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Vitiligo vs. Pityriasis versicolor
There are several possible explanations for skin depigmentation. However when 'spots' does not cause any symptoms the two most likely diagnoses are pityriasis versicolor or vitiligo. It is important before trying any treatment to get your doctor to look at it and confirm what it is, so that any treatment is appropriate. These are the main characteristics:
Pityriasis versicolor/alba (Synonyms: tinea alba, tinea versicolor, tinea flava, achromia parasitica, dermatomycosis furfuracea) is a common skin condition caused by infection of the dead outer layer of skin cells with a yeast fungus (yeast Pityrosporum orbiculare (also known as Malassezia furfur). Young adults are the most affected. This causes spots or patches that have either reduced or increased pigmentation - they may be pale and white, brown or even salmon pink. There are often no other symptoms although sometimes the spots are a little dry and flaky.
Pityriasis versicolor is not contagious - most people carry the yeast which causes it on the skin without problems.
The upper trunk, arms and neck are the commonest sites. Lesions are macular and sharply demarcated, and have fine scaling. They may become confluent over large areas. On sun-protected 'white' skin the patches are skin-coloured or pale brown, but after skin exposure and in darker races they are hypopigmented. The patches often occur close together and often coalesce (grow together) to form large sheets or areas of rash. Pityriasis versicolor differs from rosea in that the color of rosea is usually pink. Versicolor is a rash with various shades of pale yellow, faun and light brown.
High temperatures and humidity favor the occurrance of Pityriasis versicolor.
Treatment consists of antifungal creams or lotions from the pharmacy that must be used regularly all over the skin to clear the fungus. This usually gets rid of the yeast quickly. However the skin colour of the spots will not change back to normal until the depigmented areas have been shed, which can take weeks. Systemic therapy with either ketoconazole, fluconazole, and itraconazole are alternative for patients not responding to topical therapy.
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