible for tinea versicolor.
- Apple Cider Vinegar: Additionally, apple cider vinegar has potent antibacterial and antifungal properties that may help fight fungal infections, including tinea versicolor. A study published in the Health Sciences Journal found that apple cider vinegar, when used in combination with an antifungal shampoo, was more effective in treating tinea versicolor than using the shampoo alone.
Apple cider vinegar and essential oils such as oregano, tea tree, thyme, and grapefruit seed are potential antifungal agents that can be used separately or combined to improve skin health. It’s recommended to mix four drops of each remedy into one teaspoon of oil and apply it to the affected area daily. Coconut oil is one of the best carrier oils for making a natural tinea versicolor remedy due to its antibacterial and antifungal effects, enhancing the effectiveness of essential oils while providing soothing relief to the skin. However, apple cider vinegar is acidic and can irritate or burn the skin if applied undiluted. While natural remedies can offer effective tinea versicolor relief, it’s important to consult a healthcare provider if symptoms persist or worsen.
The Role of Diet
The well-known statement “you are what you eat” is supported by a great deal of scientific evidence. It makes sense this logic is often applied to treatment of tinea versicolor. Research supports the notion that dietary changes can influence immune function and inflammation, both of which have been associated with Malassezia overgrowth. Additionally, Malassezia relies on sebum, an oily substance produced by the skin, for its growth and survival. So, you may find information online suggesting that limiting intake of saturated fats, which increase sebum production (and are Malassezia’s preferred source of fat), as well as reducing refined sugar intake, which may also decrease sebum overall, are suggested interventions for tinea versicolor. However, these biological links are largely theoretical.
- Probiotic-Rich Foods: By increasing gut bacteria diversity, you can support your microbiome and may help prevent tinea versicolor from recurring. Consuming probiotic foods containing beneficial bacteria, such as sauerkraut, kimchi, natto, and kefir, is an excellent strategy to promote a balanced gut microbiome.
- Fiber and Prebiotic Foods: Additionally, it’s essential to consume plenty of dietary fiber and prebiotic foods, such as leafy greens, garlic, onions, avocados, and asparagus.
- Immune-Boosting Foods: Eat plenty high immune-boosting vitamins, minerals and antioxidants, which include fruits and vegetables which are great sources of vitamins A, C, and E-all which are antioxidant powerhouses. To facilitate your body's detoxification and a smoother recovery, consider using Candidate (which contains effective and safe detoxification herbs: Pau d'arco, Marigold and Lemon grass) and other Candida defense supplements.
Prevention and Lifestyle Adjustments
Tinea versicolor usually happens again, needing additional treatments. It is also important to know that improvement in the skin may be only temporary, and the condition can happen again. Tinea versicolor is a common and persistent condition affecting up to 40 percent of people living in tropical climates. In addition, between 60 and 90 percent of those who are treated for this skin issue experience a recurrence. The tinea versicolor rash continues to return in 40 percent to 60 percent of people. If you have had more than one episode of tinea versicolor, skin treatment every two weeks with a shampoo that destroys yeast (such as anti-dandruff shampoos that contain selenium sulfide) can help to prevent the rash from recurring. This may be especially helpful prior to travel to a tropical climate or during months with warm weather. Your healthcare provider may also recommend using the shampoo monthly to help prevent it from happening again.
There are certain lifestyle changes that can reduce the likelihood of developing this fungal infection.
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- Avoid Excessive Heat and Humidity: Because the rash occurs more readily in hot, humid conditions, keep your skin as dry and cool as possible when you are in this climate. This includes avoiding excessive heat and humidity, limiting excessive sweating, and avoiding sun exposure.
- Skincare Practices: Additionally, avoid using oily skin products, and wear sunscreen (at least SPF 30) every day.
- Hygiene: We recommend keeping the skin clean and dry, as the fungus thrives in warm, moist environments. Wearing breathable fabrics and changing out of sweaty clothes promptly can create an inhospitable environment for the fungus.
- Long-Term Care: For thorough long-term care, patients should implement several lifestyle modifications: avoiding excessive heat and humidity, wearing loose-fitting clothing made of natural fibers, and promptly showering after sweating.
Some patients with frequent recurrences may benefit from scheduled maintenance therapy with oral antifungals once or twice monthly.
Additional Considerations
- Tattoos: Yes, tinea versicolor can affect tattoos by causing temporary discoloration. We recommend prompt treatment to minimize skin reactions and preserve tattoo integrity.
- Contagious Nature: No, tinea versicolor isn’t typically contagious through shared clothing.
- Resolution Time: After treatment, skin discoloration from tinea versicolor typically resolves within 2-3 months as skin recovery progresses. The treatment will not bring the normal color back to the skin immediately. This will happen naturally and may take several months. In most people, the rash goes away with treatment. However, it takes several months for the skin to return to its normal appearance.
- Swimming Pools and Hot Tubs: Yes, swimming pools and hot tubs can trigger tinea versicolor.
- Children: Yes, children can develop tinea versicolor. We often observe tinea symptoms like discolored patches on their skin.
- When to See a Dermatologist: A dermatologist consultation is important when tinea versicolor covers large areas of the body, causes significant discomfort, or frequently recurs.
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