Grzybica różowata – Epidemiologia

Grzybica różowata
Epidemiologia

Grzybica różowata (Tinea versicolor) jest powszechną powierzchowną infekcją grzybiczą skóry wywołaną przez drożdżopodobne grzyby z rodzaju Malassezia (M. furfur, M. globosa, M. sympodialis). Prewalencja choroby wykazuje silną zależność od klimatu: w krajach tropikalnych i subtropikalnych sięga 30-50%, w klimacie umiarkowanym wynosi 1-4%, a w chłodnych regionach, np. Szwecji, spada do 1,1%. W USA częstość występowania szacuje się na 2-8%. Choroba najczęściej dotyka młodych dorosłych w wieku 15-30 lat, co wiąże się ze zwiększoną produkcją sebum w okresie dojrzewania. Czynniki ryzyka obejmują gorący i wilgotny klimat, nadmierną potliwość (31,8% pacjentów w badaniu indyjskim), tłustą skórę (21,1%), noszenie okluzyjnej odzieży, immunosupresję, choroby współistniejące (cukrzyca, choroba Cushinga) oraz stosowanie kortykosteroidów i preparatów na bazie olejów. Występuje z podobną częstością u obu płci i we wszystkich grupach etnicznych.

Epidemiologia grzybicy różowatej

Występowanie geograficzne
Sezonowość
Dystrybucja demograficzna
Czynniki ryzyka
Predyspozycje rodzinne

Charakterystyka nawrotów
Metody nadzoru i diagnozowania

Nietypowe lokalizacje i kliniczne warianty

Znaczenie dla zdrowia publicznego

Kolejne rozdziały

Epidemiologia grzybicy różowatej

Grzybica różowata (łac. Tinea versicolor, Pityriasis versicolor) jest powszechną powierzchowną infekcją grzybiczą skóry, występującą na całym świecie, jednak z wyraźnie zróżnicowaną częstością w zależności od regionu geograficznego i warunków klimatycznych. Choć nie jest chorobą zagrażającą życiu, stanowi istotny problem dermatologiczny ze względu na swoją powszechność oraz tendencję do nawrotów.¹²

Występowanie geograficzne

Częstość występowania grzybicy różowatej wykazuje silną korelację z warunkami klimatycznymi:¹²

W krajach tropikalnych i subtropikalnych o wysokiej wilgotności i temperaturze, częstość występowania może sięgać 30-50% populacji¹²³
W Zachodnim Samoa, gdzie panuje gorący i wilgotny klimat, prewalencja osiąga nawet 50%¹²
W klimacie umiarkowanym częstość występowania wynosi około 1-4%¹²
W chłodnych regionach, takich jak Szwecja, prewalencja spada nawet do 1,1%¹²

W Stanach Zjednoczonych szacuje się, że 2-8% populacji cierpi na tę chorobę, choć dokładna częstość występowania jest trudna do oszacowania, gdyż wielu pacjentów nie szuka pomocy medycznej.¹²

Sezonowość

Grzybica różowata wykazuje wyraźną sezonowość w regionach o klimacie umiarkowanym:¹²

W strefach umiarkowanych (w tym większość USA) zmiany skórne najczęściej pojawiają się w cieplejszych miesiącach roku i zwykle zanikają w chłodniejszych i suchszych miesiącach¹
Badania z Iraku wykazały, że największą liczbę przypadków (46,3%) odnotowano w okresie od kwietnia do czerwca²
W Indiach zaobserwowano wyraźną sezonową zmienność z największą liczbą przypadków w sierpniu i wrześniu³

W krajach tropikalnych, gdzie ciepło i wysoka wilgotność utrzymują się przez cały rok, choroba jest bardziej rozległa i trwała.¹

Dystrybucja demograficzna

Wiek

Grzybica różowata najczęściej dotyka określone grupy wiekowe:¹²

Najwyższą częstość występowania obserwuje się u nastolatków i młodych dorosłych, głównie w przedziale wiekowym 15-30 lat¹²³
W USA najczęściej występuje u osób w wieku 15-24 lat¹
W krajach tropikalnych, takich jak Liberia i Indie, najczęściej dotyczy osób w wieku 10-19 lat¹
Rzadziej występuje u małych dzieci i niemowląt, choć zostały opisane takie przypadki¹²
Po 40 roku życia poziom lipidów w skórze stopniowo maleje, co sprawia, że grzybica różowata staje się rzadkością¹

Znaczny wzrost występowania choroby między dzieciństwem a okresem dojrzewania może być związany ze zmianami hormonalnymi, które zwiększają produkcję sebum, tworząc środowisko bogate w lipidy, sprzyjające wzrostowi grzyba.¹²

Płeć

Większość badań wskazuje, że grzybica różowata dotyka mężczyzn i kobiety w równym stopniu, bez wyraźnej przewagi którejkolwiek z płci.¹²³ Jednakże niektóre badania lokalne wykazują pewne zróżnicowanie:

Niektóre badania sugerują nieznacznie częstsze występowanie u mężczyzn¹²
Badanie z Indii wykazało, że 69% pacjentów stanowili mężczyźni, a 31% kobiety¹
Badanie z Iraku wykazało odwrotną tendencję – 40,6% mężczyzn i 59,4% kobiet²

Rasa i pochodzenie etniczne

Grzybica różowata występuje we wszystkich grupach etnicznych z podobną częstością:¹²

Nie wykazano przewagi występowania w żadnej konkretnej grupie etnicznej¹
Chociaż zmiany barwnikowe są bardziej widoczne u osób o ciemniejszej karnacji, częstość występowania choroby wydaje się być taka sama we wszystkich rasach¹²

Czynniki ryzyka

Zidentyfikowano szereg czynników zwiększających ryzyko zachorowania na grzybicę różowatą:¹²

Gorący i wilgotny klimat¹²
Nadmierna potliwość (hyperhidrosis) – obserwowana u 31,8% pacjentów w badaniu indyjskim¹²
Tłusta skóra (skóra łojotokowa) – występująca u 21,1% pacjentów w badaniu indyjskim¹²
Noszenie okluzyjnej odzieży – odnotowane u 19,4% pacjentów¹
Aktywność fizyczna i regularne ćwiczenia¹²
Immunosupresja lub niedobory odporności¹²
Choroby współistniejące jak cukrzyca, choroba Cushinga, łojotokowe zapalenie skóry, łupież¹²³
Stosowanie kortykosteroidów (miejscowo lub ogólnie)¹
Stosowanie kremów lub płynów na bazie olejów¹
Niedożywienie¹

Predyspozycje rodzinne

Badania wskazują na możliwy wpływ czynników genetycznych lub środowiskowych w obrębie rodziny na występowanie grzybicy różowatej:¹

Dodatni wywiad rodzinny odnotowano u około 25-38,3% pacjentów¹²³
Rozprzestrzenianie się choroby z rodziców na dzieci było częstsze (13,3%) w porównaniu z przenoszeniem między małżonkami (10%), co sugeruje rolę czynnika dziedzicznego w transmisji choroby¹

Chociaż grzybica różowata nie jest uważana za chorobę zakaźną w konwencjonalnym znaczeniu, czasami dotyka więcej niż jednego członka rodziny.¹ Udane zakażenie eksperymentalne nastąpiło w warunkach laboratoryjnych przy użyciu olejów miejscowych i okluzji.¹²

Charakterystyka nawrotów

Grzybica różowata charakteryzuje się wysokim wskaźnikiem nawrotów, nawet po skutecznym leczeniu:¹²

Według niektórych badań nawroty dotyczą około 60% pacjentów w pierwszym roku i 80% w drugim roku po leczeniu¹
W badaniu indyjskim nawroty zgłaszało 60% pacjentów¹
W innym badaniu nawroty obserwowano u 35% pacjentów¹

Czynniki przyczyniające się do nawrotów obejmują:¹

Ciepłe i wilgotne środowisko¹²
Nadmierne pocenie się¹
Predyspozycja do tłustej skóry¹
Przetrwanie grzyba w mieszkach włosowych, co może przyczyniać się do wysokiego wskaźnika nawrotów¹

Zapobiegawcze leczenie za pomocą terapii miejscowej lub doustnej, stosowanej okresowo, jest często wymagane, aby uniknąć nawrotów w większości przypadków.¹² Po leczeniu zaleca się profilaktyczne stosowanie preparatów przeciwgrzybiczych, zwłaszcza w okresach zwiększonego ryzyka, takich jak ciepłe i wilgotne miesiące.¹

Metody nadzoru i diagnozowania

Diagnoza grzybicy różowatej często opiera się na obrazie klinicznym, jednak w przypadkach niejednoznacznych stosuje się dodatkowe metody diagnostyczne:¹²

Bezpośrednie badanie mikroskopowe (preparat KOH) – charakterystyczny obraz „spaghetti i klopsy” (strzępki i zarodniki grzyba), wykazujące wysoką czułość¹²
Badanie w świetle Wooda – fluorescencja żółto-złota lub pomarańczowo-brązowa¹
Dermatoskopia¹
Dermatoskopia fluorescencyjna indukowana promieniowaniem ultrafioletowym¹
Objaw Besniera – łuszczenie się zmian po zadrapaniu, użyteczna metoda diagnostyki klinicznej, szczególnie gdy dostęp do badania bezpośredniego jest ograniczony¹
Hodowla – rzadziej stosowana ze względu na niższą czułość w porównaniu z mikroskopią (24,7% pozytywnych hodowli w porównaniu do 92,9% pozytywnych wyników mikroskopii w badaniu indyjskim)¹

Na podstawie badań indyjskich zaleca się mikroskopię KOH jako użyteczny test przesiewowy dla grzybicy różowatej ze względu na wysoką czułość.¹

Nietypowe lokalizacje i kliniczne warianty

Chociaż grzybica różowata typowo dotyka górnej części tułowia, szyi i ramion, klinicyści powinni być świadomi możliwości wystąpienia zmian w nietypowych lokalizacjach:¹

Twarz i skóra głowy¹
Ramiona i nogi¹
Okolice narządów płciowych i pachwiny¹
Dłonie i podeszwy stóp¹

Lekarze powinni być świadomi tych wariantów lokalizacji i przeprowadzać odpowiednią diagnostykę, gdy zmiany mają morfologiczne cechy grzybicy różowatej, mimo nietypowej lokalizacji.¹

Znaczenie dla zdrowia publicznego

Grzybica różowata, choć rzadko prowadzi do poważnych powikłań zdrowotnych, ma istotne znaczenie dla zdrowia publicznego ze względu na:¹²

Wysoką częstość występowania – szacuje się, że globalnie częstość występowania powierzchownych grzybic skóry wynosi 20-25%¹
Trudności w całkowitej eradykacji i skłonność do nawrotów¹²
Wpływ na jakość życia pacjentów, szczególnie ze względu na widoczne zmiany barwnikowe skóry¹
Potrzebę długotrwałego leczenia i profilaktyki¹

W Stanach Zjednoczonych grzybice powierzchowne są drugą najczęściej zgłaszaną chorobą skóry po trądziku, a szacowane ryzyko zachorowania w ciągu życia wynosi między 10 a 20%.¹

Chociaż grzybica różowata jest często nazywana „grzybicą”, jest ona wywoływana przez drożdżopodobny grzyb z rodzaju Malassezia (M. furfur, M. globosa, M. sympodialis), a nie przez dermatofity, które są odpowiedzialne za prawdziwe grzybice.¹²

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Materiały źródłowe

#1 Tinea Versicolor – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/sites/books/NBK482500/
Tinea versicolor is common worldwide but most prevalent in warm and humid regions. Tinea versicolor can reach a prevalence of up to 50% in tropical countries, while in colder climates such as Sweden, it can be as low as 1.1%. Adolescents and young adults experience the highest incidence, possibly because their sebaceous glands produce more sebum, which creates a lipid-rich environment that promotes the growth of Malassezia. However, there have been reported cases in infants and children. Tinea versicolor affects men and women equally, without any specific ethnic predominance. […] The cause of tinea versicolor is a fungus usually present on the skin. Generally, this fungus does not cause any problems, but a rash can develop in people living in hot and humid climates. Tinea versicolor causes multiple small patches of the skin to have more or less color than usual. The colors vary from white to light brown, dark brown, gray-black, or pinkish red. The rash most often appears on the upper back, chest, and upper arms. Tinea versicolor is not contagious.
#1 Tinea Versicolor: Practice Essentials, Pathophysiology, Etiology
https://emedicine.medscape.com/article/1091575-overview
Tinea versicolor occurs more frequently in areas with higher temperatures and higher relative humidities. The national prevalence of this condition is 2-8% of the population. The exact incidence in the United States is difficult to assess because many individuals who are affected may not seek medical attention. […] Tinea versicolor occurs worldwide, with prevalences reported to be as high as 50% in the humid, hot environment of Western Samoa and as low as 1.1% in the colder temperatures of Sweden. […] Although the alteration in skin pigmentation is more apparent in darker-skinned individuals, the incidence of tinea versicolor appears to be the same in all races. […] Several studies have addressed the frequency of tinea versicolor based on sex, and no dominance of either sex is apparent.
#1
https://step1.medbullets.com/dermatology/112070/tinea-versicolor
Epidemiology […] prevalence […] 30-40% in tropical climates […] 1-4% in temperate climates […] demographics […] most common in adolescents and young adults […] risk factors […] hot and humid weather […] excessive sweating […] immunosuppression
#1 Pityriasis versicolor. Tinea versicolor
https://dermnetnz.org/topics/pityriasis-versicolor
Pityriasis versicolor most frequently affects young adults and is slightly more common in men than in women. […] Pityriasis versicolor is more common in hot, humid climates than in cool, dry climates. […] Although it is not considered infectious in the conventional sense, pityriasis versicolor sometimes affects more than one member of a family. […] Pityriasis versicolor generally clears satisfactorily with treatment but often recurs when conditions are right for malassezia to proliferate. […] Pityriasis versicolor often recurs when the weather becomes warm and humid again.
#1 Pediatric Tinea Versicolor: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/911138-overview
Depending on the method and sensitivity of sampling methods, Malassezia species may be found in as many as 18% of infants and 90-100% of adults in the United States. Clinical tinea versicolor is more common in areas with higher temperatures and higher relative humidities. The incidence of this condition is approximately 2-8% of the population. The exact incidence is difficult to assess because many affected individuals may not seek medical attention. […] Tinea versicolor occurs worldwide, with incidence figures ranging from 1.1% in the cold environment of Sweden to 50% in the humid, hot environment of Western Samoa. In temperate zones, the onset typically occurs during the warmer months of the year, and the lesions generally fade in the cooler and drier months. In tropical countries, where heat and high humidity are more continuous, people develop more extensive and persistent disease.
#1 Tinea Versicolor: Practice Essentials, Pathophysiology, Etiology
https://emedicine.medscape.com/article/1091575-overview
In the United States, tinea versicolor is most common in persons aged 15-24 years, when the sebaceous glands are more active. The occurrence of tinea versicolor before puberty or after age 65 years is uncommon. In more tropical countries, age frequency varies; most cases involve people aged 10-19 years who live in warmer, humid countries, such as Liberia and India.
#1 Pediatric Tinea Versicolor: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/911138-overview
In temperate zones (including most of the United States), tinea versicolor is rare in children. Affected infants or children often have an atypical presentation. In temperate areas, the disorder is common in young adults aged 17-24 years. In tropical climates, tinea versicolor is more common in individuals in the age range of 20-30 years. Beyond age 40 years, lipid levels in the skin gradually decrease, and tinea versicolor becomes uncommon. […] Females and males are equally affected. […] Although tinea versicolor is usually more apparent in darker-skinned individuals, the incidence of tinea versicolor appears to be the same in all races.
#1
https://journals.lww.com/jfmpc/fulltext/2022/09000/epidemiological,_clinical_and_mycological.45.aspx
Pityriasis versicolor is a common fungal infection of the skin which leads to the formation of scaly and discoloured small lesions on skin. […] A total of 113 patients [78 (69.0%) male; 35 (31%) female] were included in the study. […] A total of 87 (76.9%) patients were from rural area. […] Outdoor occupation and positive family history of pityriasis versicolor was present in 65 (57.5%) and 38 (33.6%) patients, respectively. […] Recurrent episodes were reported by 66 (60%) patients. […] Excessive sweating and oily skin were seen in 36 (31.8%) and 24 (21.1%) patients, respectively. […] History of occlusive clothing was present in 22 (19.4%) patients. […] Pityriasis versicolor is more common in young adults and males with the most common presentation of hypopigmentation lesions.
#1 Clinical-epidemiological characteristics of patients with tinea versicolor in a Colombian reference center
http://www.scielo.org.co/scielo.php?script=sci_abstract&pid=S0123-93922021000100011
ORTIZ-FLOREZ, Andrea et al. Clinical-epidemiological characteristics of patients with tinea versicolor in a Colombian reference center. Infect. [online]. 2021, vol.25, n.1, pp.11-15. ISSN 0123-9392. https://doi.org/10.22354/in.v25i1.902. […] to describe the sociodemographic aspects, clinical presentation and extrinsic conditions that may increase the risk of developing pityriasis versicolor. […] a total of 42 patients were included in the study, all of them had confirmed mycological diagnosis of pityriasis versicolor. […] The main factors involved in the development of pitiraisis versicolor were traveling to places with high temperatures and sport practice. […] The Besnier sign is a useful method for the clinical diagnosis of pityriasis versicolor, particularly when access to direct examination is limited.
#1 Clinico-epidermiological studies on tinea versicolor – Indian Journal of Dermatology, Venereology and Leprology
https://ijdvl.com/clinico-epidermiological-studies-on-tinea-versicolor/
In our study the disease was seen in association with systemic diseases like malignancy, tuberculosis or diabetes. The disease flares up when the immunity goes down. […] Recurrence rate of tinea versicolor is very high. Even though the yeast is a part of normal flora, sometimes it resides deep in the hair follicles. This may contribute to the high recurrence rate. Unless the predisposing factors are removed after the completion of the treatment, the recurrences cannot be prevented.
#1 Malassezia – Infectious Disease Advisor
https://www.infectiousdiseaseadvisor.com/ddi/malassezia/
Tinea versicolor is a chronic superficial fungal infection characterized by scaly hypopigmented or hyperpigmented macules or patches primarily on the upper trunk, neck, and upper arms. Although tinea versicolor is found worldwide, it is more common in hot, humid climates. The prevalence is as low as 0.5% in dry climates but up to 50% in tropical climates. It is most common among adolescents and young adults, and occurs less often in young children or older adults. […] Tinea versicolor is caused by M furfur, M globosa, and M sympodialis. The yeast grows uncontrollably, leading to a fungal infection in the stratum corneum. […] Although tinea versicolor can develop in individuals of any age, it is most common in adolescents and young adults. Researchers believe this may be related to excess sebum production in these age groups. Other factors that increase the risk for tinea versicolor include hyperhidrosis, pregnancy, diabetes, Cushing disease, immunodeficiency, malnutrition, wearing a mask, using oily creams or lotions, use of corticosteroids (topical or systemic), and use of oral contraceptives.
#1 Pityriasis Versicolor: Symptoms and Treatment | Doctor
https://patient.info/doctor/pityriasis-versicolor-pro
It occurs worldwide but is most common in hot and humid climates. It occurs more often in the summer than in the winter months in temperate zones. […] Prevalence may be up to 50% in some tropical countries compared with less than 1% in temperate climates. […] It most often affects teenagers and young adults. It is less common in infants and the elderly. […] It occurs in people of all skin types but the changes in pigment are more obvious in those with darker skin. […] Most infections occur in normal healthy people but the following factors increase the risk: Hyperhidrosis or increased physical activity causing sweating. […] Immunosuppression or immune deficiency. […] Malnutrition.
#1 Clinico-epidermiological studies on tinea versicolor – Indian Journal of Dermatology, Venereology and Leprology
https://ijdvl.com/clinico-epidermiological-studies-on-tinea-versicolor/
One hundred and twenty patients with tinea versicolor who attended the outpatient department of Dermatology, K.M.C Hospital, Mangalore were studied with reference to their clinical features, age and sex distribution, relation to climate and personal habits. The disease was commonest among the age group of 21-30 years (30%). It was found to be distributed predominantly over the neck (71.6%), chest (58.3%) and back (70%). […] Tinea versicolor is a cutaneous, superficial fungal infection characterized by pigmentary changes in the skin due to colonization of stratum corneum by a dimorphic fungus in the normal flora of the skin known as Malassezia furfur. It is more common in young males and more prevalent in tropical region due to the relative high temperature and humidity. […] A positive family history was obtained in 38.3% of the patients. Among the family members, spread from parents to children was more (13.30%) compared to spread among spouses (10%) indicating the role of a hereditary factor in the transmission of the disease.
#1 Tinea versicolor (pityriasis versicolor) – UpToDate
https://www.uptodate.com/contents/tinea-versicolor-pityriasis-versicolor
Tinea versicolor occurs worldwide. […] Tinea versicolor most commonly affects adolescents and young adults but can also occur in children and infants. […] The disorder is not considered contagious, although successful inoculation has occurred under experimental conditions utilizing topical oils and occlusion. […] Epidemiology â Tinea versicolor is a common superficial fungal skin infection that occurs most often in adolescents and young adults.
#1 What Is Tinea Versicolor? – Consensus: AI Search Engine for Research
https://consensus.app/home/blog/what-is-tinea-versicolor/
Tinea versicolor is prevalent worldwide but is especially common in tropical and subtropical regions where the warm and humid climate promotes the growth of Malassezia yeasts. […] The infection is more frequently observed in adolescents and young adults, likely due to the increased activity of sebaceous glands during these life stages, which provides a lipid-rich environment favorable for the yeast. […] Tinea versicolor is known for its high recurrence rate, even after successful treatment. Factors contributing to recurrence include a warm and humid environment, excessive sweating, and a predisposition to oily skin.
#1
https://ukinstitute.org/journals/2/jchs/article/view/46
A significant rise in disease prevalence between childhood and adolescence had been reported and it may be due to hormonal changes that increase sebum production and this lipid-rich environment prefers fungal growth. […] Recurrence rate of Malassezia infection is high, approximately 60% in first year and 80% in the second year. […] This study found that the magnitude of Pityriasis versicolor was relatively lower than a study conducted in tropical regions. The current study finding revealed that male gender, educational status (diploma and above), habit of exercise regularly, sweating excessively and wearing heavy cloths were significantly associated with Pityriasis Versicolor.
#1
https://www.msjonline.org/index.php/ijrms/article/view/5019
Pityriasis versicolor, a chronic superficial fungal infection caused by lipophilic yeasts of the genus, Malassezia is a common infection in the tropical and subtropical regions. […] Objective was to study the epidemiology, clinical presentation, associations, etiological agents and clinico-mycological correlation of pityriasis versicolor. […] Out of the 100 patients with pityriasis versicolor (PV), 70% were males and 30% were females and the most affected age group was between 21-30 years (43%). […] Recurrence was observed in 35% of them. […] Achromic type of PV was the most common clinical presentation in 68% of patients. […] Malassezia globosa is the most common etiological agent of pityriasis versicolor.
#1 Tinea Versicolor – Ø§ÙØ¬ÙØ¹ÙØ© Ø§ÙØ³Ø¹ÙØ¯ÙØ© ÙØ£ÙØ±Ø§Ø¶ ÙØ¬Ø±Ø§ØØ© Ø§ÙØ¬ÙØ¯
https://ssdds.org/en/5242/
Tinea versicolor occurs worldwide, with a higher occurrence in tropical climates. Adolescents and young adults are the most common age groups to develop tinea versicolor. It can also impact children and infants. […] Tinea versicolor has a high recurrence rate. Preventive treatment with topical or oral medication administered intermittently is required to avoid recurrences in most cases.
#1 Tinea Versicolor Treatment, Causes, Pictures, Remedies & Symptoms
https://www.emedicinehealth.com/tinea_versicolor/article_em.htm
Tinea versicolor is a common fungal infection of the skin in adolescents and young adults and leads to discolored patches of skin, usually pale (hypopigmented) spots on the upper back and shoulders. […] Tinea versicolor is more common in males than females. It is most common in the teens and 20s than in younger and older individuals. These risk factors likely have to do with age and hormonally related variations in the natural skin oils. […] Worldwide it is quite common in hot, humid environments and is rare in dry northern nations. […] The diagnosis of tinea versicolor is often made clinically (by appearance), but the best way to make the diagnosis is with a potassium hydroxide (KOH) scraping that shows a characteristic „spaghetti and meatballs” of hyphae (which resemble long branches) and spores (spheres). […] Once treated, maintenance body washes with over-the-counter (OTC) or prescription dandruff shampoos can prevent or decrease the rate of recurrence of tinea versicolor.
#1 Pityriasis VersicolorâA Narrative Review on the Diagnosis and Management
https://www.mdpi.com/2075-1729/13/10/2097
Pityriasis versicolor (PV), also known as tinea versicolor, is a mild, non-contagious chronic, superficial fungal skin infection caused by lipid-dependent yeast-like fungus Malassezia. The disease occurs worldwide but is most prevalent in humid and warm tropical regions. PV tends to be more active in summer seasons. The diagnosis of PV is often simple. It solely relies on the clinical appearance and hardly ever requires biopsy. However, in clinically ambiguous cases, additional non-invasive work-up (e.g., dermatoscopy, ultraviolet-induced fluorescence dermatoscopy, Woodâs light examination or direct microscopy) may facilitate the diagnostic process. […] No sex or ethnic predominance has been reported in PV. PV may affect persons of any age. Nevertheless, it most often develops in adolescents and young adults due to increased sebum production by the sebaceous glands, responsible for the lipid-rich environment, optimal for the yeasts. Higher incidence has been noted in physically active individuals, patients suffering from diabetes and obesity, and immunocompromised individuals. The disease occurs globally, but it is most commonly found in tropical regions and shows a higher incidence during the summer seasons. The prevalence of PV reaches up to 50% in tropical regions, whereas it is estimated to be around 1â4% and 1% in moderate and cold climates, respectively.
#1
https://journals.lww.com/jfmpc/fulltext/2022/09000/epidemiological,_clinical_and_mycological.45.aspx
In our study population, presentation with large patches was more common than macular lesions. […] Pruritus was more in patients with large patches than those with macules. […] Insufficient studies from India reporting clinico epidemiology of p. versicolor creates a knowledge gap which needs to be fulfilled. […] Therefore, this study is an attempt to fill existing research gap by providing recent data on epidemiology and mycology of p. versicolor from Northern India. […] Positive family history was present in almost one-third cases in our study. […] Out of 113 clinically suspected cases, 92.9% were mycologically positive for the fungus by KOH microscopy (characteristic spaghetti and meat balls seen), of which 24.7% were positive by culture indicating high sensitivity of microscopy over culture. […] Based on our findings, we recommend KOH microscopy as a useful screening test for p. versicolor.
#1 Groin (Inguinal) Tinea Versicolor Caused by Malassezia furfur in Iran: Case Report – Tarbiat Modares University Journals System – Infection Epidemiology and Microbiology
https://iem.modares.ac.ir/article-4-7397-en.html
Tinea versicolor (TV) is a common superficial fungal infection of the skin, characterized by scaling and mild disturbance of the skin pigmentation. It typically affects the chest, upper back, and shoulders. However, the involvement of more unusual regions of the body such as the face and scalp, arms and legs, genitalia, groin and palms and soles has been reported. […] The clinician must be aware of these variations in the location of TV and perform an appropriate diagnostic workup when lesions have the morphological characteristics of TV despite an unusual location.
#1 (PDF) Tinea Versicolor – An Epidemiology
https://www.academia.edu/105842945/Tinea_Versicolor_An_Epidemiology
Dermatophytic infections have been one of the major crises prevalent all over the world. […] It has global occurrence and is prominent in hot and humid region. It predominantly affects late teens and young adults of both sexes. […] Tinea versicolor is one of the most common dermatologic disorders seen. […] According to the previously published reports, throughout India incidence of dermatophytosis is 36%. […] Globally, the prevalence of superficial dermatophytes was reported to be 20-25%.
#1
https://ukinstitute.org/journals/2/jchs/article/view/46
Pityriasis versicolor (PV) is a chronic superficial fungal infection caused by Malassezia species. It is the most common dermatologic disorder in tropical countries including Ethiopia and skin discoloration is the principal morbidity resulting from pityriasis versicolor. […] The overall magnitude of PV among patients attending Dermatovenereology OPD at the UGCSH was 12.6% (95%CI; 9.2%, 15.0%). […] The study revealed that educational status (diploma and above), male gender, habit of regular exercise, excessive sweating and wearing heavy cloths were significantly associated with Pityriasis Versicolor. […] Tinea versicolor distributed worldwide, predominantly in tropical countries. […] A 3040% prevalence of PV had been reported in tropical areas worldwide. […] The prevalence of PV is dissimilar among different countries for instance in South America 50%, Egypt 11.6%, and Ethiopia 6.1%.
#1 Topical Treatment of Common Superficial Tinea Infections | AAFP
https://www.aafp.org/pubs/afp/issues/2002/0515/p2095.html
Because tinea infections are highly common, it is likely that the primary care physician will frequently treat affected patients. The estimated lifetime risk of acquiring dermatophytosis (tinea infection) is between 10 and 20 percent. In the United States, dermatophytosis is second only to acne as the most frequently reported skin disease. The majority of superficial fungal infections are tineas and, of those, the most common are tinea pedis, tinea corporis, and tinea cruris. Trichophyton rubrum is the most likely agent in these dermatomycoses. T. rubrum accounted for 76.2 percent of all superficial fungal diseases in a representative sample of the U.S. population. With the exception of tinea capitis (in which Trichophyton tonsurans was the most likely etiologic agent), T. rubrum was the most common dermatophyte isolated in all superficial fungal diseases studied. […] Although tinea versicolor is commonly called a tinea, it is caused by the non-dermatophyte Malassezia furfur (also referred to as Pityrosporum orbiculare and Pityrosporum ovale) and is not a true tinea infection.
#2 Tinea Versicolor: Practice Essentials, Pathophysiology, Etiology
https://emedicine.medscape.com/article/1091575-overview
Tinea versicolor occurs more frequently in areas with higher temperatures and higher relative humidities. The national prevalence of this condition is 2-8% of the population. The exact incidence in the United States is difficult to assess because many individuals who are affected may not seek medical attention. […] Tinea versicolor occurs worldwide, with prevalences reported to be as high as 50% in the humid, hot environment of Western Samoa and as low as 1.1% in the colder temperatures of Sweden. […] Although the alteration in skin pigmentation is more apparent in darker-skinned individuals, the incidence of tinea versicolor appears to be the same in all races. […] Several studies have addressed the frequency of tinea versicolor based on sex, and no dominance of either sex is apparent.
#2 Pediatric Tinea Versicolor: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/911138-overview
Depending on the method and sensitivity of sampling methods, Malassezia species may be found in as many as 18% of infants and 90-100% of adults in the United States. Clinical tinea versicolor is more common in areas with higher temperatures and higher relative humidities. The incidence of this condition is approximately 2-8% of the population. The exact incidence is difficult to assess because many affected individuals may not seek medical attention. […] Tinea versicolor occurs worldwide, with incidence figures ranging from 1.1% in the cold environment of Sweden to 50% in the humid, hot environment of Western Samoa. In temperate zones, the onset typically occurs during the warmer months of the year, and the lesions generally fade in the cooler and drier months. In tropical countries, where heat and high humidity are more continuous, people develop more extensive and persistent disease.
#2
https://step1.medbullets.com/dermatology/112070/tinea-versicolor
Epidemiology […] prevalence […] 30-40% in tropical climates […] 1-4% in temperate climates […] demographics […] most common in adolescents and young adults […] risk factors […] hot and humid weather […] excessive sweating […] immunosuppression
#2
https://step2.medbullets.com/dermatology/120056/tinea-versicolor
Epidemiology […] Prevalence […] 30-40% in tropical climates […] 1-4% in temperate climates […] Demographics […] most common in adolescents and young adults […] Risk factors […] hot and humid weather […] excessive sweating […] immunosuppression […] […] […] Tinea versicolor is a very common cutaneous fungal infection. […] It is characterized by variably colored macules and patches. […] It is also known as pityriasis versicolor.
#2 Open Access Macedonian Journal of Medical Sciences (OAMJMS).
https://oamjms.eu/index.php/mjms/article/view/9714
Pityriasis versicolor (PV) is a common and chronic superficial mycosis seen in all age groups and characterized by dyspigmented lesions caused by dimorphic lipophilic yeast. […] The aim of the study was to study the clinical aspects, prevalence, and demographic data of patients with PV in Baghdad City. […] From 175 patients with PV, there were 71 (40.6%) males and 104 (59.4%) females. […] The majority of cases 71 (40.6%) were 21-30 years. […] Eighty-one (46.3%) patients were presented from April to June. […] The most common age group affected was 21-30 years. […] Peak incidence was observed in April-July months.
#2 Tinea versicolor (pityriasis versicolor) – UpToDate
https://www.uptodate.com/contents/tinea-versicolor-pityriasis-versicolor
Tinea versicolor occurs worldwide. […] Tinea versicolor most commonly affects adolescents and young adults but can also occur in children and infants. […] The disorder is not considered contagious, although successful inoculation has occurred under experimental conditions utilizing topical oils and occlusion. […] Epidemiology â Tinea versicolor is a common superficial fungal skin infection that occurs most often in adolescents and young adults.
#2 Pediatric Tinea Versicolor: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/911138-overview
In temperate zones (including most of the United States), tinea versicolor is rare in children. Affected infants or children often have an atypical presentation. In temperate areas, the disorder is common in young adults aged 17-24 years. In tropical climates, tinea versicolor is more common in individuals in the age range of 20-30 years. Beyond age 40 years, lipid levels in the skin gradually decrease, and tinea versicolor becomes uncommon. […] Females and males are equally affected. […] Although tinea versicolor is usually more apparent in darker-skinned individuals, the incidence of tinea versicolor appears to be the same in all races.
#2
https://ukinstitute.org/journals/2/jchs/article/view/46
A significant rise in disease prevalence between childhood and adolescence had been reported and it may be due to hormonal changes that increase sebum production and this lipid-rich environment prefers fungal growth. […] Recurrence rate of Malassezia infection is high, approximately 60% in first year and 80% in the second year. […] This study found that the magnitude of Pityriasis versicolor was relatively lower than a study conducted in tropical regions. The current study finding revealed that male gender, educational status (diploma and above), habit of exercise regularly, sweating excessively and wearing heavy cloths were significantly associated with Pityriasis Versicolor.
#2 Tinea Versicolor Treatment, Causes, Pictures, Remedies & Symptoms
https://www.emedicinehealth.com/tinea_versicolor/article_em.htm
Tinea versicolor is a common fungal infection of the skin in adolescents and young adults and leads to discolored patches of skin, usually pale (hypopigmented) spots on the upper back and shoulders. […] Tinea versicolor is more common in males than females. It is most common in the teens and 20s than in younger and older individuals. These risk factors likely have to do with age and hormonally related variations in the natural skin oils. […] Worldwide it is quite common in hot, humid environments and is rare in dry northern nations. […] The diagnosis of tinea versicolor is often made clinically (by appearance), but the best way to make the diagnosis is with a potassium hydroxide (KOH) scraping that shows a characteristic „spaghetti and meatballs” of hyphae (which resemble long branches) and spores (spheres). […] Once treated, maintenance body washes with over-the-counter (OTC) or prescription dandruff shampoos can prevent or decrease the rate of recurrence of tinea versicolor.
#2 Pityriasis Versicolor: Symptoms and Treatment | Doctor
https://patient.info/doctor/pityriasis-versicolor-pro
It occurs worldwide but is most common in hot and humid climates. It occurs more often in the summer than in the winter months in temperate zones. […] Prevalence may be up to 50% in some tropical countries compared with less than 1% in temperate climates. […] It most often affects teenagers and young adults. It is less common in infants and the elderly. […] It occurs in people of all skin types but the changes in pigment are more obvious in those with darker skin. […] Most infections occur in normal healthy people but the following factors increase the risk: Hyperhidrosis or increased physical activity causing sweating. […] Immunosuppression or immune deficiency. […] Malnutrition.
#2 Tinea Versicolor | Enhanced Dental CPD Online
https://www.dentaljuce.com/shorts-tinea-versicolor
Tinea versicolor commonly affects adolescents and young adults, particularly in warm and humid climates. […] Infections are more frequent in individuals with seborrheic dermatitis, dandruff, and hyperhidrosis.
#2
https://ukinstitute.org/journals/2/jchs/article/view/46
Pityriasis versicolor (PV) is a chronic superficial fungal infection caused by Malassezia species. It is the most common dermatologic disorder in tropical countries including Ethiopia and skin discoloration is the principal morbidity resulting from pityriasis versicolor. […] The overall magnitude of PV among patients attending Dermatovenereology OPD at the UGCSH was 12.6% (95%CI; 9.2%, 15.0%). […] The study revealed that educational status (diploma and above), male gender, habit of regular exercise, excessive sweating and wearing heavy cloths were significantly associated with Pityriasis Versicolor. […] Tinea versicolor distributed worldwide, predominantly in tropical countries. […] A 3040% prevalence of PV had been reported in tropical areas worldwide. […] The prevalence of PV is dissimilar among different countries for instance in South America 50%, Egypt 11.6%, and Ethiopia 6.1%.
#2
https://journals.lww.com/ijd/fulltext/2008/53040/pityriasis_versicolor__a_clinicomycological_and.6.aspx
Pityriasis versicolor is a mild, chronic, usually asymptomatic superficial fungal infection of the stratum corneum, caused by Malassezia yeasts. […] The purpose of the present study is to assess the clinical profile of a group of patients with pityriasis versicolor and to find out the epidemiological characteristics in this part of India as well as any association, if any, with other diseases. […] Majorities of the patients were young adults. […] There is prominent seasonal variation of the patients with a peak in August and September months. […] Pityriasis versicolor may be variably associated with various systemic diseases such as diabetes mellitus, Cushing’s disease, immunosuppressive conditions and corticosteroid intake. […] The objective of the present study is to find out the clinical pattern, epidemiological characteristics of pityriasis versicolor as well as any significant associations with other diseases from this part of India.
#2 Clinico-epidermiological studies on tinea versicolor – Indian Journal of Dermatology, Venereology and Leprology
https://ijdvl.com/clinico-epidermiological-studies-on-tinea-versicolor/
One hundred and twenty patients with tinea versicolor who attended the outpatient department of Dermatology, K.M.C Hospital, Mangalore were studied with reference to their clinical features, age and sex distribution, relation to climate and personal habits. The disease was commonest among the age group of 21-30 years (30%). It was found to be distributed predominantly over the neck (71.6%), chest (58.3%) and back (70%). […] Tinea versicolor is a cutaneous, superficial fungal infection characterized by pigmentary changes in the skin due to colonization of stratum corneum by a dimorphic fungus in the normal flora of the skin known as Malassezia furfur. It is more common in young males and more prevalent in tropical region due to the relative high temperature and humidity. […] A positive family history was obtained in 38.3% of the patients. Among the family members, spread from parents to children was more (13.30%) compared to spread among spouses (10%) indicating the role of a hereditary factor in the transmission of the disease.
#2 Tinea versicolor (pityriasis versicolor) – UpToDate
https://www.uptodate.com/contents/tinea-versicolor-pityriasis-versicolor/print
Tinea versicolor occurs worldwide. […] Tinea versicolor most commonly affects adolescents and young adults but can also occur in children and infants. […] The disorder is not considered contagious, although successful inoculation has occurred under experimental conditions utilizing topical oils and occlusion. […] Tinea versicolor is a common superficial fungal skin infection that occurs most often in adolescents and young adults.
#2 Pityriasis versicolor. Tinea versicolor
https://dermnetnz.org/topics/pityriasis-versicolor
Pityriasis versicolor most frequently affects young adults and is slightly more common in men than in women. […] Pityriasis versicolor is more common in hot, humid climates than in cool, dry climates. […] Although it is not considered infectious in the conventional sense, pityriasis versicolor sometimes affects more than one member of a family. […] Pityriasis versicolor generally clears satisfactorily with treatment but often recurs when conditions are right for malassezia to proliferate. […] Pityriasis versicolor often recurs when the weather becomes warm and humid again.
#2 What Is Tinea Versicolor? – Consensus: AI Search Engine for Research
https://consensus.app/home/blog/what-is-tinea-versicolor/
Tinea versicolor is prevalent worldwide but is especially common in tropical and subtropical regions where the warm and humid climate promotes the growth of Malassezia yeasts. […] The infection is more frequently observed in adolescents and young adults, likely due to the increased activity of sebaceous glands during these life stages, which provides a lipid-rich environment favorable for the yeast. […] Tinea versicolor is known for its high recurrence rate, even after successful treatment. Factors contributing to recurrence include a warm and humid environment, excessive sweating, and a predisposition to oily skin.
#2 (PDF) Tinea Versicolor – An Epidemiology
https://www.academia.edu/51868085/Tinea_Versicolor_An_Epidemiology
Tinea versicolor (pityriasis versicolor or PV) is a superficial fungal infection, characterized by changes in skin pigment due to colonization of the stratum corneum by a dimorphic lipophilic fungus of the normal flora of the skin, known as Malassezia furfur. […] T. versicolor has a high rate of recurrence and may require frequent prophylactic treatment with topical or oral therapy on an intermittent basis. […] Tinea versicolor is one of the most common infectious skin diseases that is seen in abundance during summer. […] According to the previously published reports, throughout India incidence of dermatophytosis is 36%. […] Tinea corporis and Tinea cruris are estimated to affect 22% to 55% of the Indian population.
#2
https://journals.lww.com/jfmpc/fulltext/2022/09000/epidemiological,_clinical_and_mycological.45.aspx
In our study population, presentation with large patches was more common than macular lesions. […] Pruritus was more in patients with large patches than those with macules. […] Insufficient studies from India reporting clinico epidemiology of p. versicolor creates a knowledge gap which needs to be fulfilled. […] Therefore, this study is an attempt to fill existing research gap by providing recent data on epidemiology and mycology of p. versicolor from Northern India. […] Positive family history was present in almost one-third cases in our study. […] Out of 113 clinically suspected cases, 92.9% were mycologically positive for the fungus by KOH microscopy (characteristic spaghetti and meat balls seen), of which 24.7% were positive by culture indicating high sensitivity of microscopy over culture. […] Based on our findings, we recommend KOH microscopy as a useful screening test for p. versicolor.
#2 Topical Treatment of Common Superficial Tinea Infections | AAFP
https://www.aafp.org/pubs/afp/issues/2002/0515/p2095.html
Because tinea infections are highly common, it is likely that the primary care physician will frequently treat affected patients. The estimated lifetime risk of acquiring dermatophytosis (tinea infection) is between 10 and 20 percent. In the United States, dermatophytosis is second only to acne as the most frequently reported skin disease. The majority of superficial fungal infections are tineas and, of those, the most common are tinea pedis, tinea corporis, and tinea cruris. Trichophyton rubrum is the most likely agent in these dermatomycoses. T. rubrum accounted for 76.2 percent of all superficial fungal diseases in a representative sample of the U.S. population. With the exception of tinea capitis (in which Trichophyton tonsurans was the most likely etiologic agent), T. rubrum was the most common dermatophyte isolated in all superficial fungal diseases studied. […] Although tinea versicolor is commonly called a tinea, it is caused by the non-dermatophyte Malassezia furfur (also referred to as Pityrosporum orbiculare and Pityrosporum ovale) and is not a true tinea infection.
#2 Malassezia – Infectious Disease Advisor
https://www.infectiousdiseaseadvisor.com/ddi/malassezia/
Tinea versicolor is a chronic superficial fungal infection characterized by scaly hypopigmented or hyperpigmented macules or patches primarily on the upper trunk, neck, and upper arms. Although tinea versicolor is found worldwide, it is more common in hot, humid climates. The prevalence is as low as 0.5% in dry climates but up to 50% in tropical climates. It is most common among adolescents and young adults, and occurs less often in young children or older adults. […] Tinea versicolor is caused by M furfur, M globosa, and M sympodialis. The yeast grows uncontrollably, leading to a fungal infection in the stratum corneum. […] Although tinea versicolor can develop in individuals of any age, it is most common in adolescents and young adults. Researchers believe this may be related to excess sebum production in these age groups. Other factors that increase the risk for tinea versicolor include hyperhidrosis, pregnancy, diabetes, Cushing disease, immunodeficiency, malnutrition, wearing a mask, using oily creams or lotions, use of corticosteroids (topical or systemic), and use of oral contraceptives.
#3 Pityriasis VersicolorâA Narrative Review on the Diagnosis and Management
https://www.mdpi.com/2075-1729/13/10/2097
Pityriasis versicolor (PV), also known as tinea versicolor, is a mild, non-contagious chronic, superficial fungal skin infection caused by lipid-dependent yeast-like fungus Malassezia. The disease occurs worldwide but is most prevalent in humid and warm tropical regions. PV tends to be more active in summer seasons. The diagnosis of PV is often simple. It solely relies on the clinical appearance and hardly ever requires biopsy. However, in clinically ambiguous cases, additional non-invasive work-up (e.g., dermatoscopy, ultraviolet-induced fluorescence dermatoscopy, Woodâs light examination or direct microscopy) may facilitate the diagnostic process. […] No sex or ethnic predominance has been reported in PV. PV may affect persons of any age. Nevertheless, it most often develops in adolescents and young adults due to increased sebum production by the sebaceous glands, responsible for the lipid-rich environment, optimal for the yeasts. Higher incidence has been noted in physically active individuals, patients suffering from diabetes and obesity, and immunocompromised individuals. The disease occurs globally, but it is most commonly found in tropical regions and shows a higher incidence during the summer seasons. The prevalence of PV reaches up to 50% in tropical regions, whereas it is estimated to be around 1â4% and 1% in moderate and cold climates, respectively.
#3
https://journals.lww.com/ijd/fulltext/2008/53040/pityriasis_versicolor__a_clinicomycological_and.6.aspx
Pityriasis versicolor is a mild, chronic, usually asymptomatic superficial fungal infection of the stratum corneum, caused by Malassezia yeasts. […] The purpose of the present study is to assess the clinical profile of a group of patients with pityriasis versicolor and to find out the epidemiological characteristics in this part of India as well as any association, if any, with other diseases. […] Majorities of the patients were young adults. […] There is prominent seasonal variation of the patients with a peak in August and September months. […] Pityriasis versicolor may be variably associated with various systemic diseases such as diabetes mellitus, Cushing’s disease, immunosuppressive conditions and corticosteroid intake. […] The objective of the present study is to find out the clinical pattern, epidemiological characteristics of pityriasis versicolor as well as any significant associations with other diseases from this part of India.
#3 Pityriasis versicolor – Knowledge @ AMBOSS
https://www.amboss.com/us/knowledge/pityriasis-versicolor
Occurs worldwide, with a higher incidence in tropical climates. […] More prevalent in healthy individuals 2130 years of age.
#3 Pediatric Tinea Versicolor: Background, Pathophysiology, Etiology
https://emedicine.medscape.com/article/911138-overview
In temperate zones (including most of the United States), tinea versicolor is rare in children. Affected infants or children often have an atypical presentation. In temperate areas, the disorder is common in young adults aged 17-24 years. In tropical climates, tinea versicolor is more common in individuals in the age range of 20-30 years. Beyond age 40 years, lipid levels in the skin gradually decrease, and tinea versicolor becomes uncommon. […] Females and males are equally affected. […] Although tinea versicolor is usually more apparent in darker-skinned individuals, the incidence of tinea versicolor appears to be the same in all races.
#3 Tinea Versicolor | Enhanced Dental CPD Online
https://www.dentaljuce.com/shorts-tinea-versicolor
Tinea versicolor commonly affects adolescents and young adults, particularly in warm and humid climates. […] Infections are more frequent in individuals with seborrheic dermatitis, dandruff, and hyperhidrosis.
#3
https://journals.lww.com/ijd/fulltext/2008/53040/pityriasis_versicolor__a_clinicomycological_and.6.aspx
A descriptive epidemiological study with a cross-sectional design was carried out at Nilratan Sircar Medical College, Kolkata – a tertiary health care set up. […] In the present study, family history was present in approximately 25% of patients. […] The overall clinicomycological and epidemiological profile of pityriasis versicolor infection in eastern India as observed in a tertiary care hospital does not differ significantly from those observed by previous workers.