Tinea versicolor in dark-skinned individuals.

In this article, we review the salient features of tinea versicolor and describe the epidemiology, clinical presentation, and histopathology of this mycosis in dark-skinned individuals. Tinea versicolor is caused by an overgrowth of the Malassezia genus. It manifests clinically as asymptomatic hypopigmented macules, hyperpigmented macules, or a combination of the two. Under light microscopy, Malassezia presents as a dimorphic fungus - in both the hyphal and yeast form. Most clinicians have found that the majority of dark-skinned patients present solely with hypopigmented lesions. Under light microscopy, lesions on dark skin involved with tinea versicolor tend to have a thicker stratum corneum, more tonofilaments in the granulosum, and more sequestered melanosomes. Differential diagnosis includes confluent and reticulated papillomatosis, seborrheic dermatitis, pityriasis rosea, pityriasis alba, and vitiligo. Tinea versicolor can be successfully managed in most cases with topical antifungal treatments. Cases of recurrence, such as those seen in immunocompromised patients, may necessitate scheduled oral or topical therapy.