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Patients call it "sunspots," "damned spots," or other synonyms. Hawaiians call it "kane", and Samoans call it "tane", visitors to Hawaii may hear it termed "haole rot." Some may even call it "ringworm" but it is not a true fungus and the usual antifungal preparations - external or internal - usually do not work. ("Kane" is the same word for man in Hawaiian language, but wahine, or women, also get "kane" or tinea versicolor.)
What is it?
Tinea Versicolor is a rather melodious name, but really well describes the superficial organism. This T.V. infection is different from other fungi in that it never goes inside the body -- nor does it invade the hair root and cause baldness. It just likes to grow on the uppermost layers of the skin, especially where there is oil on the surface.
What does it look like?
The infection is usually seen as small and slowly enlarging scaly, white-to-tan spots scattered over the upper arms, chest, and back. The spots may appear on the neck and face on some individuals. On light skin, the spots may not be recognized, or they may show up as tan-to-pink spots. The fungal cells growing in large numbers on the skin prevent the skin from tanning normally; therefore, as the individual's skin tans in the sun, the spots become more noticeable. On dark skin, the lesions are very noticeable.
They appear as discreet white-to-pale tan spots with a slightly scaly surface. When they occur on the exposed areas, such as the face and neck, their appearance may be very disturbing to the patient.
How is this infection diagnosed?
Either the light or dark colored spots may resemble other skin conditions, but this infection is easily recognized in the office. In most cases, the signs and symptoms are sufficient to make an adequate diagnosis. In difficult cases, a simple, fast, and economical direct examination of the fine scales scraped from the lesions will confirm the presence of the fungus.
The patient's lesions are lightly scraped with a sterile blade onto a microscope slide. The preparation is moistened and observed under the microscope to identify the fungal cells. Under the high power of the microscope, we can see the "spaghetti and meatballs" or hyphae and spores of the organism Mallasea Furfur - a big name for a small fungus!
Treatment of "T.V."
If you are prone to the T.V. infection, do not "grease up", lubricate, use moisturizing sunscreens or use Lanolin-containing moisturizing soaps.
On the contrary, dry your skin. Yes, dry your skin. Even though this is a dry, scaly infection, lubricants "feed the fungus", so no moisturizers, please.
How to dry the skin:
1. Use an acne-type soap and cream such as those over-the-counter preparations that contain sulfur, salicylic acid or benzoyl peroxides.
2. Abrasives, such as grains ("natural" or otherwise), and pads such as the Buf-Puf with the backscrub handle are very helpful.
O.T.C. Products
Some over-the-counter products do work. Try an antidandruff shampoo. Use it as a soap to wash the involved areas, or use it as a lotion and leave it on the skin for a few hours, or even overnight. Products such as Selsun Blue, Sebulex, lanil, are all available without a prescription and can help kill the microorganism, as well as drying the skin at the same time. Tar shampoos also work, but be careful. Tars potentiate the sun and ultraviolet light.
Use extreme caution if getting tanning exposures while using tar shampoos.
Prescription Products:
Prescriptions creams, lotions or oral medications may be necessary for persistent "T.V. infections". The antifungal pill Griseofulvin does not work, but "Nizoral" or Ketoconazole does and may be required for persistent cases. The doctor and patient must discuss this oral medication and the best way to give it.
What to do during treatment:
1. For the six week period of treatment, avoid tanning. Since sunshine tans noninfected skin but does not permit tanning of the Tinea Versicolor areas, avoid excessive sun exposure.
2. Keep the area as oil-free as possible.
3. After the infection is finished and there are no more scales, resume your normal activity with daily sunscreen.
If you have any questions about your T.V. infection, call our office.
© 2006 Pacific Monograph