Pictorial Case Study

A 28-year-old man had noticed a rash for a few weeks on his upper body.

The rash comprised well-defined, uneven brownish patches which were scaly in appearance.

He was otherwise well and the rash was non-itchy, so he ignored it. After a holiday in the Mediterranean the rash appeared white against his tanned skin and although he remained well, he decided to seek GP advice. What is the diagnosis, management and differential diagnoses?

Diagnosis and management

The diagnosis is pityrisis versicolor which is a common skin infection caused by overgrowth of the yeast, Pityrosporum orbiculare or Malassezia furfur. The yeast is present in most adults. Scrapings should be taken to confirm the diagnosis. Treatment should be undertaken with ketoconazole shampoo or cream.

Possible different diagnoses
- Pityriasis rosea.
- Eczema.
- Vitiligo.
Differential diagnosis
Pityriasis rosea
- Self-limiting.
- Herald patch.
- Affects children and young adults.

Contributed by Dr Gwen Lewis, a GP in Windsor, Berkshire.

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