Pityriasis Versicolor in Children - Clinicals, Diagnosis, and Management

Dermatology

Clinicals - History

Fact Explanation
Macular areas of depigmentation of the skin Pityriasis Versicolor is a benign superficial cutaneous fungal infection of the commensal yeast in the genus Malassezia. The macules are lighter, but sometimes darker than the surrounding skin. Sun exposure may make it more apparent. Carboxylic acid is released by the organisms through the oxidation of unsaturated fatty acids of skin surface lipids. It competitively inhibit tyrosinase, the enzyme of pigment production in melanocytes which results in hypopigmented macules. But sometimes hyper pigmented macules will appear as a result of enlarged melanosomes induced by the organism. The upper trunk is commonly affected. ,, Macular areas of depigmentation of the skin
Pityriasis Versicolor is a benign superficial cutaneous fungal infection of the commensal yeast in the genus Malassezia. The macules are lighter, but sometimes darker than the surrounding skin. Sun exposure may make it more apparent. Carboxylic acid is released by the organisms through the oxidation of unsaturated fatty acids of skin surface lipids. It competitively inhibit tyrosinase, the enzyme of pigment production in melanocytes which results in hypopigmented macules. But sometimes hyper pigmented macules will appear as a result of enlarged melanosomes induced by the organism. The upper trunk is commonly affected. ,,
Fine scaling over the lesions Pityriasis Versicolor is a superficial fungal infection localized to the stratum corneum., Fine scaling over the lesions
Pityriasis Versicolor is a superficial fungal infection localized to the stratum corneum.,
Mild pruritis This is not common. But sometimes mild pruritus may occur in the affected areas, when the person's body temperature is elevated by exercise or a warm environment, usually just before starting to sweat. Once sweating begins the itching subsides. ,, Mild pruritis
This is not common. But sometimes mild pruritus may occur in the affected areas, when the person's body temperature is elevated by exercise or a warm environment, usually just before starting to sweat. Once sweating begins the itching subsides. ,,
Common among young adults ie. when the sebaceous glands are more active, especially during puberty. This is a lipophilic organism; therefore the high lipid content in sebum is a suitable medium for growth. , , Common among young adults
ie. when the sebaceous glands are more active, especially during puberty. This is a lipophilic organism; therefore the high lipid content in sebum is a suitable medium for growth. , ,
Common in children living in a warm humid environment. This is a common disorder in temperate zones and seen more frequently in tropical countries. Warmth and humidity provide a suitable environment on skin surface for the growth of Malassezia yeast. , Common in children living in a warm humid environment.
This is a common disorder in temperate zones and seen more frequently in tropical countries. Warmth and humidity provide a suitable environment on skin surface for the growth of Malassezia yeast. ,
There may be a history of increased sweating. Increased sweating and sebum secretion encourages the growth of the causative organism. There may be a history of increased sweating.
Increased sweating and sebum secretion encourages the growth of the causative organism.
There may be a history of immunosuppression. Pityriasis Versicolor is common among children with AIDS, Cushings syndrome, patients on long term steroids and in children with other immuno deficiencies. When considering the immune mechanisms of defense against fungal infections, it is accepted now that cell-mediated immunity is the main mechanism of defense. There may be a history of immunosuppression.
Pityriasis Versicolor is common among children with AIDS, Cushings syndrome, patients on long term steroids and in children with other immuno deficiencies. When considering the immune mechanisms of defense against fungal infections, it is accepted now that cell-mediated immunity is the main mechanism of defense.
There may be a history of malnutrition. Malnutrition disrupts the function of immune system components. This weakens the immune system defense. The depressed immunity results in the pathogenic growth of Malassezia yeast. There may be a history of malnutrition.
Malnutrition disrupts the function of immune system components. This weakens the immune system defense. The depressed immunity results in the pathogenic growth of Malassezia yeast.

Clinicals - Examination

Fact Explanation
Numerous, well marginated, oval to irregularly shaped macules scattered across the skin. Initially appears as oval to round macules and as the macules coalesce, they form irregular shapes. , Numerous, well marginated, oval to irregularly shaped macules scattered across the skin.
Initially appears as oval to round macules and as the macules coalesce, they form irregular shapes. ,
Predominantly involving the upper trunk. Skin regions of chest, back and axillae are commonly affected. Pityriasis versicolor is caused by lipophillic organisms.The mentioned areas in the body have more sebaceous glands; therefore these regions are more commonly involved. But the lesions may appear anywhere on the body. ,, Predominantly involving the upper trunk.
Skin regions of chest, back and axillae are commonly affected. Pityriasis versicolor is caused by lipophillic organisms.The mentioned areas in the body have more sebaceous glands; therefore these regions are more commonly involved. But the lesions may appear anywhere on the body. ,,
Light scraping over lesion produces fine scales. Pityriasis Versicolor is a superficial fungal infection localized to stratum corneum. Light scraping can easily remove Keratin scales over the Lesions. , Light scraping over lesion produces fine scales.
Pityriasis Versicolor is a superficial fungal infection localized to stratum corneum. Light scraping can easily remove Keratin scales over the Lesions. ,
Hyperhydrosis. Local hyperhidrosis affects many young adults, most commonly noted are palms, soles and axillae. Increased rates of sweating and sebum secretion encourages the growth of the causative organism. , , Hyperhydrosis.
Local hyperhidrosis affects many young adults, most commonly noted are palms, soles and axillae. Increased rates of sweating and sebum secretion encourages the growth of the causative organism. , ,
Features of Cushings syndrome. Children with Cushing's syndrome have a suppressed immunity. Pityriasis versicolor is more common in children with immunodeficiencies due to their weak defense mechanisms against fungal infections. Therefore features of Cushing's syndrome such as central obesity, buffalo hump, moon face, acne, purple skin striae and hypertension may be noted during examination. Features of Cushings syndrome.
Children with Cushing's syndrome have a suppressed immunity. Pityriasis versicolor is more common in children with immunodeficiencies due to their weak defense mechanisms against fungal infections. Therefore features of Cushing's syndrome such as central obesity, buffalo hump, moon face, acne, purple skin striae and hypertension may be noted during examination.
Features of malnutrition. Features of macro and micronutrient deficiencies such as dry eyes, pale conjunctiva Bitot's spots, angular stomatitis, cheilosis, glossitis, spongy bleeding gums, brittle hair, poor wound healing may be positive findings on general examination. Features of malnutrition.
Features of macro and micronutrient deficiencies such as dry eyes, pale conjunctiva Bitot's spots, angular stomatitis, cheilosis, glossitis, spongy bleeding gums, brittle hair, poor wound healing may be positive findings on general examination.

Investigations - Diagnosis

Fact Explanation
Wood's lamp examination The Wood's lamp examination is a test that uses long wave ultraviolet light to closely examine the skin. It shows the coppery orange or apple green fluorescence of Pityriasis Versicolor. , Wood's lamp examination
The Wood's lamp examination is a test that uses long wave ultraviolet light to closely examine the skin. It shows the coppery orange or apple green fluorescence of Pityriasis Versicolor. ,
Light microscopic examination This is the confirmatory investigation. Scrapings prepared with 20% Potassium hydroxide (KOH) are examined with a light microscope. The spores with short branched hyphae gives the typical 'Spaghetti and meatballs ' appearance. Light microscopic examination
This is the confirmatory investigation. Scrapings prepared with 20% Potassium hydroxide (KOH) are examined with a light microscope. The spores with short branched hyphae gives the typical 'Spaghetti and meatballs ' appearance.
Culture Culture is not helpful as special media are required and as a result are performed rarely as diagnosis can be achieved with light microscopic examination of slides prepared with KOH. Culture
Culture is not helpful as special media are required and as a result are performed rarely as diagnosis can be achieved with light microscopic examination of slides prepared with KOH.

Management - Supportive

Fact Explanation
Explain the condition. Explain that Pityriasis versicolor is a benign fungal infection of the superficial skin. It is not contagious as it is due to a common commensal on the skin. It does not cause permanent scarring and can be treated successfully.The treatment will not immediately resolve the skin lesion; it may take up to several months. Recurrence is common. , Explain the condition.
Explain that Pityriasis versicolor is a benign fungal infection of the superficial skin. It is not contagious as it is due to a common commensal on the skin. It does not cause permanent scarring and can be treated successfully.The treatment will not immediately resolve the skin lesion; it may take up to several months. Recurrence is common. ,
Improve self hygiene. Bathing regularly, wearing clean dry clothes and washing garments regularly can effectively reduce recurrence rates. Improve self hygiene.
Bathing regularly, wearing clean dry clothes and washing garments regularly can effectively reduce recurrence rates.

Management - Specific

Fact Explanation
Imidazole group of antifungals Applied locally at night to all affected areas for 2 - 4 weeks. (Eg. Clotrimazole, Miconazole, Econazole cream). These drugs interfere with fungal oxidative enzymes and results in lethal accumulation of hydrogen peroxide and reduces the ergosterol synthesis which is an important constituent of the fungal wall; therefore rendering the fungal wall permeable to intracellular constituents., , Imidazole group of antifungals
Applied locally at night to all affected areas for 2 - 4 weeks. (Eg. Clotrimazole, Miconazole, Econazole cream). These drugs interfere with fungal oxidative enzymes and results in lethal accumulation of hydrogen peroxide and reduces the ergosterol synthesis which is an important constituent of the fungal wall; therefore rendering the fungal wall permeable to intracellular constituents., ,
Ketoconazol Shampoo Easy to use, non irritant and as effective as Selenium sulphide.It is recommend to use it monthly to prevent recurrences. , , Ketoconazol Shampoo
Easy to use, non irritant and as effective as Selenium sulphide.It is recommend to use it monthly to prevent recurrences. , ,
Selenium suphide lotion This can be applied for 10 min and rinsed off. This is to be continued daily for 1 week. Is relatively less tolerable than Ketoconazole shampoo Selenium suphide lotion
This can be applied for 10 min and rinsed off. This is to be continued daily for 1 week. Is relatively less tolerable than Ketoconazole shampoo
2.5% Selenium sulphide mixture in a detergent base Equally effective as Imidazole and cheaper. But it is irritant and not preferred in treating children. 2.5% Selenium sulphide mixture in a detergent base
Equally effective as Imidazole and cheaper. But it is irritant and not preferred in treating children.
Systemic antifungals Oral Itraconazole, Fluconazole or Ketoconazole are used for wide spread lesions. These drugs show P450-mediated drug interactions , , Systemic antifungals
Oral Itraconazole, Fluconazole or Ketoconazole are used for wide spread lesions. These drugs show P450-mediated drug interactions , ,

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