How to treat ringworm with ointment. Pityriasis versicolor: treatment, causes, symptoms, photos. Treatment of versicolor

Pityriasis versicolor received its name due to the appearance on the skin of spots of varying degrees of maturity in many shades - from pink to brown. This mycodermatosis occurs mainly in spring or summer, when optimal conditions for the development of the fungus are created - increased sweating, high skin temperature.

A common variant of tinea versicolor is the pityriasis form. With it, spots appear on the skin that resemble bran. A differential sign of the disease is insensitivity to the effects of ultraviolet radiation. Light brown, whitish spots appear at the initial stage of the pathology. Dermatologists determine the nosology by the presence of areas of depigmentation against the background of tanned skin, which are clearly limited and resemble bran. For reliable diagnosis, a microscopic examination is performed. The threads and mycelium of the fungus are clearly visualized under a microscope.

Dermatologists called the disease “leopard color” due to the presence of multi-colored foci of de- and hyperpigmentation.

Pityriasis versicolor - symptoms

The symptoms of pityriasis versicolor are specific, treatment is long-term. Skin mycoses are eliminated over months or years of regular use of antifungal drugs and ointments. At the initial stage, outlined lesions of a café-au-lait color appear. Gradually, the individual components of the rash merge, forming large lesions.

Pigmentation disorders in pityriasis versicolor are formed due to the production of a special substance by the fungus - azelaic acid. The compound blocks the activity of melanocytes, the cells that produce skin pigment. Without melanin, tanning does not occur. As a result, the affected areas with lichen versicolor have a spotted structure. The pathology resembles another nosological form - “vitiligo”.

Common symptoms of versicolor:

1. Severe itching;
2. Skin rash;
3. Pityriasis peeling when the top layer of skin loosens;
4. The glow of areas is yellow-green in the rays of a Wood's lamp;
5. Positive iodine test (Balzer) - when stains are treated with iodine, the formations become brown;
6. Pronounced peeling of the pathological focus when scraping.

The diagnostic criteria for diagnosing multicolored (including tubular and pityriasis versicolor) are sufficient for early detection.

Pathogenesis of pityriasis versicolor

The early stages of mycosis are characterized by single spots on the skin, localized in the hair follicles. With magnification, lesions up to 1 cm in size are formed. The nodes have a pink tint with a smooth color gradient of elements to brown. The different colors of the elements of the rash contributed to the creation of a unique definition of pityriasis versicolor - “multi-colored”.

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When the stratum corneum of the epidermis is loosened, scales form. Morphologically, the formations have the appearance of bran. Pronounced peeling after healing of the spots may not be visible, but when externally scraped, shavings appear - the “chips” syndrome.

Individual clinical forms, when merging, are capable of forming large foci of the “geographical outline” type. The nodes reach a diameter of 15 cm and have uneven contours. Symptoms are characteristic of mycoses that occur during HIV infection. Gradually, other types of rash appear - plaques or papules.

With frequent sunbathing, pathological lesions are not prone to peeling, and areas of lichen become lighter. The condition is called in clinical language - leukoderma, when light spots appear under the influence of blockade of melanin synthesis in the skin, provoked by changes in metabolism.

When tanning, itching is characterized by mild severity. The pathology is especially often accompanied by excessive sweating. Treatment of the pityriasis form is long-term. During therapy, exacerbations periodically appear.

How to treat lichen versicolor: general and local recommendations

When describing how to properly treat lichen versicolor, the importance of combined methods should be highlighted, including the following procedures:

1. Good nutrition;
2. Local therapy;
3. Antifungal drugs.

The diet for pityriasis versicolor involves limiting spices, marinades, smoked meats, and meat broths. You should avoid cheese, beans, peas, other legumes, and chocolate products. To treat mycosis, you need to add dairy dishes, vegetables, and animal protein to your diet. Full saturation of the body with vitamin and mineral components allows you to restore local immunity and accelerate the healing of lesions.

Local treatment of pityriasis versicolor

If a person has pityriasis versicolor, local treatment is based on antifungal, keratolytic ointments. Drugs for the treatment of ringworm should be discussed with a dermatologist.

Common antifungal ointments:

• The mixture, bifonazole cream (1%) is applied in a thin layer once daily for 2-3 weeks;
• Mycozoral (ketoconazole) uses a 2% ointment according to a similar prescription;
• Terbinafine – for rubbing in for 2-3 weeks (1% ointment);
• Clotrimazole –1% solution is rubbed in for 3 weeks;
• Ciclopirox - cream is applied for 10 days in the form of a 1% solution.

When treating pityriasis versicolor, it is imperative to lubricate all skin. You should also rub the ointment into your scalp. Statistics describe cases of repeated relapse of the disease after long-term careful treatment, but without treatment of the head. It is in this place that a reservoir of infection can persist, which will become a source of re-infection.

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Dermatologists prefer to use terbinafine to treat tinea versicolor. The drug has been studied by domestic and foreign doctors. Clinical practice of its use has shown its high effectiveness.

Drugs for local therapy of mycosis are well tolerated. The drugs occasionally provoke erythema, burning, minor erosions, and itching at the site of fungal foci. Maceration of the integument and individual sensitivity to individual components of antifungal ointments are often observed in the first trimester of pregnancy. Antimycotic gels and creams are used during breastfeeding only after careful selection.

It is better for pregnant women to smear the spots with alternative compositions:

• Sodium hyposulfite (60%);
• Treatment of skin with hydrochloric acid - Demyanovich's method;
• Lubricating the skin with sulfur-salicylic ointment (10%);
• Benzyl benzoate.

These methods are considered outdated, as they provoke an unpleasant odor, burning, and itching in areas where the skin is affected.

When determining how to treat pityriasis versicolor, which is not eliminated by local ointments, dermatologists look at antimycotic drugs. Tablet and capsule forms, together with local remedies, can more effectively cope with a fungal infection, but treatment is long-term.

Most treatment regimens for pityriasis versicolor include the drugs fluconazole and itraconazole.

The standard method requires the use of drugs for 15 days, 100-150 mg. For complex forms of lichen versicolor, the duration of taking the drug should be increased for 2 months.

Antimycotic drugs for the treatment of pityriasis versicolor have a number of side effects:

• Frequent causeless fatigue;
• Head pain;
• Dizziness;
• Intestinal dysfunction with symptoms of vomiting, epigastric pain, bloating, intestinal obstruction, nausea;
• Liver pathology;
• Violation of the formation of the blood system;
• Imbalance of cardiac activity;
• Allergy;
• Neurological diseases.

Antimycotic drugs should not be prescribed for the treatment of lichen versicolor in children under 4 years of age, increasing the QT interval on the electrocardiogram, or individual intolerance. Medicines should be taken with caution in cases of renal and hepatic failure, pregnancy, severe heart disease, and drinking alcohol. Antibacterial agents are not prescribed for mycoses, as they have low effectiveness.

How to treat pityriasis versicolor in a risk group

Pregnant women and children with lichen versicolor are prescribed keratolytic agents - boric, sulfuric, salicylic acid. Mixtures are used to treat the skin surface twice a day. The course of treatment is several weeks. In practice, experts have found that the effectiveness of local forms is significantly increased when systemic antifungal drugs are used together with them.

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During pregnancy, antifungal drugs are prescribed with caution, since many drugs have a negative effect on the fetus. When carrying a child, dermatologists recommend a special talker that is safe for the child. The product consists of talc, alcohol ingredients, zinc, starch, stabilizing additives, glycerin. The “tsindol” mixture is used to treat damaged skin areas three times a day using a cotton swab.

The chatterbox has the following mechanisms of action: anti-inflammatory, antiallergic, disinfectant, and drying.

Preparations for the treatment of pityriasis versicolor

Let's consider the common options for drugs used to treat lichen versicolor:

• Resorcinol or salicylic alcohol – 5% solution;
• Bifonazole, ciclopirox, clotrimazole, psoril are fungicidal drugs;
• Kelual, nizoral, keto-plus, sebazol, foltene-pharma - for the treatment of seborrheic dermatitis due to a fungal infection;
• Fluconazole, ketoconazole, intraconazole - antifungal drugs that increase sweating;
• Shampoo with selenium, zinc sulfide - for the treatment of folliculitis caused by the fungus Pityrosporum.

To increase the effectiveness of treatment of lichen, a combination of medications of different forms is used - local ointments, antifungal drugs, shampoos with zinc pyrithione. In severe cases, a combination of systemic ketoconazole with shampoo is recommended.

For the etiological treatment of dermatomycosis, 2 drugs are used - lamisil spray and itraconazole. The effect of these drugs has been studied by European dermatologists.

When studying through an electron microscope, it was possible to establish changes occurring in cultures of pathogens - the fungi M. furfur under the influence of itraconazole.

Studies have shown that under the influence of an antimycotic, destructive changes appear in the cells of the fungus. At the same time, when using the drug, structural changes appear in the cytoplasm and destruction of the cell membrane. The drug affects not only the active cells of the fungus, but also the reproductive form - blastospores.

The high antifungal activity of itraconazole is obvious. The drug can be used to treat patients with atypical forms of pityriasis versicolor.

Lamisil spray (terbinafine) is prescribed to patients with limited forms. Used to treat lesions lasting up to 7 days.

When using the drug, mycological and clinical cure of pityriasis versicolor occurs.

Fungicidal activity is limited to individual forms, but the product is characterized by minimal side effects. Itching was observed only in certain categories of patients.

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The therapeutic effect increases when antimycotic drugs are combined with disinfection of bed and underwear. Nizoral shampoo is recommended for treating scalp pathologies. Apply 3 days after the start of treatment, and then once for 1 month.

When assessing the results of the above examinations, it was possible to establish that for generalized types, local treatment cannot be carried out due to low rationality. The best antimycotic activity is observed with the use of itraconazole and fluconazole.

In the local form, therapeutic effectiveness is achieved by taking local topical agents such as terbinafine.

A lasting positive effect is achieved by using antifungal drugs in conjunction with corrective treatment with local ointments. At the same time, compliance with diet, skin hygiene and other specialist recommendations is required.

Ringworm is a fungal skin lesion that appears as spots on the body. The disease is also called sun fungus or pityriasis versicolor.

The risk group includes men and women with reduced immunity and a predisposition to the disease.

Problem Definition

A dermatologist diagnoses lichen versicolor based on the characteristics of the spots.

He looks different: formations can be located on any part of the body, but are most often localized on the sides of the torso, chest and shoulders. The duration of treatment may be delayed due to the ability of fungi to form protection against the medications used.

The main causes and diseases that provoke the appearance of colored spots:

• a sharp decrease in immunity;
• tuberculosis;
• seborrhea;
• chronic lung diseases;
• diabetes.

Since lichen spottedeum provokes severe sweating, it is often found in people suffering from hyperhidrosis. In this case, the spots are located in areas of active sweat production.

A person’s individual predisposition to a fungus of the genus Pityrpsporum orbiculare, combined with the peculiarities of the body’s functioning, can provoke the occurrence of lichen. The disease is promoted by the special chemical composition of sweat, disruption of the functioning of epidermal cells, and general weakening of the body by various problems and neuroses.

Additional factors leading to the development of pityriasis versicolor:

In case of contact infection, the incubation period of the disease can last from two weeks to six months.

Signs of the disease (symptoms)

The presence of fungus can only be determined by a specialist. However, the appearance of a fungal infection can be assumed by the presence of pink, brown or yellowish spots on the skin. The formations have uneven edges and an asymmetrical shape.

For each individual patient, the location, volume of the lesion, and color of the spots will be different. The size of the spots in the initial stage can be up to one centimeter in diameter. As the disease spreads, the spots begin to increase in size and merge into one.

The shape of the spots also changes: it becomes oval or diamond-shaped, with active peeling in the center.

Most often, spots are located on the chest, shoulders, neck and abdomen. In adolescents, lichen florida can be found on the legs and arms.

With tinea versicolor, spots appear on the body in a chaotic manner. In order not to confuse sunburn spots with pink lichen, the diagnosis should be carried out by a specialist. Often these types of fungal infections are similar due to the same symptoms - in some cases, the spots of tinea versicolor have a pink tint.

What does tinea versicolor look like: photo

To accurately determine the type of disease, a specialist applies a five percent iodine tincture to healthy and infected areas of the body. Fungi of the genus Pityposporum are stained more strongly than in the healthy zone.

This diagnosis is called Balzer breakdown and helps doctors make a diagnosis without scraping.

In the lesions for tinea versicolor no itching or pain. Ringworm can be identified by the peeling of the skin on the affected areas after wetting them with water.

To further check, a dermatologist may examine the spots under a special lamp. Under the light of a Wood's lamp, the tinea versicolor spots will have a yellowish tint.

Wood's lamp in action when detecting lichen

The most effective way to determine the disease is by scraping.

To do this, skin flakes are scraped off at the spots where the spots are located, which are then sent for microscopic examination. Having confirmed a person's symptoms, treatment begins immediately.

Additional symptoms of ringworm:

• increased sweating is observed in the affected area;
• due to disruption of melanin synthesis, areas with spots do not tan;
• peeling changes intensity from weak to strong;
• spots lighten under ultraviolet light and darken during the cold season;
• Lichen formations merge with the skin, rarely protruding above the surface.

Consequences of the disease

The presence of tinea versicolor does not lead to dangerous complications and does not harm health. Other types of fungus can affect and negatively affect human internal organs and systems.

The only trouble that can be caused by lichen– scratching the spots can cause inflammation and suppuration of the skin.

If you constantly touch the spots, wet them with water or damage the skin in the inflamed area, this can cause seborrheic eczema and other similar diseases of the epidermis.

After the patient has managed to cure tinea versicolor, white pigment spots remain on the skin for a long time. They are gradually compared to the skin tone under the influence of ultraviolet radiation.

Video:

In addition to disrupting the aesthetic appearance of the skin, tinea versicolor can lead to social problems. Stress and fear of appearing in public places lead to neuroses, insomnia, and loss of ability to work. If you don't think about how to treat lichen, it can cause a relapse.

Methods for treating ringworm

Treatment of formations is carried out at home. Exceptions are rare cases of complications when a bacterial infection is associated with the fungus.

A set of measures aimed at combating tinea versicolor includes local and systemic medications (ointments and tablets). One ointment for lichen will not be fully effective, since the external agent cannot penetrate deep into the skin and destroy the main causative agent of the disease.

In addition to taking medications and treating the infected area of ​​skin, to destroy the fungus you need:

• follow a diet that excludes the consumption of fried and fatty foods, alcoholic beverages, yeast bread, sweet dishes and kvass;
• sunbathing (provided that the treatment takes place in the warm season);
• carefully observe body hygiene;
• disinfect the patient’s apartment, clothes, bed linen and household items.

For tinea versicolor of moderate severity, the doctor prescribes systemic antimycotics that prevent relapse and shorten the treatment period as much as possible. The drugs need to be taken for several days.

These medications include:

The advanced form of the disease is difficult to treat and often provokes relapse. Therefore, measures in this case will be more stringent; you will need the medicine Neotigason, which normalizes the functioning of epidermal cells.

If the spots affect a large area of ​​the skin, severe pigmentation cannot be avoided. In this case, after the basic course of treatment, the dermatologist will prescribe a drug that will regulate the synthesis of skin pigments and restore color.

Since in most cases, fungal infection is caused by a decrease in immunity, in parallel with the main treatment, the doctor may prescribe drugs to increase the body's resistance. This is echinacea tincture, Immunal, Leuzea and various complexes of vitamins and minerals.

External treatment of the affected areas is carried out regularly for two to three weeks.:

• wiping and applying the area with fungus with salicylic alcohol;
• covering areas with sulfur ointment;
• treating the area affected by lichen with antifungal agents in the form of solutions, lotions, sprays;
• replacing regular shampoo during treatment with Nizoral shampoo for body hygiene.

External use of the products is indicated until the elements of lichen completely disappear.

Traditional methods of treatment

Additionally, treatment with proven folk remedies can be used:

Strictly following the doctor’s instructions will help you quickly get rid of spots on your body and forget about tinea versicolor forever. For preventive purposes, it is recommended to use medicated anti-fungal shampoos or lotions once a week. To preventive measures it is worth adding sweating control and timely body hygiene.

Traditional methods of treatment: video

Pityriasis versicolor (synonym: pityriasis versicolor) is a fungal infection of the superficial stratum corneum of the skin (epidermis) in humans.
Latin name: Pityriasis versicolor
ICD10 code: B36.0
Other synonyms: yellow lichen, multicolored lichen, sun fungus, sun or beach lichen.

Treatment for pityriasis versicolor is with a dermatologist.

Causes

The only cause of pityriasis versicolor in humans is the yeast-like fungus Pityrosporum (that is, it is similar to yeast fungi).
This pathogen has three forms: Malassezia furfur (mycelial form), Pityrosporum orbiculare (round form) and Pityrosporum ovale (oval form of the fungus). Normally, a person may have Pityrosporum orbiculare and Pityrosporum ovale in their skin, but they do not cause lichen. Once these forms of the fungus transform into the Malassezia furfur form, the person develops tinea versicolor.

Mostly young people, often men, are affected in countries with hot and humid climates. Children and old people rarely get sick.
If pityriasis versicolor appears in a child or an elderly person, you should look for the underlying disease or predisposing factor that led to the development of a fungal infection on the skin.

The disease is chronic and relapses occur frequently.

Contagiousness (that is, infectiousness) is low. That is, the fungus, of course, is transmitted from person to person. But you are unlikely to be able to become infected with pityriasis versicolor from a patient. After all, with a 90% probability, every person on Earth has this pathogen.

In addition to the main cause, there are predisposing factors that contribute to the development of fungus in human skin:

• diabetes mellitus and other endocrine diseases,
• HIV and immunodeficiency as a result of treatment for blood cancer,
• increased sweating of the human body,
• stress,
• hereditary predisposition, special composition of sweat and excess sebum,
• diseases of the gastrointestinal tract,
• in general - a decrease in immunity, which is designed to fight the fungus.

Symptoms

On the head

If pityriasis versicolor is located on the scalp, it is called seborrhea, or dandruff.

The symptoms are exactly the same - spots, itchy scalp, flaking. At the same time, it is peeling that most often worries patients.
How to treat pityriasis versicolor on the head and other hairy areas of the body - and in the same way as on other parts of the body. Just choose not a cream or ointment, but a spray or solution for external skin treatment plus shampoo with an antifungal agent.

Diagnostics

The diagnosis of pityriasis versicolor in a person is made on the basis of:

1) Main symptoms: spots on the skin of different colors, merging into conglomerates.

2) Pityriasis-like peeling of spots.

3) Spots without inflammation.

4) Diagnostics under a microscope is the main instrumental method for diagnosing lichen versicolor. Scrape off exfoliated skin particles from the surface of the spots, treat with potassium alkali and look under a microscope. Both the mushrooms themselves and their mycelium are visible.

5) Examination of the skin under a Wood's lamp. Wood's lamp is an ultraviolet fluorescent lamp with a magnifying glass for examining the skin.
Pityriasis versicolor spots under a Wood's lamp give a yellow-greenish or reddish-brown glow different from the surrounding skin. Moreover, lichen spots of different colors also give a different glow under a Wood’s lamp.

What does pityriasis versicolor look like under a Wood's lamp?

6) Iodine test, or Balzer test, is an important diagnostic symptom. It can be done at home and if not diagnosed, then suspect the diagnosis of versicolor versicolor yourself.
Take iodine tincture, lubricate the spots and surrounding healthy skin. After a few seconds, wipe so that there are no drops of iodine on the skin. Healthy skin becomes yellowish, and pityriasis versicolor spots overabsorb iodine and turn brown.

7) Beignet's sign, or floury peeling. When skin lesions are scraped, for example with a glass slide or scalpel, fine flour-like peeling appears.

Beignet's sign - floury peeling

Differential diagnosis is carried out:

• With Becker's nevus in the stage when there is no hair growth yet.
• Zhiber's rosacea is also in the initial stage.

Treatment

Treatment of pityriasis versicolor has only cosmetic indications, since there is no inflammation or damage to other organs in this disease. Such patients are not contagious, since the fungus is present in almost all people, it’s just a matter of immunity.

How to treat pityriasis versicolor:

1) Correction of the underlying disease (if any) that led to the appearance of pityriasis versicolor. We must not forget about this direction. It is imperative to get rid of the provoking factor.

2) Local skin treatment.

Always done.
Creams, ointments, shampoos, sprays and solutions with antifungal (antimycotic) agents are used.

Exactly the same treatment regimen when using the following local antifungal agents:

• clotrimazole (cream or solution),
• miconazole (cream),
• terbinafine (Lamisil) – cream,
• fungoterbin (spray or gel),
• oxiconazole (cream),
• termikon (spray or cream).

If lichen versicolor affects areas with hair growth (on the head, groin, labia or penis), it is better to use sprays or solutions of the above-mentioned drugs rather than ointments or creams.

3) General treatment.

Mandatory:

• for widespread lesions over large areas of skin,
• with weakened immunity,
• if local treatment is ineffective after 2 weeks.

But a number of dermatologists advise always using systemic antifungal drugs simultaneously with creams or ointments. The effectiveness of this treatment is higher due to its effect on fungi in the hair follicles.

Attention: general treatment without local treatment is ineffective!

Antifungal drugs are prescribed in tablets or capsules that must be taken orally.

• Fluconazole (150 mg capsules). How to take: 2 capsules 1 time per week for a course of 2 weeks. That is, we took 2 capsules on Monday, and a week later - 2 more capsules. Fast, cheap and effective.
• Itraconazole – 200 mg once a day – for 1 week.
• Ketoconazole - 200 mg once a day - for 3-4 weeks.

Approximate treatment plan for pityriasis versicolor

1. Fluconazole – 2 capsules 1 time per week – course 2 weeks.
2. Nizoral shampoo - wash your hair and body every evening for the first week. And every other day - 2 and 3 weeks.
3. Instead of Nizoral, you can use Thermikon spray for the body - apply once a day to the affected areas for 3 weeks.
4. Salicylic acid – lubricate the affected areas once a day in the morning.
5. Taking multivitamins (Complivit, Selmevit and others).
6. A set of activities to improve immunity.

Treatment of pityriasis versicolor during pregnancy

Peculiarities:

• You should not take any antifungal agents orally, as they may have a negative effect on the fetus.
• Externally, locally, it is best to use Nizoral shampoo. And only in cases where the benefit to the mother’s body outweighs the risk to the fetus. Treatment should be agreed with your gynecologist.
• In most cases, it is better to wait until childbirth and then carry out a full course of treatment.
• Remember: the pathogen has no effect on the fetus and does not affect childbirth.

When breastfeeding

• Do not take medications internally.
• Do not apply ointments or creams to your breasts.

How to evaluate the effectiveness of treatment?

1. The first symptom should disappear - peeling on the spots.
2. The spots should go away, at least the pink and brown ones. White spots may persist for some time until the skin evenly tans in the sun.
3. There should be no mushrooms or threads of fungal mycelium in the skin scrapings.

Prevention

Remember: just because the stains are gone, it doesn't mean they won't come back. The disease is chronic and cannot be cured forever. Therefore, prevention is mandatory!

• Taking ketoconazole - 400 mg once a month - every month. Or taking another antifungal drug.
• In the month of May, before the summer period begins: Nizoral shampoo - wash once a day - 3 days in a row.
• Wash clothes at 95% for the entire treatment period.
• Iron clothes with a hot iron for the entire treatment period.
• Do not wear synthetic clothing - it does not absorb sweat.
• In case of excessive sweating: use antiperspirants and change clothes frequently!
• Treatment of all diseases and correction of conditions that led to the appearance of pityriasis versicolor.
• Strengthening the immune system using different methods is a must!!!
• Is it possible to go to the solarium and sunbathe? During treatment - not allowed. After treatment, you can and even need to lightly sunbathe in the sun, since sunlight kills the pathogen - the fungus.

Folk remedies at home
In fact, modern antifungal drugs are not so expensive that they cannot be treated effectively. Folk remedies for pityriasis versicolor are ineffective, since they do not act on the cause (fungus) and do not have an antifungal effect when taken orally. Although traditional methods can be used as an additional treatment.

Relapse prevention can also be done using folk remedies at home.

1) Tar soap - soap the affected areas once a day.

2) Boric acid or boric alcohol - lubricate stains 2-3 times a day.

3) 1 part 3% vinegar + 1 part iodine tincture – mix in a glass, wipe the spots on the skin once a day.

4) Vinegar 3% - lubricate the affected areas of the skin 2 times a day.

5) A decoction of the herb - moisten a gauze cloth with the decoction and apply to the affected areas 2-3 times a day.

6) Decoction of celandine herb - moisten a gauze cloth with the decoction and apply to the affected areas 2-3 times a day.

7) Salicylic acid. On Internet forums, many advise treating lichen versicolor with salicylic acid. Salicylic acid is a keratolytic agent, that is, it removes the exfoliating stratum corneum of the skin. But this remedy does not work at all on the cause of the disease - the fungus. Therefore, it can only be used in combination with other folk or pharmaceutical drugs.

8) Formic alcohol - lubricate the affected areas of the skin once a day. Often combined with sulfur ointment - first wipe the skin with alcohol, then apply the ointment.

9) Sulfur ointment – ​​apply to the skin once a day, in the evening.

10) In the summer - sunbathe in the sun.

11) Taking multivitamin preparations is mandatory.

Brief description of the disease

Pityriasis versicolor has been known to doctors for quite a long time, as a result of which this disease has a number of names, such as "tinea versicolor", "beach lichen", "Tinea Versicolor", "Pityriasis Versicolor", "Pityriasis furfuracea", "Lichen versicolor", etc. These various names were given at different times on the basis of one or another sign of the disease, which was identified by doctors as the most characteristic. Currently, the official name of the pathology is pityriasis versicolor, but all other variants of names are also still in use, so you need to know them in order to navigate in any situation and understand what the disease means.

Pityriasis versicolor must be distinguished from another skin disease that has a similar name, namely, pityriasis pilaris Devergie (pityriasis versicolor acuminata). Devergie's lichen is red, and pityriasis versicolor is multi-colored, and these two different diseases are united solely by the presence of the word “pityriasis versicolor” in the names.

The essence of pityriasis versicolor is that the pseudomycelium of the fungus constantly grows in the stratum corneum of the skin. Due to the proliferation and growth of pseudomycelium in the stratum corneum, a subacute inflammatory reaction occurs, as well as increased proliferation and death of cells with the formation of a large number of horny scales. As a result of these pathological processes, areas of the stratum corneum soften, peel off and lose their normal color, forming characteristic lesions on the skin in the form of spots of uneven shape and varying sizes. That is, the main external manifestation of pityriasis versicolor are spots on the skin of different shapes and sizes, colored yellowish-brown on untanned skin, and white-yellow on tanned skin.

The disease is caused by opportunistic fungi, which can be present on human skin in several forms. When the fungus is in a non-pathogenic form, it is part of the normal microflora of the skin, does not harm humans and does not cause pityriasis versicolor. But if for some reason the fungus transforms into one of two pathogenic forms, then it becomes capable of penetrating from the surface of the skin into the depths of its stratum corneum and thereby causing the development of pityriasis versicolor. Classifying a fungus as opportunistic means that normally it does not harm a person, but when conditions are favorable for it, it causes the development of a disease.

Usually, conditions favorable for fungus In which it turns into a pathogenic form and causes lichen, is high humidity of the skin, and high temperature of the air or skin. This means that any factors that contribute to prolonged exposure of the skin to a wet and hot state (for example, excessive sweating, intense physical work, being in a hot, stuffy room, taking antipyretic drugs, vegetative-vascular dystonia, heavy sweats due to tuberculosis, too warm clothes etc.), can actually be considered as provoking the development of pityriasis versicolor. That is why pityriasis versicolor is much more common in people living in hot and humid climates, compared to those who constantly live in a temperate climate zone.

Separately, it should be noted that people may have a genetic tendency to develop this mycosis. This category is characterized by the occurrence of the disease even with a slight influence of provoking factors.

The disease most often occurs between the ages of 10 and 50 years. Children under 10 years of age and people over 55 years of age almost never suffer from pityriasis versicolor.

Since pityriasis versicolor is caused by opportunistic representatives of a person’s own normal microflora of the skin, this disease, despite its infectious nature, is non-contagious. This means that a person suffering from pityriasis versicolor is not dangerous to others, since the disease is not transmitted from him to other people. Therefore, everyone around can fearlessly enter into close tactile contacts (hugs, handshakes, etc.) with people suffering from pityriasis versicolor.

At the initial stages of the disease, the fungus, which has transformed into a pathogenic form, penetrates the outlet openings of the sebaceous glands located in the area of ​​the hair follicles. The fungus multiplies in the sebaceous glands, affecting a small area of ​​the stratum corneum of the skin around the hairs. The affected areas appear as small yellow-brown dots on the skin. As the disease progresses, the affected areas of the skin increase in size, taking on the appearance of irregularly shaped spots of various sizes. Such spots can be any shade of brownish, brown or yellow-brown on untanned skin and whitish-yellow on tanned skin. With a long course of the disease, the spots merge with each other, forming extensive lesions with a diameter of up to 15 cm.

The surface of the spots is covered with scales, which, when lightly scraped, begin to peel off intensively. The more often a person washes, the less noticeable is the peeling and scales on the spots, due to the fact that they are constantly removed mechanically and do not have time to accumulate in large quantities. However, under the influence of ultraviolet radiation (including when tanning in the sun), the spots begin to peel off intensively and acquire white-yellowish or creamy shades, in contrast to the rest of the skin, which becomes dark. Intense peeling of spots that occurs under the influence of sunlight can lead to spontaneous healing due to the fact that the fungus is simply removed from the stratum corneum of the skin along with the falling scales.

Pityriasis versicolor spots are usually localized on the upper part of the body - on the torso, chest, back, décolleté, armpits, shoulders, abdomen, etc. In more rare cases, spots appear on the arms, legs, neck, genital area, and also on the head under the hair.

Pityriasis versicolor spots usually do not manifest themselves clinically, only occasionally provoking mild itching.

Ringworm can last for years, but by the age of 55–60 years it almost always heals spontaneously. Unfortunately, due to genetic predisposition, lichen can recur even after quality treatment.

Pityriasis versicolor is treated with antifungal drugs and keratolytic agents, as well as specialized skin cleansers. Antifungal drugs destroy fungus, keratolytic agents cause increased peeling, which allows you to simultaneously kill the pathogenic microbe and remove it from the affected areas. Skin washes allow you to quickly and effectively remove peeling and prevent relapses of the disease. Almost all remedies for the treatment of pityriasis versicolor are used externally, and only in rare cases are antifungal drugs taken orally.

Photo of pityriasis versicolor (varicolored) on the skin and head

This photograph shows patches of pityriasis versicolor in the armpit.

This photograph shows spots of pityriasis versicolor on untanned skin, localized in the décolleté area.

This photograph shows an area of ​​pityriasis versicolor in the back area on tanned skin.

This photograph shows pityriasis versicolor spots on tanned skin.

This photo shows pityriasis versicolor spots on untanned skin.

This photograph shows lichen spots on the face.

Causes of pityriasis versicolor

The causative factor of pityriasis versicolor is a fungus of the genus Pityrosporum, which is classified as opportunistic and is present on the human skin as part of the normal microflora. This means that the fungus is normally present on the skin, like other representatives of microflora, without causing any diseases. But if conditions favorable for the fungus are formed (high humidity and temperature), then it transforms into a pathogenic form and causes lichen.

The usual form of the fungus, in which it is present on the skin as part of normal microflora, is called Pityrosporum orbiculare. In this form, the fungus has the characteristic round shape from which it gets its name. The transition of the fungus to the pathogenic form in which it causes pityriasis versicolor can occur in two directions. That is, from a normal fungus it can transform into two different pathogenic forms, each of which can cause lichen. Each pathogenic form of the fungus has its own name - it is Pityrosporum ovale And Malassezia furfur. The fungus in the form of Pityrosporum ovale has a characteristic oval shape, thanks to which it is able to penetrate the stratum corneum of the skin and cause lichen. It is the oval shape of the fungus that causes the primary foci of lichen. The fungus in the form of Malassezia furfur forms mycelium, penetrates deeply into the stratum corneum and is characteristic of the progressive course of pityriasis versicolor.

That is, normally the fungus that causes pityriasis versicolor is present on the skin in the form of Pityrosporum orbiculare. At the initial stages of the disease, when lichen is just developing, the fungus is on the skin in the form of Pityrosporum ovale. Further, when the first spots have already formed, the fungus transforms into the form of Malassezia furfur mycelium and in this state can exist for years, supporting the progression of lichen.

Thus, we can generally say that the cause of pityriasis versicolor is three forms of opportunistic fungus, which are called Pityrosporum orbiculare, Pityrosporum ovale and Malassezia furfur. In various sources you can find any of the three names, but you need to know that these are forms of the same microorganism, two of which cause pityriasis versicolor.

The transition of the fungus to pathogenic forms occurs with increased humidity and increased skin temperature. That is, any situations in which the skin is often wet and hot provoke the transition of the fungus into a pathogenic form and thereby lead to the development of pityriasis versicolor. These factors that activate the fungus are called predisposing.

Currently Predisposing factors for pityriasis versicolor include the following:

• Excessive sweating (idiopathic, during heavy physical work or active sports training, when being in hot conditions (for example, in the heat on the street, in a hot workshop, in a bathhouse, etc.), when wearing excessively warm clothes that are not suitable for the weather, when taking medications against the background of various diseases, such as vegetative-vascular dystonia, tuberculosis, rheumatism, etc.);
• Oily skin seborrhea;
• Lubricating the skin with fats;
• Inadequate nutrition;
• Diseases that occur with long periods of increased body temperature;
• Taking hormonal glucocorticoid medications (Dexamethasone, Prednisolone, etc.) or antibiotics for a long time;
• Changing the pH of sweat to the alkaline side (for example, with diabetes, obesity, malignant tumors, Itsenko-Cushing syndrome, etc.);
• Age under 10 years and over 55 years;
• Genetic predisposition to pityriasis versicolor, inherited;
• High air humidity in tropical and subtropical countries;
• Taking oral contraceptives.

Since high humidity and temperature are necessary for the development of lichen, this disease most often affects people living in countries with hot and humid climates. Thus, in the tropics and subtropics, about 30–40% of people have suffered from pityriasis versicolor at least once in their lives, and in countries with a temperate climate this figure is only 2–5%.

Despite the fact that pityriasis versicolor is caused by a fungus and is essentially an infectious disease, it is not contagious, that is, it is not transmitted from person to person or from animals to people. The non-infectiousness of lichen is due to the fact that the pathogen is a representative of the normal human microflora, and certain conditions are necessary for its transition to a pathogenic form.

Pityriasis versicolor (varicolored) - symptoms

Pityriasis versicolor in children

In children under 10 years of age, pityriasis versicolor almost never occurs, since they have protective mechanisms against the negative effects of moisture and high temperature on the skin of the body. However, if a child’s skin is often lubricated with hard fats (for example, butter, cocoa butter, etc.), then he or she may develop pityriasis versicolor even before the age of 7–10 years.

Starting from about the age of 10 years, when children enter prepuberty and their body begins to undergo restructuring with the production of sex hormones, the skin acquires properties like that of adults, that is, it becomes sensitive to high humidity and temperature. As a result, starting from the age of 10 years, children also become susceptible to pityriasis versicolor, which develops in them in the same way as in adults - when an opportunistic fungus transforms into a pathogenic form under the influence of predisposing factors.

Pityriasis versicolor in children usually occurs in exactly the same way as in adults, without any fundamental differences or features. Only its spots on untanned skin in children are often painted in light colors, including white, reminiscent of those on tanned skin. Otherwise, there are no features or differences in the course and treatment of pityriasis versicolor in adults and children, so considering this disease separately in childhood does not make practical sense.

Tinea versicolor during pregnancy

The development of pityriasis versicolor during pregnancy is not dangerous, since this disease does not have a negative effect on the fetus. This means that a pregnant woman does not have to worry about the condition of her child if she gets pityriasis versicolor.

Moreover, since pityriasis versicolor is not fraught with complications and does not have a negative impact on human health, and medications for its treatment, on the contrary, can be dangerous for the growth and development of the fetus, many doctors recommend not starting its therapy during pregnancy. Gynecologists and dermatologists recommend calmly carrying and giving birth to a child, and then begin treating pityriasis versicolor with antifungal agents that will no longer be able to harm the baby.

However, if for some reason a woman wants to begin treatment for pityriasis versicolor during pregnancy, then medications that are safe for the fetus should be selected. In the vast majority of cases these are external means. But you should not use any external medications for the treatment of pityriasis versicolor; their choice must be approached very responsibly, choosing those medications that do not penetrate the systemic bloodstream and, accordingly, do not harm the fetus. A gynecologist or pharmacist can give comprehensive recommendations on which topical antifungal medications are safe for use during pregnancy.

Pityriasis versicolor (varicolored) in children and pregnant women: treatment, prevention (opinion of a dermatovenerologist) - video

Diagnostics

The diagnosis of pityriasis versicolor is made on the basis of the characteristic appearance of the spots, as well as several tests that make it possible to distinguish the disease from others similar to it in clinical manifestations, such as vitiligo, pityriasis alba or pink, psoriasis, seborrheic dermatitis, dermatophytosis of the trunk, eczema, cutaneous syphilis.

Currently, the following diagnostic tests are carried out to clarify the diagnosis of pityriasis versicolor and distinguish it from other diseases with similar manifestations:

• Microscopy of scrapings from stains– when studying scales under a microscope, pre-treated with a 20% KOH solution, in pityriasis versicolor, threads of the fungal mycelium and the yeast cells themselves are visible in the form of a characteristic picture with the figurative name “navy-style pasta”. This means that the mycelium of the fungus appears as long strands, between which are dark, round yeast fungal cells. That is, in total, white strands and dark rounded pieces between them are visible in the microscope, which is reminiscent of the appearance of the dish “naval pasta”;
• Iodine test– the spots and surrounding skin are treated with a 5% iodine solution and after a few minutes the color intensity is recorded. Pityriasis versicolor spots are dark brown, and their color is much more intense than the surrounding normal skin;
• Examining spots under a Wood's lamp– with pityriasis versicolor, the spots glow reddish-yellow or greenish-golden;
• Positive "chips" symptom (Bernier's sign)– when the stain is scraped, peeling appears. The exfoliating particles are very small, similar to flour.

To independently identify the disease, you can use accessible and simple methods, which are given in this video:

Treatment

General principles of treatment for pityriasis versicolor (how to treat?)

Treatment of pityriasis versicolor should be aimed at the simultaneous destruction of the fungus and the accelerated exfoliation of horny scales of the affected areas of the skin. This means that in the treatment of pityriasis versicolor, antifungal agents are used, which have a detrimental effect on the causative agent of the infection, and keratolytics - agents that accelerate the exfoliation of dead skin cells.

All keratolytics are external agents, that is, they are applied to the affected areas of the body for a certain period of time, after which they are washed off. Antifungal drugs can be intended for both external use and oral administration. As a rule, to treat pityriasis versicolor, antifungal agents are used for external use, since they are able to penetrate the loosened layer of dead cells of the stratum corneum of the skin and destroy the fungi and mycelium threads contained in it. Antifungal drugs for oral administration are used to treat lichen versicolor only in cases of severe and extensive lesions (for example, follicular form due to diabetes mellitus, etc.) or in case of persistent recurrence of the disease with ineffectiveness of external agents.

So, In general, the treatment regimen for pityriasis versicolor is as follows: alternately lubricating the spots, first with antifungal external agents, and then with keratolytics 1 - 2 times a day for 2 - 4 weeks, until the peeling disappears. When the peeling on the spots disappears, this will mean that the fungus has died and the lichen has been cured. But, despite the death of the fungus, the spots will remain visible for some time until a new layer of completely healthy skin grows in their place, after which there will be no traces left of them.

If pityriasis versicolor is localized on the scalp, then instead of ointments, use shampoos containing antifungal components, such as selenium sulfide, zinc pyrithione, ketoconazole, etc. Shampoos are applied to the scalp daily for 1 to 4 weeks, depending on the speed of recovery. The moment of recovery is also determined by the disappearance of peeling in the area of ​​the spots. Keratolytics are not used in this case, since they can have a negative effect on the hair.

If the lichen stubbornly does not respond to treatment with external means(after use for more than 4 weeks, peeling in the area of ​​the spots persists) or recurs, then, in addition to antifungal ointments or shampoos and keratolytics, take antifungal drugs in tablets. Usually the tablets are taken for 1 to 4 weeks, focusing on the disappearance of peeling in the area of ​​the spots, as a sign of recovery. During the entire period of taking the tablets, the spots are lubricated with antifungal ointments and keratolytics.

Also a useful auxiliary, and sometimes the main treatment for pityriasis versicolor, is exposure to the sun (tanning). The fact is that under the influence of sunlight, active exfoliation of skin cells occurs, along with which the fungus is removed from the stratum corneum. With intense peeling, spontaneous recovery from pityriasis versicolor is possible. That is, the sun's rays, in fact, act like a powerful keratolytic, leading to the removal of the fungus from the skin structures and, accordingly, complete recovery. Thus, you can try to cure pityriasis versicolor by intensely sunbathing throughout the warm period of the year.

If pityriasis versicolor spots are very itchy, then you must follow the following recommendations to reduce the severity of itching:

• Wash only with water without soap;
• Wash in warm water and avoid hot water as it increases itching;
• After washing, apply moisturizing creams to your skin.

Compliance with any diet during treatment for pityriasis versicolor is not required. Also, when treating lichen, you can freely wash as much as necessary. But during therapy, you should often change your underwear and bed linen, giving preference to products made from natural fabrics, and after recovery, disinfect all linen items (sheets, underwear, towels, etc.) by boiling.

Unfortunately, despite the relative safety of the disease, lichen versicolor is prone to recurrence, so in most people the infection reappears within 2 years after successful treatment. Relapses do not mean that the treatment was performed poorly, it’s just that a person most likely has a hereditary predisposition to the disease, as a result of which he develops an infection very quickly compared to others if conditions are favorable for it.

To prevent relapses pityriasis versicolor, it is necessary to periodically (once a month) take one tablet of antifungal drugs.

Drugs for the treatment of pityriasis versicolor

Below we list the names