PITYRIASIS VERSICOLOR

This is a common, chronic, superficial fungal infection which is caused by
the yeast pityrosporum. It is usually asymptomatic, causing only cosmetic
complaints. Pityrosporum is a normal skin resident predominantly of
seborrhoeic areas which becomes pathogenic under favourable circumstances:
warmth and humidity, pregnancy, serious underlying disease or
a genetic predisposition. On the scalp the infection presents as dandruff,
from there the neck and upper trunk become infected. Recurrences are
common, especially after inadequate treatment or re-infection.
Management of pityriasis versicolor
- Scrubbing the skin with a brush takes away a lot of the infected scales.
- Do not use vaseline, olive oil or palm oil.
- An imidazole cream twice daily on affected areas for 4 weeks. Add selenium
sulphide shampoo or ketaconazole 2% shampoo (expensive) twice weekly for the
scalp if lesions are widespread or if they are recurrences or
- Selenium sulphide suspension (e.g. Selsun shampoo) to affected areas overnight as a lotion or
- Selenium sulphide suspension (e.g. Selsun shampoo) to affected areas and the scalp
for 10 minutes daily for 2-4 weeks or
- Sodiumthiosulphate 20% solution overnight for
2-4 weeks or
- Propylene glycol 50% in water applied twice daily to
affected areas + scalp for 2-4 weeks or
- Salicylic acid 5% + sulphur 5% ointment
overnight for 2-4 weeks or
- Salicylic acid 5% gel or lotion overnight for
2-4 weeks.
- Recurrences can be prevented by 2 weekly or
once monthly preventiive treatment with any
of the above.
- In severe recurrent cases: ketaconazole 400 mg
stat or ketaconazole 200 mg once daily for 5 days
or itraconazole 200 mg once daily for 1 week.
- Treatment is complete when all the scales have
disappeared. You can test this by stretching
affected skin between two fingers; if scales
appear the infection is still active. After treatment
hypopigmentation may persist for some time and
wil re-pigment faster when exposed to the sun.