Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android

For further information, see CMDT Part 6-16: Fungal Infections of the Skin

Key Features

Essentials of Diagnosis

  • Velvety, tan, pink, or white macules or white macules that do not tan with sun exposure

  • Fine scales that are not visible but are seen by scraping the lesion

  • Central upper trunk the most frequent site

  • Yeast and short hyphae observed on microscopic examination of scales

General Considerations

  • Mild, superficial Malassezia infection of the skin (usually of the upper trunk)

  • Patients often first notice that involved areas will not tan, causing hypopigmentation

  • High recurrence rate after treatment

Clinical Findings

Symptoms and Signs

  • Lesions are asymptomatic, with occasional itching

  • The lesions are velvety, tan, pink, white, or brown macules that vary from 4–5 mm in diameter to large confluent areas

  • The lesions initially do not look scaly, but scales may be readily obtained by scraping the area

  • Lesions may appear on the trunk, upper arms, neck, and groin

Differential Diagnosis

  • Seborrheic dermatitis

  • Vitiligo

    • Usually presents with periorificial lesions or lesions on the tips of the fingers

    • Characterized by total depigmentation, not just a lessening of pigmentation as with tinea versicolor

    • Does not scale


Laboratory Tests

  • Large, blunt hyphae and thick-walled budding spores ("spaghetti and meatballs") are seen on KOH preparation

  • Fungal culture is not useful


  • Stress to the patient that the raised and scaly aspects of the rash are being treated; the alterations in pigmentation may take months to fade or fill in

  • Irritation and odor from therapeutic agents are common complaints from patients


Table 6–2.Useful topical dermatologic therapeutic agents.1

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.