As summer comes to an end our office is full of patients who need their physicals for school and sports.

 

I was doing such a sports physical on a teenage patient who was on the high school water polo team. Needless to say he was in perfect shape. His mop of blond hair was going in every direction. He had a golden tan from working out all summer with virtually no body fat, and had a resting pulse of 56/minute; great cardiovascular shape. Upon examining his heart and lungs mom said, “Oh, now that your shirt is off, let’s ask the doctor about the spots on your back”. She had noticed these spots early this summer but they were not bad nor had they caused any problems.Inevitably she forgot about them. But it seems as if they had gotten worse as the summer progressed. I chuckled to myself because this was the third patient I had seen in the past two weeks with the very same rash.

 

He had classic Tinea versicolor which is a rash that usually occurs on the trunk and causes pigment changes to the skin that may be subtle.

 

Tinea versicolor is caused by the fungus Malassazia furor which lives on our skin and normally causes no problems. This fungus lives alongside our body’s skin cells. It helps fight off pathogens and exists in a sort of symbiotic relationship. But when certain conditions arise the fungus may grow out of control. Then this may affect the normal pigmentation of our skin. When this occurs it is known as Tinea versicolor.
 

It is not clear why the fungus grows out of control.

But the conditions that exacerbate the overgrowth are hot and humid weather, excessive sweating, oily skin, hormonal changes and a weakened immune system. Tinea versicolor occurs in people of all races and is more common in adolescents and young adults.
 

Tinea versicolor does not cause any constitutional symptoms such as fever, chills or pain.

 

It only affects the pigmentation of our skin cells causing a discoloration that is usually seen on the back and neck, less so on the chest and arms. The typical discoloration is a hypo-pigmentation where there is a lightening of the skin tone causing round or oval patches on the back in various sizes. These patches rang from one- half an inch to 3-5 inches. They may coalesce or merge into larger blotches or patches that can cover a large portion of the back. They are flat, not raised, and can be subtle. When one is in the sun getting a tan they seem more obvious because of the differential with the normal skin tone. They “stand out”. Less commonly, the rash may be a pink, tan or brown in color. There may be dryness, itching or scaling. Tinea versicolor is NOT contagious and cannot be spread from person-to-person.

 

Tinea versicolor is not dangerous or serious. It is easily treatable.

 

In mild cases one can use an over-the-counter anti-fungal such as Lotrimin AF cream or lotion, Micaderm cream, Lamisil AT cream or gel or Selsun Blue 1% lotion or shampoo. These should be applied twice a day for 14 days. If one uses the shampoo, it should be applied for 5-10 minutes, then rinsed off, twice a day for 14 days. In more severe cases or in recurrent cases a doctor may prescribe a stronger prescription strength topical anti-fungal medication or even an oral anti-fungal drug. If this does not treat the rash completely, then it would be wise to see a Dermatologist.