At a Glance - Pityriasis versicolor versus vitiligo

PITYRIASIS VERSICOLOR
CLINICAL FEATURES

  • Common fungal infection of the skin by Malassezia furfur.
  • Abnormal pigmentation of well-defined, white to red-brown papules and round or oval macules on the skin.
  • More frequent in hot climates and in the immunosuppressed.

MANAGEMENT

  • Fluoresces yellow under Wood's light.
  • Treat with ketoconazole shampoo (daily for up to five days) or selenium sulphide shampoo diluted with water (unlicensed).
  • Topical imidazole or terbinafine creams may be helpful.
  • Systemic fluconazole or itraconazole for widespread pityriasis, failure to respond to other measures, or repeated recurrences.

VITILIGO
Clinical features

  • Depigmentation of the epidermis due to loss of melanin.
  • Affects approximately 1 per cent of the population.
  • Thought to be an autoimmune disorder.
  • Well-defined asymptomatic, depigmented areas of the skin that may gradually increase in number and size.

MANAGEMENT

  • Extent may be assessed using Wood's light.
  • Skin biopsy may be indicated if the diagnosis is in doubt.
  • Advise sunscreen to protect the depigmented areas.
  • Treatment is phototherapy with PUVA, UV-B or excimer laser.
  • Topical steroids are helpful. Systemic steroids have been tried.
  • Skin grafts from areas of pigmented skin or cosmetic camouflage may be required.
  • Areas may benefit more from removal of remaining pigment with a bleaching agent such as a hydroquinone.

 

Contributed by Dr Jean Watkins, a GP locum in Hampshire.

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