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Essentials of Diagnosis
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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
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General Considerations
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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
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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
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Differential Diagnosis
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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
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Large, blunt hyphae and thick-walled budding spores ("spaghetti and meatballs") are seen on KOH preparation
Fungal culture is not useful
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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
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