Is it tinea versicolor or vitiligo?
Updated April 9, 2017
There are always mistakes made when self-diagnosing. For instance, when I first noticed tiny white areas at the base of a couple of my nail beds, I assumed it was a fungal infection from getting my nails done at a salon. The thought of fungus growing on my hand disgusted me enough to warrant a visit to the dermatologist. Imagine my great surprise when I was told, off-handedly, that the white patches were vitiligo.
If you notice white patches on your skin, the best way to get it diagnosed and begin treatment is to visit a dermatologist. But since you’re searching the internet right now for answers, I’m going to tell you the differences between vitiligo and tinea versicolor; the 2 most common reasons for those pesky white patches on your skin.
Vitiligo commonly affects sun-exposed areas, or areas of injury on the body, including the face, lips, hands, arms, and feet. Vitiligo often starts as a small area of white skin, the pigment loss can then spread and become larger over time. Other common areas for patches to appear are the groin, armpits, torso, wrists, elbows, knees, nostrils and genitals. The severity of vitiligo varies with the individual and there is no way to predict how much pigment a person will lose or the rate at which it will spread. Other less common symptoms of vitiligo include premature graying of the hair, eyelashes, eyebrows or other facial hair; loss of color in the retina (inner layer of the eye) and loss of color in the mucous membranes (i.e. the skin that lines the inside of the mouth). While vitiligo does not cause physical impairment, many patients suffer psychological impacts; such as low self-esteem, emotional distress, and depression; which can significantly affect their quality of life.
Types of vitiligo
Vitiligo is classified into three main types, based on the distribution of the lesions. These categories are further subdivided depending on specific features of the disease.
- Localised Vitiligo: Presents in distinct sections.
- Focal Vitiligo– lesions are limited to one or two areas; commonly in a pattern parallel to the trigeminal nerve, which lies beneath the face.
- Segmental Vitiligo– lesions develop in patches on one side of the body only. Occurs most frequently in children.
- Mucosal Vitiligo– affects mucous membranes only (i.e. inside the mouth and eyes).
Generalized/Nonsegmental Vitiligo(NSV) : Widespread across the body; the most common form of vitiligo.
- Acrofacial Vitiligo– affects the face and other extremities.
- Vulgaris Vitiligo– Lesions are scattered all over the body with a symmetrical distribution.
- Mixed Vitiligo– some combination of acrofacial, vulgaris and segmental vitiligo.
Universal Vitiligo: Near complete loss of pigment (over 80% of the body); this type of vitiligo is rare.
In addition to the different classes of vitiligo, there are a number of clinical variants based on the appearance of the lesion.
- Trichrome Vitiligo – between the unaffected skin and the unpigmented area appears an intermediate zone of moderate pigmentation. This results in 3 shades of color; brown, tan, and white; in the same patient.
- Quadrachrome Vitiligo – this reflects the presence of a fourth band around the lesion. It is usually a hyperpigmented band which develops during spontaneous repigmentation.
- Inflammatory Vitiligo – the depigmented lesion is surrounded by a raised, inflamed border. It can be present from the onset or develop over time
- Blue Vitiligo – this occurs when the patches develop a blue colouration. It has been observed in patients who have developed vitiligo on areas of skin where there was previously post-inflammatory hyperpigmentation (dark spots which occur following inflammation or injury).
Every human being has yeast living on the surface of their skin. In hot and humid climates, yeast tend to grow more quickly. An overgrowth of yeast can cause tinea versicolor, a common skin condition. Tinea versicolor also may be referred to as a common fungal infection because yeast is one type of fungus. Although tinea versicolor is a fungal skin infection, it is not contagious.
- The first sign is usually small spots on the skin, which are generally lighter than the surrounding skin. Sometimes the spots are darker. The spots may be tan to pink, or very faint.
- The affected skin may be itchy and show spots which are scaly.
- Oily areas of the body, such as the chest, back, shoulders, and upper arms seem to be more affected; however, it may also appear on the neck and face.
- The fungus prevents the skin from tanning, so pale spots become more noticeable as the skin tans. This is especially noticeable on darker skin.
How is it diagnosed?
A dermatologist can often diagnose tinea versicolor by looking at the skin. If the dermatologist needs to confirm the diagnosis, the doctor may gently scrape a bit of scale from the affected skin. By looking at this scale under a microscope, the dermatologist can see if this is indeed tinea versicolor.
Another way to confirm tinea versicolor is to look at the skin with a special device called a Wood’s lamp. The dermatologist will hold the Wood’s lamp about 4 or 5 inches from the affected skin. If the patient has tinea versicolor, the affected skin appears yellowish green in color.
How is tinea versicolor treated?
Before prescribing treatment, a dermatologist considers several things. These include where tinea versicolor appears on the body, the severity, the weather, and the patient’s wishes. Treatment for tinea versicolor may include:
- Topical (applied to the skin) medications. Medicated shampoos, soaps, creams, and lotions are frequently used to treat tinea versicolor. The active ingredient in this medication is usually selenium sulfide, ketoconazole, or pyrithione zinc. These active ingredients can keep the yeast under control.
- Medicated cleansers. Tinea versicolor frequently returns when it is warm and humid outdoors. Using a medicated cleanser once or twice a month, especially during warm and humid periods, can help.
- Oral (taken by mouth) medications. If the infection is severe, covers a large area of your body, or frequently returns, a dermatologist may prescribe anti-fungal pills. Due to possible side effects and interactions with other medications, a dermatologist will closely supervise a patient who is taking this medication.
Although the yeast is easy to kill, it can take weeks or months for the skin to return to its normal color. Just because the pigment may be lighter does not mean the fungal infection is still present. The skin just needs some time for incidental sun exposure to stimulate pigment production. Protecting the skin from the sun and not tanning will help the skin tone even out more quickly by preventing increased darkening of the uninfected skin.