Tinea Versicolor (Pale or Brown Patches): Causes, Treatment and Vitiligo Difference

Light brown, pink or white patches that appear on the neck, chest, back or upper arms every summer, and look more obvious after you tan. Many people in Pakistan worry that it is vitiligo or leprosy. In most cases it is neither. It is a harmless fungal condition called tinea versicolor (also called pityriasis versicolor), and it responds well to treatment.

This guide explains what tinea versicolor is, how to tell it apart from vitiligo, how it is treated, why it keeps coming back in hot weather, and when you need a doctor.

What is tinea versicolor?

It is caused by an overgrowth of a yeast (Malassezia) that normally lives on everyone’s skin. In hot, humid conditions, or when the skin is oily or sweaty, the yeast multiplies and produces a substance that interferes with normal skin colour. The result is patches that are lighter or darker than the surrounding skin. It is not contagious, and it is not caused by poor hygiene.

Symptoms

• Small, oval patches that slowly join together, on the chest, back, shoulders, neck and upper arms.
• Colour: pink, tan, brown or white. On darker skin the patches are often lighter.
• Fine, dusty scaling when you scratch the surface.
• Mild itching, mostly when sweating. Some people have none.
• The patches become more obvious after sun exposure, because the affected skin does not tan.

Tinea versicolor or vitiligo?

• Tinea versicolor: patches have fine scale, uneven edges and may be itchy. Colour is not always completely white. It is more common in hot weather and responds to antifungal treatment.
• Vitiligo: patches are chalky white, smooth and without scale. They often appear on the hands, around the mouth and eyes, and over joints, and they have sharp edges. The cause is the immune system, not a fungus. Antifungals do not help.

A doctor can usually tell the difference by looking, and sometimes by shining a special lamp or testing a skin scraping.

Why does it happen?

• Hot, humid weather and sweating, which is why it is so common in summer.
• Oily skin and heavy oils or creams.
• Wearing tight, non-breathing clothes.
• A weak immune system, or steroid use.
• Family tendency. Some people simply get it repeatedly.

How it is treated

Antifungal products clear the yeast, but the skin colour takes weeks to months to return to normal after the infection is gone. Do not expect the patches to vanish quickly. Always follow the directions on the pack or from your doctor.

• Antifungal creams and lotions: products such as Ketagen Cream, which is used for fungal skin infections, are applied to the patches and the skin around them.
• Medicated solutions: Sodium Thiosulphate Solution is a traditional preparation used for tinea versicolor.
• Keratolytic ointments and soaps: Whitfield DS Ointment and AFS Soap contain ingredients such as salicylic acid and benzoic acid that are used for fungal skin infections.
• Shampoos: anti-dandruff shampoos with ingredients such as selenium sulfide, for example Scalp Plus Shampoo, are sometimes used as a body wash for widespread patches, as directed by a doctor.
• Tablets: for widespread or repeated cases, a doctor may prescribe an antifungal tablet.

Browse our fungal infections category for more. If you suspect another fungal infection, see our guide to cracked heels and foot care.

How to stop it coming back

• Wear loose cotton clothes, and change out of sweaty clothes quickly.
• Shower after exercise and on hot days, and dry well.
• Avoid heavy oils or greasy creams on the chest and back in summer.
• Use sunscreen, because tanned skin makes the contrast clearer. Our guide to choosing a sunscreen will help.
• Ask your doctor about a preventive antifungal wash before the hot season, if it returns every year.
• Wash towels, bedding and clothes regularly.

When to see a doctor

• You are not sure what the patches are.
• The patches are numb, thickened or have lost feeling. This needs urgent assessment.
• There is no improvement after four weeks of treatment.
• The condition keeps returning, or is widespread.
• You have a weak immune system, or you are using steroid medicines.
• The skin is very itchy, red or sore.

Frequently asked questions

Is tinea versicolor contagious?

No. The yeast already lives on your skin, and overgrowth does not spread from person to person.

Why are the patches still pale after treatment?

The yeast may be gone, but pigment takes time to recover, often several weeks to months. Sun exposure on the patches helps, with sunscreen on the rest of the skin.

Can I use a steroid cream?

No. Steroid creams can worsen a fungal infection and thin the skin.

Does it affect the face?

It can, especially in children and in hot, humid climates, but it is more common on the trunk.

You can order antifungal skin care from Khasmart, with delivery across Pakistan.

This article is for general information and is not a substitute for advice from your doctor or dermatologist. It does not include dosage or strengths to use; always follow the directions on the pack or from your doctor.