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.

Have you registered with us yet?

Register now to enjoy more articles and free email bulletins

Register

Already registered?

Sign in

Follow Us:

Just published

Renewable energy

GP practices can be 'more ambitious' on tackling climate change

GP practices can be more ambitious in taking steps to tackle climate change than...

GP surgery sign

Risks of being a partner have outstripped benefits, GPs told

The risks of being a partner have become greater that the benefits, the RCGP conference...

Image of Dr Farzana Hussain

GPs urged to use their voices to improve the lives of patients in deprived areas

The can-do attitude and independence of GPs offers a unique opportunity to help reverse...

Professor Sir Michael Marmot

Unequal impact of COVID-19 'utterly predictable' amid rising inequality, says Marmot

The disproportionate impact of COVID-19 on people in the most deprived parts of England...

Consulting room door

NHS on course for shortfall of 11,000 GPs within a decade

One in four GP and practice nurse posts will be vacant within a decade without a...

Dr Iona Heath

Lessons from the COVID-19 pandemic can help GPs tackle health inequalities

GPs can use evidence from the COVID-19 pandemic to put pressure on the government...