Tinea versicolor: Difference between revisions

	Dermatophytosis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Dermatophytosis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiographic Findings
X-Ray Findings
CT scan Findings
MRI Findings
Ultrasound Findings
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Tinea versicolor On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Tinea versicolor All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA onTinea versicolor
CDC on Tinea versicolor
Tinea versicolor in the news
Blogs on Tinea versicolor
Directions to Hospitals Treating Dermatophytosis here
Risk calculators and risk factors for Tinea versicolor

	Tinea versicolor;
ICD-10	B36.0
ICD-9	111.0
DiseasesDB	10071
MedlinePlus	001465
eMedicine	derm/423

VisualWikitext

Latest revision as of 20:19, 25 August 2017

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Overview

Tinea versicolor or pityriasis versicolor is a common skin infection caused by the yeast Malassezia furfur (formerly termed Pityrosporum ovale). This yeast is normally found on the human skin and only becomes troublesome under certain circumstances, such as a warm and humid environment.

Symptoms

The symptoms of this condition include:

Generally oval or irregularly-shaped spots of 1/4 to 1 inch in diameter, often merging together to form a larger patch
Occasional fine scaling of the skin producing a very superficial ash-like scale
Pale, dark tan, or pink in color, with a reddish undertone that can darken when the patient is overheated, such as in a hot shower or during/after exercise
Sharp border

These spots commonly affect the back, underarm, upper arm, chest, lower legs, and neck. Occasionally it can also be present on the face. The yeasts can often be seen under the microscope within the lesions and typically have a so called "spaghetti and meat ball appearance" as the round yeasts produce filaments.

In people with dark skin tones, pigmentary changes such as hypopigmentation (loss of color) are common, while in those with lighter skin color, hyperpigmentation (increase in skin color) are more common. These discolorations have led to the term "sun fungus".

Diagnosis

Physical Examination

Skin

Trunk

Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]

Extremities

Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]
Pityriasis versicolor. With permission from Dermatology Atlas.^[1]

Differential diagnosis

Tinea versicolor must be differentiated from other diseases presenting with an erythmatous, scaly, annular and pruritic rash. The differentials include the following:

Name of superficial infection	Clinical presentation	Extension to hair follicle	Fungus(i)	Systemic disease	KOH preparations	Morphology in tissue sections
Tinea or ringworm	Round lesions with scaly border, accompanied by pruritis and burning	Yes; when suppurative known as kerion, when chronic known as Majocchi's granuloma	Dermatophytes (Epidermophyton spp., Trichophyton spp., Microsporum spp.)	Very rare but can invade the dermis and soft tissues, causing mycetomas	Hyphae with or without septations	Hyphae cannot be visualized in the keratin with H&E, special stains are needed
Tinea versicolor	Hypo and hyperpigmentation in patients with oily and sweaty skin, fine scales when scratching	Yes, known as Pityrosporum folliculits	Malassezia spp.	Systemic infections may occur in premature neonates receiving parenteral nutrition and in other immunosuppressed hosts	Yeasts and hyphae (“spaghetti and meat balls”)	Faintly basophilic hyphae in the stratum corneum
Tinea nigra	Brown to black macule, usually on palms, with some scaling	No	Phaeoannellomyces werneckii	Not described	Darkly pigmented, septated, and branching hyphae	Pigmented hyphae in the stratum corneum
White piedra	Creamy-white, small, soft nodules in hair shafts	No	Trichosporon spp.	Immunosuppressed patients may have lung infiltrates, renal involvement, and fungemia	Septate hyphae perpendicular to hair shaft	Not used for diagnosis
Black piedra	Hard dark nodules in hair shafts	No	Piedraia hortae	Not described	Collections of crescent ascospores surrounded by pigmented hyphae	Not used for diagnosis
Superficial candidiasis	Intertrigo, chronic paronychia, onychodystrophy, cheilitis	Yes	Candida spp.	Yes, particularly in patients with AIDS and depending on the level of immunosuppression	Yeasts, pseudohyphae may be observed	Fungal elements may be seen through the biopsy, vascular invasion must be determined

Prevalence

Tinea versicolor is a common condition. It is estimated that 2 to 8% of the population of the United States has it. This skin disease commonly affects adolescents and young adults, especially in warm and humid climates. It is thought that the yeast feeds on skin oils (lipids) as well as dead skin cells.

Treatment

Treatments for tinea versicolor include:

Topical antifungal medications - containing either 2.5% selenium sulfide (Selsun® shampoo in UK, but not Selsun Blue which contains only 1%) or 2% ketoconazole (Nizoral® ointment and shampoo) applied to dry skin and washed off after 10 minutes, repeated daily for 2 weeks. Other topical antifungal agents such as clotrimazole, miconazole or terbinafine are less widely recommended. Additionally, hydrogen peroxide has been known to lessen symptoms, and on certain occasions, remove the problem.
Oral antifungal prescription only medications include 400 mg of ketoconazole or fluconazole in a single dose, or ketoconazole 200 mg daily for 7 days, or itraconazole 400 mg daily for 3-7 days. The single-dose regimens can be made more effective by having the patient exercise 1-2 hours after the dose, to induce sweating. The sweat is allowed to evaporate, and showering is delayed for a day, leaving a film of the medication on the skin.
Recurrence is common and may be reduced by intermittent application of topical agents (such as tea tree oil) or adding a small amount of anti-dandruff shampoo to water used for bathing.

Antimicrobial Regimen

Tinea versicolor^[2]

Preferred regimen: Ketoconazole 400 mg PO single dose OR 200 mg q24h for 7 days OR 2% cream once q24h for 2 weeks
Alternative regimen: Fluconazole 400 mg PO single dose OR Itraconazole 400 mg PO q24h for 3–7 days

External links

References

↑ ^1.00 ^1.01 ^1.02 ^1.03 ^1.04 ^1.05 ^1.06 ^1.07 ^1.08 ^1.09 ^1.10 ^1.11 ^1.12 ^1.13 ^1.14 ^1.15 ^1.16 ^1.17 ^1.18 ^1.19 ^1.20 ^1.21 ^1.22 ^1.23 ^1.24 ^1.25 ^1.26 ^1.27 ^1.28 ^1.29 ^1.30 ^1.31 ^1.32 ^1.33 ^1.34 ^1.35 ^1.36 ^1.37 ^1.38 ^1.39 ^1.40 ^1.41 ^1.42 ^1.43 ^1.44 ^1.45 ^1.46 ^1.47 ^1.48 ^1.49 ^1.50 ^1.51 ^1.52 ^1.53 ^1.54 ^1.55 ^1.56 ^1.57 ^1.58 ^1.59 ^1.60 ^1.61 ^1.62 "Dermatology Atlas".
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

Template:Mycoses sv:Pityriasis versicolor sr:Tinea_versicolor

Template:WH Template:WikiDoc Sources

[Dermatology_Atlas-1] 1.00 ^1.01 ^1.02 ^1.03 ^1.04 ^1.05 ^1.06 ^1.07 ^1.08 ^1.09 ^1.10 ^1.11 ^1.12 ^1.13 ^1.14 ^1.15 ^1.16 ^1.17 ^1.18 ^1.19 ^1.20 ^1.21 ^1.22 ^1.23 ^1.24 ^1.25 ^1.26 ^1.27 ^1.28 ^1.29 ^1.30 ^1.31 ^1.32 ^1.33 ^1.34 ^1.35 ^1.36 ^1.37 ^1.38 ^1.39 ^1.40 ^1.41 ^1.42 ^1.43 ^1.44 ^1.45 ^1.46 ^1.47 ^1.48 ^1.49 ^1.50 ^1.51 ^1.52 ^1.53 ^1.54 ^1.55 ^1.56 ^1.57 ^1.58 ^1.59 ^1.60 ^1.61 ^1.62 "Dermatology Atlas".

[2] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[1]

[2]

@@ Line 14: / Line 14: @@
 }}
 __NOTOC__
-{{SI}}
+{{Dermatophytosis}}
 {{CMG}}; {{AE}} {{KS}}
 ==Overview==
@@ Line 34: / Line 36: @@
 ===Physical Examination===
 ====Skin====
+=====Trunk=====
 <gallery>
-Image:Pityriasis versicolor01.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor01.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor02.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor02.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor03.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor04.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor04.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor06.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor05.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor07.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor06.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor08.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor07.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
@@ Line 67: / Line 69: @@
-Image:Pityriasis versicolor08.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor09.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor11.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor09.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor12.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor10.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor11.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor13.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor15.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor12.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor16.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor17.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor13.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor18.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor14.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor19.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor15.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor20.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor16.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor23.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor17.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor24.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor25.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor18.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor26.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor27.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor28.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor29.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor30.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor31.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor32.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor19.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor33.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor20.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor34.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor21.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor35.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor22.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor36.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor23.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor38.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor24.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor25.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor39.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor26.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor27.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor28.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor29.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor30.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor31.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor32.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor33.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor40.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor34.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor35.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor41.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor42.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor36.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor43.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor37.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor44.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor38.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor45.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor39.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor40.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor46.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor47.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor41.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor48.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor42.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor49.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor43.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor52.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor53.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor44.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor54.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor55.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor45.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor56.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor46.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor47.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor57.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor48.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor58.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor49.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor50.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor59.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor51.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor60.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor61.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor52.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor62.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor53.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor63.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor54.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor64.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor05.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor50.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor55.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+</gallery>
+=====Extremities=====
+<gallery>
+Image:Pityriasis versicolor03.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor10.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor56.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor21.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor22.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
@@ Line 277: / Line 288: @@
-Image:Pityriasis versicolor57.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor37.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor58.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor59.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
-Image:Pityriasis versicolor60.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+Image:Pityriasis versicolor51.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  With permission from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+</gallery>
-Image:Pityriasis versicolor61.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+==Differential diagnosis==
+Tinea versicolor must be differentiated from other diseases presenting with an erythmatous, scaly, annular and pruritic rash. The differentials include the following:
+{| class="wikitable"
-Image:Pityriasis versicolor62.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+! align="center" style="background: #4479BA; color: #FFFFFF; " |Name of superficial infection
+! align="center" style="background: #4479BA; color: #FFFFFF; " |Clinical presentation
+! align="center" style="background: #4479BA; color: #FFFFFF; " |Extension to hair follicle
+! align="center" style="background: #4479BA; color: #FFFFFF; " |Fungus(i)
+! align="center" style="background: #4479BA; color: #FFFFFF; " |Systemic disease
-Image:Pityriasis versicolor63.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+! align="center" style="background: #4479BA; color: #FFFFFF; " |KOH preparations
+! align="center" style="background: #4479BA; color: #FFFFFF; " |Morphology in tissue sections
-Image:Pityriasis versicolor64.jpg|Pityriasis versicolor. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/  Adapted from Dermatology Atlas.]''<ref name="Dermatology Atlas">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/}}</ref></SMALL></SMALL>
+|-
+| colspan="1" rowspan="1" |Tinea or [[Ringworm Infection|ringworm]]
+| colspan="1" rowspan="1" |Round lesions with [[Scaling skin|scaly]] border, accompanied by [[pruritis]] and burning
+| colspan="1" rowspan="1" |Yes; when [[suppurative]] known as [[kerion]], when chronic known as [[Majocchi's granuloma]]
+| colspan="1" rowspan="1" |Dermatophytes (''[[Epidermophyton]]'' spp., ''[[Trichophyton]]'' spp., ''[[Microsporum]]'' spp.)
+| colspan="1" rowspan="1" |Very rare but can invade the [[dermis]] and [[Soft tissue|soft tissues]], causing [[Mycetoma|mycetomas]]
-</gallery>
+| colspan="1" rowspan="1" |[[Hyphae]] with or without septations
+| colspan="1" rowspan="1" |[[Hyphae]] cannot be visualized in the [[keratin]] with [[H&E stain|H&E]], special stains are needed
+|-
+| colspan="1" rowspan="1" |[[Tinea versicolor]]
+| colspan="1" rowspan="1" |Hypo and [[hyperpigmentation]] in patients with oily and sweaty skin, fine [[Scaling skin|scales]] when scratching
+| colspan="1" rowspan="1" |Yes, known as ''Pityrosporum'' folliculits
+| colspan="1" rowspan="1" |''[[Malassezia]]'' spp.
+| colspan="1" rowspan="1" |Systemic infections may occur in [[Premature birth|premature]] [[neonates]] receiving [[parenteral]] nutrition and in other [[Immunosuppression|immunosuppressed]] [[Host (biology)|hosts]]
+| colspan="1" rowspan="1" |[[Yeast|Yeasts]] and [[hyphae]] (“spaghetti and meat balls”)
+| colspan="1" rowspan="1" |Faintly [[basophilic]] hyphae in the [[stratum corneum]]
+|-
+| colspan="1" rowspan="1" |[[Tinea nigra]]
+| colspan="1" rowspan="1" |Brown to black [[macule]], usually on palms, with some scaling
+| colspan="1" rowspan="1" |No
+| colspan="1" rowspan="1" |''Phaeoannellomyces werneckii''
+| colspan="1" rowspan="1" |Not described
+| colspan="1" rowspan="1" |Darkly pigmented, septated, and branching [[hyphae]]
+| colspan="1" rowspan="1" |Pigmented [[hyphae]] in the [[stratum corneum]]
+|-
+| colspan="1" rowspan="1" |[[White piedra]]
+| colspan="1" rowspan="1" |Creamy-white, small, soft nodules in hair shafts
+| colspan="1" rowspan="1" |No
+| colspan="1" rowspan="1" |''[[Trichosporon]]'' spp.
+| colspan="1" rowspan="1" |[[Immunosuppressed]] patients may have [[lung]] infiltrates, [[renal]] involvement, and [[fungemia]]
+| colspan="1" rowspan="1" |Septate [[hyphae]] perpendicular to hair shaft
+| colspan="1" rowspan="1" |Not used for diagnosis
+|-
+| colspan="1" rowspan="1" |[[Black piedra]]
+| colspan="1" rowspan="1" |Hard dark nodules in hair shafts
+| colspan="1" rowspan="1" |No
+| colspan="1" rowspan="1" |''Piedraia hortae''
+| colspan="1" rowspan="1" |Not described
+| colspan="1" rowspan="1" |Collections of crescent ascospores surrounded by [[Pigmented lesions|pigmented]] [[hyphae]]
+| colspan="1" rowspan="1" |Not used for diagnosis
+|-
+| colspan="1" rowspan="1" |[[Candidiasis|Superficial candidiasis]]
+| colspan="1" rowspan="1" |[[Intertrigo]], chronic [[paronychia]], [[onychodystrophy]], [[cheilitis]]
+| colspan="1" rowspan="1" |Yes
+| colspan="1" rowspan="1" |''[[Candida]]'' spp.
+| colspan="1" rowspan="1" |Yes, particularly in patients with [[AIDS]] and depending on the level of [[immunosuppression]]
+| colspan="1" rowspan="1" |[[Yeast|Yeasts]], pseudohyphae may be observed
+| colspan="1" rowspan="1" |[[Fungal]] elements may be seen through the biopsy, vascular invasion must be determined
+|}
 ===Prevalence===
@@ Line 322: / Line 361: @@
-[[image:p_versicolorklein.jpg|left|thumb|250px|Tinea Versicolor]]
+[[image:p_versicolorklein.jpg|right|thumb|250px|Tinea Versicolor]]
 ===Treatment===
 Treatments for tinea versicolor include:
-* [[Topical]] [[antifungal]] [[medication]]s - containing either 2.5% [[selenium sulfide]] (Selsun&reg; shampoo in UK, but not [[Selsun Blue]] which contains only 1%) or 2% [[ketoconazole]] (Nizoral&reg; ointment and shampoo) applied to dry skin and washed off after 10 minutes, repeated daily for 2 weeks. Other topical antifungal agents such as [[clotrimazole]], [[miconazole]] or  [[terbinafine]] are less widely recommended. Additionally, [[hydrogen peroxide]] has been known to lessen symptoms, and on certain occasions, remove the problem.
+*[[Topical]] [[antifungal]] [[medication]]s - containing either 2.5% [[selenium sulfide]] (Selsun&reg; shampoo in UK, but not [[Selsun Blue]] which contains only 1%) or 2% [[ketoconazole]] (Nizoral&reg; ointment and shampoo) applied to dry skin and washed off after 10 minutes, repeated daily for 2 weeks. Other topical antifungal agents such as [[clotrimazole]], [[miconazole]] or  [[terbinafine]] are less widely recommended. Additionally, [[hydrogen peroxide]] has been known to lessen symptoms, and on certain occasions, remove the problem.
 * Oral  antifungal [[Prescription drug|prescription only medication]]s include 400 mg of [[ketoconazole]] or [[fluconazole]] in a single dose, or ketoconazole 200 mg daily for 7 days, or [[itraconazole]] 400 mg daily for 3-7 days. The single-dose regimens can be made more effective by having the patient exercise 1-2 hours after the dose, to induce sweating. The sweat is allowed to evaporate, and showering is delayed for a day, leaving a film of the medication on the skin.
 * Recurrence is common and may be reduced by intermittent application of topical agents (such as [[tea tree oil]]) or adding a small amount of anti-dandruff shampoo to water used for bathing.
+===Antimicrobial Regimen===
+*Tinea versicolor<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:*Preferred regimen: [[Ketoconazole]] 400 mg PO single dose {{or}} 200 mg q24h for 7 days {{or}} 2% cream once q24h for 2 weeks
+:*Alternative regimen: [[Fluconazole]] 400 mg PO single dose {{or}} [[Itraconazole]] 400 mg PO q24h for 3–7 days
 ==External links==
 *[http://www.healthinplainenglish.com/health/skin/tinea_versicolor/index.htm Health in Plain English - Tinea versicolor]
 *[http://the.honoluluadvertiser.com/article/2007/Apr/19/il/FP704190309.html Tinea versicolor is harmless but can recur]
+==References==
+{{reflist|2}}
 {{Mycoses}}
@@ Line 341: / Line 388: @@
 [[Category:Fungal diseases]]
-[[de:Pityriasis versicolor]]
 [[es:Pitiriasis versicolor]]
 [[fr:Pityriasis versicolor]]
-[[nl:Pityriasis versicolor]]
 [[pl:Łupież pstry]]
 [[pt:Pitiríase versicolor]]


Tinea versicolor
ICD-10	B36.0
ICD-9	111.0
DiseasesDB	10071
MedlinePlus	001465
eMedicine	derm/423