- 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.
- 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.
- 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.
- 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.