At a Glance - Vitiligo vs tinea versicolor

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

Vitiligo

Presentation

  • Altered pigmentation due to destruction of melanocytes.
  • May affect any part of the body, including hair. Most commonly the hands, feet, forearms and face.
  • Presents with well-demarcated white or pale round or oval patches, which may be localised or generalised. Skin itself appears normal.
  • More obvious in dark-skinned patients or after a holiday when areas of skin fail to tan.
  • May follow trauma such as sunburn or emotional stress.
  • Often associated with auto-immune problems such as thyroid disease, pernicious anaemia or alopecia areata.
  • Usually presents before the age of 30, commonly with a family history.
  • Wood's light highlights depigmented areas.

Management

  • Sunscreen to protect depigmented areas that burn rather than tan.
  • Topical steroids. Calcineurin inhibitor on the face may help and cause less damage.
  • Phototherapy - narrow band UVL or PUVA; or laser therapy.
  • If repigmentation fails, depigmentation of normal skin with 20% monobenzylether of hydroquinone may make the vitiligo less obvious.
  • Skin grafts occasionally used for small, persistent unchanging areas.

Tinea versicolor
Tinea versicolor is commonly seen on the trunk, back, arms and legs
Presentation

  • Fungal infection of the skin caused by Malassezia furfur.
  • Most common in teenagers and young adults.
  • Presents with well demarcated, round or oval, white or reddish brown macules with a fine scale.
  • Often first noticed when affected areas fail to tan.
  • Most common on trunk, back, abdomen, upper arms and legs.
  • Recurrences are common.
  • Can confirm diagnosis with skin scraping for microscopy.
  • Affected areas may fluoresce yellow-green under Wood's light.

Management

  • Topical selenium sulphide; topical imidazole antifungal agent such as ketoconazole shampoo, clotrimazole or miconazole.
  • If persistent or widespread, systemic triazole antifungal agent such as fluconazole.
  • Commonly recurs, especially in the immunocompromised.
  • Prophylactic treatment with ketoconazole or fluconazole for one to three days each month may prevent recurrences.

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