How are pediatric tinea versicolor lesions characterized?

Updated: Jan 27, 2020
  • Author: Lyubomir A Dourmishev, MD, PhD; Chief Editor: Dirk M Elston, MD  more...
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Answer

Skin lesions are either hypopigmented or hyperpigmented maculae in various shapes. Hyperpigmented maculae become hypopigmented after solar irradiation and subsequent tanning, as the name implies.

Lesions are either macules or very superficial plaques with fine scale that may not be evident except upon close examination. Even when scale is not apparent, when the skin is wiped with a wet cloth and scraped for examination, it yields a surprising amount of dirty-brown keratin. In some cases, lesions may appear atrophic (atrophying pityriasis versicolor). [5]

If not, the areas of dyschromia may represent residual effects of previously treated tinea versicolor. Occasionally, determining whether the lighter or darker skin is affected is difficult.

Lesions have relatively sharp margins and may be lighter or darker than the normal skin color. The lesions are frequently a light tan color in light-skinned individuals. The color of lesions varies from individual to individual, but each individual's lesions are approximately the same color. Lesions are evenly pigmented. The inflammatory border, relative central clearing, and erythema seen in most fungal infections are lacking.

Small lesions are usually circular or oval. Confluent patches with scattered circular or oval macules around the edges are common. Other lesions may be large enough to cover most of the trunk.

Lesions are usually asymptomatic but may be mildly pruritic. The pruritus is more intense when the patient is excessively warm.

Residual hypopigmentation, without overlying scale, may remain for many months following effective treatment. These areas may become more apparent following sun exposure, causing the patient to incorrectly suspect that the infection has recurred.

Examples of findings in tinea versicolor are shown in the images below.

In patients with lighter skin color, lesions frequ In patients with lighter skin color, lesions frequently are a light tan or salmon color.
Scale is frequently difficult to appreciate upon c Scale is frequently difficult to appreciate upon clinical examination.
This individual developed skin discoloration and m This individual developed skin discoloration and mild itching every summer for the past few years. These patients should be instructed on the prophylactic use of topical therapy.
This superficial plaque of tinea versicolor is loc This superficial plaque of tinea versicolor is located in the right antecubital fossa of an adult. This appearance and distribution is uncommon but not rare. A potassium hydroxide (KOH) preparation confirmed the diagnosis.
Although tinea versicolor is uncommon in children Although tinea versicolor is uncommon in children in temperate climates, when it does occur, it is more likely to be atypical in distribution. This 7-year-old boy had areas of tinea versicolor across the forehead and both temples. He was in good health and lived in Washington state when he was diagnosed.
In some patients, the areas affected by tinea vers In some patients, the areas affected by tinea versicolor are not always obvious. In this patient, the abnormal areas are hypopigmented.
Some patients present with extensive tinea versico Some patients present with extensive tinea versicolor. This patient related that his discoloration had been present for more than 20 years. The light-colored areas on the abdomen are the normal areas of skin. Although topical therapy alone is usually effective, this patient may benefit from initial therapy with oral ketoconazole, followed by selenium sulfide applications in the shower 2-3 times a month.
Significant hyperpigmentation caused by a tinea ve Significant hyperpigmentation caused by a tinea versicolor infection.

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