Dermatology-Online

Pityriasis versicolor

introduction

Pityriasis versicolor (also known as bran lichen, bran fungus) is a fungal infection of the top layer of the skin, which is noticeable by patches distributed over the entire body that appear lighter than the rest of the skin.

causes

The causer of this disease is Malassezia furfur yeast (formerly also called Pityrosporum ovale or Pityrosporum orbiculare).
This is located on the surface of almost everyone's skin, especially on the Scalp, however mostly without symptoms to evoke.
Why the fungus causes disease in some and not in others has not yet been definitively clarified.
However, it is known that there are some factors that favor pathological (morbid) development. This includes Summer months (with a humid, warm climate and high UV radiation), increased sweating and certain underlying diseases (for example Diabetes mellitus or Thyroid disease).
In addition, like almost all fungal infections, pityriasis versicolor is more likely to manifest itself in people who, for whatever reason, have Weakened immune system is (for example, when taking certain medications or in diseases that suppress the immune system, such as AIDS).

Symptoms of pityriasis vesicolor

Pityriasis versicolor is a fungal skin infection.

The main symptom of the bran fungus is that white spots (Hypopigmentation) on the skin.
Depending on the infestation, these spots are small and only step sporadically, especially at areas exposed to sweat again forehead or that move, on, or they are bigger and can "flow together".
This creates a marbled complexion, which is often also called "map-like". This discoloration is caused by the fact that the fungus spreads over the skin. Er produces a toxin (Toxin), which inhibits the production of the pigment melanin, which is responsible for tanning the skin. In addition, the affected areas are physically not as exposed to sunlight as the rest, because they are covered by the fungal lawn. This is why patients tend to tan on all parts of their bodies when they are in the sun, except those on which the fungus is located.
In some cases, the Skin changes itch a littlebut not very strong. If sufferers scratch themselves, it can lead to one superficial desquamation of the skin come.
Pityriasis versicolor is not painful; besides, it is harmless and not infectious.

Diagnosis

The diagnosis of pityriasis versiocolor is at least for an experienced dermatologist due to the characteristic appearance mostly one Eye diagnosis In some cases it makes sense to do another examination of the skin special examination lamp to use which one Black light radiates. In order to distinguish it from other skin diseases, it is important, if any, just minor itching and the typical patterns of infestation in areas with a particularly large number of sweat glands.
If necessary, the doctor can use a Light microscope to secure. For that he has to have some Scrape off and color skin flakeswhich are then placed under the microscope. There the fungal cells appear as grape-shaped balls arranged in clusters.

therapy

The therapy of pityriasis versicolor can local or systemic respectively. Usually with a local treatment began. Various Antifungal agents (Antifungal drugs) be used.
Frequently used Clotrimazole, Bifonazole, Econazole or Naftifin.
These are mostly in the form of a ointment or cream used, but there is also Shampoos, Washing gels or Sprays with these active ingredients.

In more severe and therapy-resistant cases, a Therapy with tabletn take place. These contain either Fluconazole, Ketoconazole or Itraconazole and are prescription only.

After a treatment, it can sometimes take some time until the skin is evenly pigmented again, although the fungal attack has been eliminated.
Often, even after successful therapy, one occurs recurring illness (Relapse). In patients who are prone to recurrent pityriasis versicolor, consideration may be given to whether it is useful regular topical antimycotics (for example as a shampoo with selenium disulfide).

Medication

Patients under Pityriasis versicolor In most cases, ailments are treated with a special drug. To prevent the infection from spreading Antifungal agents (so-called Antifungal drugs) used as a drug.

As a rule, antifungal agents are chosen for the treatment of pityriasis versicolor purely external can be applied.
The drug against pityriasis versicolor is mainly used as ointment, shampoo and or gel applied to the affected skin areas.

When using the Pityriasis versicolor drug, care must be taken to ensure that the Scalp is involved in the treatment. The hairy head in particular is an ideal habitat for the pathogens that lead to the development of pityriasis versicolor. If the scalp is left out when the drug is applied, the fungi are able to spread again starting from the head and infect other parts of the body.

The medication prescribed by the attending physician must at least be used by the patient concerned once or twice a day should be used carefully. The entire duration of use of the drug should be a period of approximately two weeks be.

In severe cases of pityriasis versicolor for which a purely external treatment is not sufficient, an additional orally applicable drug be taken. This treatment method is the only effective treatment strategy for patients who develop pityrosporum folliculitis. Oral administration of a suitable drug is the only effective treatment strategy.

Oral medicines for Pityriasis versicolor are also common antifungal medicines. Possible drugs contain the active ingredient Ketoconazole, fluconazole or Itroconazole. The effectiveness of the administered drug can be increased by leaving the patient about an hour after taking the drug sports exercises.The reason for this is the fact that the active ingredients are able to increasingly reach the affected areas of the skin through the secretion of sweat.

However, there are some inherent challenges in using a drug for pityriasis versicolor orally Risks. The most commonly used active ingredients can have a number of undesirable ones Drug effects (Side effects) cause.
Taking the drug can include a headache, Dizziness, nausea and Vomit occur.
In addition, many of the affected patients suffer from severe symptoms while they are taking the drug Gastrointestinal complaints.
In addition, this is the occurrence of allergic reactions not uncommon with the use of antifungal medication.

The treatment of pityriasis versicolor by an orally ingestible drug should be used in patients with Liver or kidney damage be disregarded.

Even during the pregnancy and the subsequent Lactation Such drugs must not be administered as it is not yet known whether the (unborn) child will be harmed.

Risk of contagion

Direct contact with the sweat of those affected can lead to infection.

The mushrooms responsible for the occurrence of Pityriasis versicolor are Skin yeast fungi, which are basically completely harmless and can be detected on the surface of the skin and in the area of the hair roots of almost everyone.

The presence of this skin yeast fungus only becomes problematic if, in connection with a tendency to sweat profusely, there is an excessive multiplication of the pathogen. Because of this, it can be assumed that pityriasis versicolor is not particularly contagious.

Read more on this topic at: How contagious are yeasts?

Nevertheless, it can be observed that in some families there are more frequent cases of pityriasis versicolor. Whether this phenomenon can ultimately be an indication of how contagious the disease is remains to this day unclear. In professional circles it is rather assumed that a certain hereditary component for increased sweat production plays a decisive role in the development of pityriasis versicolor.

The fact that patients suffering from pityriasis versicolor are not considered particularly contagious so far represents a decisive difference to other fungal diseases of the skin surface. Fungal infections caused by Candida albicans, for example, are considered to be many times more contagious.

Only direct contact with the sweat of people suffering from pityriasis versicolor can lead to the fungus relocating and the disease becoming contagious.

In addition, it must be noted that patients in whom the skin symptoms have already significantly receded can become infected again with the yeast themselves. The reason for this is often insufficient treatment of the scalp. The responsible fungus is able to settle in the area of the scalp and persist there if an anti-fungal shampoo is not used sufficiently. For the affected patient, the yeast remaining on the head surface is highly contagious.

As soon as the symptoms in the area of the skin surface subside and the treatment is discontinued for this reason, the Fungal spores colonize the body surface again starting from the scalp.

forecast

For patients who have already taken Pityriasis versicolor have suffered significantly increased risk develop another skin disease caused by the responsible yeast. For this reason, the prognosis for these patients is rather poor.

The Taking special medicines (Antifungal drugs) that contain the active ingredient ketoconazole, fluconazole or itroconazole can improve the prognosis for those patients for whom external application is not effective even after weeks. In terms of the possible Side effects However, the prescription of such drugs must be carefully considered.

However, the majority of affected patients only suffer from light and less pronounced forms the pityriasis versicolor. With the regular use of special ointments, gels and shampoos, the prognosis of these patients is much better.

In patients who have already suffered from pityriasis versicolor caused by the yeast and who have successfully treated it, the preventive use from Selenium sulfide or KetoconazoleShampoos help to reduce the likelihood of a new outbreak and in this way improve the prognosis enormously.

In addition, the prognosis of Pityriasis versicolor is decisively influenced by it what time the condition is diagnosed and appropriate treatment initiated. Starting the use of antifungal agents (antimycotics) at an early stage will, in most cases, quickly reduce the fungal infestation. The prognosis for these patients is usually particularly good. The typical white spots caused by the skin infestation can, however, still be visible for a period of several months.