Pityriasis Versicolor in Africa: What You Need To Know For a Healthy Skin

 

By: Foluke Akinwalere. Freelance Health Writer. Medical review and editorial support provided by the DLHA Team

African male with extensive pityriasis versicolor on the back.

 

 

Highlights:

 

• Pityriasis versicolor is a common fungal skin infection caused by the overgrowth of the Malassezia yeast on the skin.

• Pityriasis versicolor thrives in warm and humid climates, making it more prevalent in tropical and subtropical regions.

• It is characterised by the presence of discolored patches on the skin.

• While not always present, some people may experience mild itching or discomfort in the affected areas.

• Pityriasis versicolor is not contagious and cannot be spread from person to person through contact.

 

 

Introduction

 

Africa’s varied climates and environmental conditions provide fertile ground for various skin conditions, among which pityriasis versicolor holds a notable place.  

 

This condition, characterised by discolored patches on the skin, not only affects one’s physical appearance but also has psychological and social implications.  Despite its common occurrence, misconceptions often surround pityriasis versicolor, leading to delayed diagnosis and treatment. 

 

By exploring the complexities of this condition, African communities can be empowered with the knowledge necessary for early detection, causes, treatment, and prevention.

 

 

What is Pityriasis Versicolor?

 

Pityriasis versicolor is a common fungal skin infection characterised by discolored patches on the skin.  It is also known as tinea versicolor (one of the types of tinea infections).   In black skin, pityriasis versicolor patches can vary in color, ranging from white, pink, or tan to  darker shades such as brown or red.  The discoloration typically occurs on areas of the body with a high concentration of sebaceous glands, such as the chest, back, neck, face, and upper arms.

 

Pityriasis versicolor is not contagious, but it can be recurrent and may cause cosmetic concerns or mild itching.  While the condition is not harmful to overall health, it can cause distress due to its impact on appearance, especially in individuals with darker skin tones.

 

A few tribal names for pityriasis versicolor in Nigeria are “Ifo” (Yoruba), “Ngwo ndi nma” (Ibo), and “Kyasfi” (Hausa). [1]

 

 

What Causes Pityriasis Versicolor?

 

Pityriasis versicolor is primarily caused by an overgrowth of a type of yeast called Malassezia Furfur, which is naturally found on the skin.  Under certain conditions, such as hot and humid weather, hormonal changes, or weakened immune system, Malassezia can multiply excessively, leading to the development of pityriasis versicolor. 

 

Malassezia yeasts are lipophilic, meaning they thrive in oily environments.  They play a role in breaking down skin oils (lipids), which is crucial for the maintenance of healthy skin.  However, when there is an imbalance or excessive sebum (oil) production, these yeasts can increase rapidly, leading to skin abnormality such as pityriasis versicolor.

 

 

What Are The Risk Factors For Developing Pityriasis Versicolor?

 

1. Human Factors Contributing to Fungal Overgrowth

 

• Sebaceous Glands Activity: Increased activity of the sebaceous glands, which produce oil (sebum) that Malassezia feeds on, can contribute to fungal overgrowth.

 

• Hormonal Changes: Fluctuations in hormonal levels, such as those occurring during puberty, pregnancy, or while taking hormonal medications, may promote the growth of Malassezia yeasts.

 

• Immunosuppression: Individuals with weakened immune systems, whether due to underlying medical conditions (such as HIV/AIDS) or certain medications, are more susceptible to fungal infections. In such cases, pityriasis versicolor may serve  as one of the skin conditions indicating the underlying issues.

 

• Humidity and Sweating: Hot and humid climates, along with excessive sweating, can create ideal conditions for Malassezia growth, increasing the risk of developing pityriasis versicolor.

 

2. Environmental Factors

 

• Climate:  Pityriasis versicolor is more common in regions with warm and humid climates, where Malassezia yeasts thrive.

 

• Geographical Location:  Certain geographical areas, such as tropical and subtropical regions, have higher rates of pityriasis versicolor due to their climate and environmental conditions.

 

3. Genetic Predisposition

 

• Inherited Factors: A study showed a genetic vulnerability that is not linked to specific gene defects but does fit the criteria for multifactorial (genetic-environmental) inheritance.  The heritability was calculated to be 22.2% in first-degree relatives. [2] This evidence suggests that genetic predisposition may play a role in the proneness to pityriasis versicolor.

 

• Family History: Individuals with a family history of pityriasis versicolor may have increased risk of developing the condition, indicating a potential genetic component.

 

Understanding these multifactorial causes of pityriasis versicolor is essential for effective management and prevention strategies.

 

 

How Common Is Pityriasis Versicolor In Africa?

 

Pityriasis versicolor is a prevalent skin condition in various regions of Africa, with its occurrence influenced by demographic factors, seasonal variations, and the impact of climate and geography.

 

• Prevalence in Different Regions of Africa

 

The prevalence of pityriasis versicolor can vary across different regions of Africa.  In countries with a more moderate climate it affects about 1% of the population, and in some tropical countries it affects about 40%.  The condition affects both men and women equally, of which most of them develop the condition during their teenage years. [3]

 

• Demographic Factors

 

Pityriasis versicolor can affect individuals of all ages and ethnicities.  However, certain demographic factors may influence its prevalence. For example, young adults and adolescents, particularly those undergoing hormonal changes during puberty, may be more susceptible to developing the condition.  Additionally, individuals with compromised immune systems, such as those living with HIV/AIDS or undergoing immunosuppressive therapy, may have an increased risk of developing pityriasis versicolor.

 

• Seasonal Variations

 

Seasonal variations can impact the prevalence of pityriasis versicolor in Africa.  The condition tends to be more common during warm and humid seasons, such as the rainy season, when environmental conditions favor the growth of Malassezia yeast.  Conversely, the prevalence may decrease during cooler and drier seasons when humidity levels are lower.

 

Understanding these influences on the prevalence of pityriasis versicolor in Africa is essential for healthcare providers to effectively diagnose, manage, and prevent the condition in affected populations.

 

 

What Are The Symptoms Of Pityriasis Versicolor?

 

The symptoms of pityriasis versicolor can vary from person to person, but commonly include:

 

Skin Manifestations:  Pityriasis versicolor typically presents as small, round or oval-shaped patches on the skin.  These patches may vary in color, ranging from white, pink, or tan to darker shades such as brown or red.  The patches are usually slightly scaly and may merge together to form larger areas of discoloration.  They commonly appear on areas of the body with a high concentration of sebaceous glands (oils), such as chest, back, neck, face, and upper arms.

 

Variations in Skin Pigmentation:  One of the hallmark symptoms of pityriasis versicolor is the presence of hypo- or hyperpigmentation patches on the skin.  These patches may contrast with the surrounding skin tone, leading to a blotchy or mottled appearance.  In individuals with darker skin tones, the patches may appear more pronounced and can cause cosmetic concerns.

 

Itching and Discomfort:  While pityriasis versicolor is typically not associated with significant itching or discomfort, some individuals may experience mild itching or irritation in the affected areas, particularly if the patches are located in areas of friction or perspiration.

 

Psychological Impact:  The cosmetic appearance of pityriasis versicolor can have a psychological impact on affected individuals.  Discolored patches on visible areas of the body, such as the chest or back, may cause embarrassment, self-consciousness, or reduced self-esteem.  In severe cases, individuals may avoid social situations or activities that expose the affected skin, leading to social withdrawal or isolation.

 

Overall, while pityriasis versicolor is not a serious health threat, its symptoms can cause distress and impact quality of life.  Early recognition and treatment of the condition can help alleviate symptoms and minimise the psychological impact on affected individuals.

 

 

How to Diagnose Pityriasis Versicolor

 

Diagnosing pityriasis versicolor typically involves a combination of clinical examination, specialised tests, and ruling out other skin conditions.  Here’s how it is diagnosed:

 

Clinical Examination:   Healthcare providers often diagnose pityriasis versicolor based on the characteristic appearance of the skin lesions.  The distinctive patches of hypo– or hyperpigmented skin, along with their typical distribution on areas of the body with a high concentration of sebaceous glands, are key diagnostic features.  The provider may also inquire about symptoms such as itching or discomfort.

 

Wood’s Lamp Examination: A Wood’s lamp, which emits ultraviolet (UV) light, can be used to aid in the diagnosis of pityriasis versicolor.  Under the Wood’s lamp, affected areas of the skin may fluoresce yellow-green or golden-orange due to the presence of fluorescent substances produced by the Malassezia yeast.  

 

Microscopic Examination (KOH Test):  A microscopic examination of skin scrapings from the affected areas can help confirm the diagnosis of pityriasis versicolor.  During this test, the skin scrapings are treated with potassium hydroxide (KOH) solution, which dissolves the skin cells and leaves behind fungal elements, if present.  Under a microscope, characteristic spaghetti and meat-ball-like structures representing Malassezia yeast and their hyphae can be observed, confirming the diagnosis.

 

Differential Diagnosis: Pityriasis versicolor can resemble other skin conditions, such as vitiligo, tinea corporis (ringworm), seborrheic dermatitis, and pityriasis alba.  A thorough clinical examination, along with the results of any additional tests, helps differentiate pityriasis versicolor from these other conditions.

 

 

What Are The Treatment Options For Pityriasis Versicolor?

 

Treatment options for pityriasis versicolor typically involve antifungal medications to eliminate the causative yeast, Malassezia.  Here’s an overview of the treatment options available:

 

Topical Antifungal Medications

 

• Antifungal creams, lotions, or shampoos containing active ingredients such as ketoconazole, selenium sulfide, or ciclopirox are commonly prescribed for mild to moderate cases of pityriasis versicolor.  These medications are applied directly to the affected areas of the skin or scalp once or twice daily for a specified duration, usually ranging from one to four weeks.

• Terbinafine or clotrimazole are also effective topical antifungal agents that may be used to treat pityriasis versicolor.

 

Oral Antifungal Medications

 

• In cases of severe or recurrent pityriasis versicolor, oral antifungal medications may be prescribed.  Oral azole antifungals, such as fluconazole or itraconazole, are often used for their systemic action against Malassezia yeast.  A typical course of oral antifungal therapy may range from a single dose to multiple doses taken over the course of several days.

 

Combination Therapies

 

• In some cases, healthcare providers may recommend a combination of topical and oral antifungal medications to achieve optimal results, especially for severe or recurrent cases of pityriasis versicolor.

• Combination therapies may also include the use of antifungal shampoos in conjunction with topical or oral medications for scalp involvement.

 

Home Remedies and Natural Treatments

 

While there is limited evidence supporting the effectiveness of home remedies and natural treatments of pityriasis versicolor, some individuals may opt for these alternative approaches.

 

Examples of home remedies and natural treatments include the application of:

• Aloe vera:  A cactus-like plant, has been traditionally used for treating various skin conditions.  High concentrations of aloe vera extract can potentially inhibit the growth of the fungus responsible for pityriasis versicolor.

• Honey:  Honey has been demonstrated to alleviate symptoms of pityriasis versicolor in limited research.  Additionally, a study indicated that a combination of honey, olive oil, and beeswax is effective in treating the condition. [4]

• Turmeric: This treatment is believed to alleviate itching and reduce pigmentation. Consider applying a paste made from turmeric powder to the affected area.

• Coconut oil: Coconut oil is an excellent natural ingredient for moisturizing and soothing the skin.  It also has anti-fungal properties that can effectively combat fungal infections.

 

It is important to exercise caution when using these remedies and to seek advice from a healthcare provider before trying them, as they may not be appropriate for all individuals and could potentially result in skin irritation or allergic reactions.

 

 

How Do You Control and Prevent Pityriasis Versicolor?

 

Here’s how individuals can effectively manage and prevent the recurrence of pityriasis versicolor:

 

Personal Hygiene Practices

 

• Regularly cleanse the skin with mild soap and water, paying particular attention to areas prone to sweating, such as the chest, neck, and upper arms.

 

• Gently shed the skin using loofah or soft brush to remove dead skin cells and reduce the buildup of oil and sweat.

 

• Avoid using oily or greasy skin care products, as these can contribute to the growth of Malassezia yeast.

 

• Practice good scalp hygiene by washing the hair regularly with a medicated shampoo containing antifungal ingredients, especially if scalp involvement is present.

 

Environmental Measures

 

• Maintain a clean and dry living environment by regularly washing bedding, towels, and clothing, particularly items that come into direct contact with the skin.

 

• Ensure proper ventilation and airflow in living spaces to reduce humidity levels, as high humidity can promote the growth of Malassezia yeast.

 

• Avoid sharing personal items such as towels, clothing, and hairbrushes with others to minimise the risk of spreading the infection.

 

Lifestyle Modifications

 

• Wear loose-fitting, breathable clothing made from natural fibers such as cotton, which allows the skin to breath and reduces sweating.

 

• Limit exposure to hot and humid environments, especially during the warmer months or in regions with tropical climates.

 

• Maintain a healthy lifestyle by eating a balanced diet, staying hydrated, getting regular exercise, and managing stress levels, as these factors can contribute to overall skin health and immune function.

 

Awareness and Education Initiatives

 

• Educate yourself and others about pityriasis versicolor, including its causes, symptoms, treatment options, and preventive measures.

 

• Raise awareness about the importance of early detection and treatment of the condition to minimise its impact on quality of life and prevent recurrence.

 

• Encourage open communication with healthcare providers about any skin concerns or symptoms, and seek prompt medical attention if symptoms persist or worsen despite self-care measures.

 

By incorporating these control and prevention strategies into daily routines and promoting awareness within communities, individuals can effectively manage pityriasis versicolor and reduce the likelihood of recurrence.

 

 

Conclusion

 

Understanding and addressing pityriasis versicolor in Africa is essential for promoting skin health and well-being across the continent.  By recognising the causes, symptoms, diagnosis, treatment options, and preventive measures outlined in this article, individuals can take proactive steps to manage and prevent this common fungal infection.  Through the control and preventive measures, Africans can empower themselves against the infection, minimising its impact on their lives and communities.

 

 

FAQs

 

Is pityriasis versicolor contagious?

 

No, pityriasis versicolor is not contagious and cannot be spread from person to person.

 

Who is at risk for pityriasis versicolor?

 

Individuals with oily skin, those living in warm and humid climates, adolescents and young adults undergoing hormonal changes, and those with weakened immune systems are at higher risk.

 

How long does it take for pityriasis versicolor to clear up?

 

With appropriate treatment, pityriasis versicolor usually clears up within a few weeks.  However, recurrence is common.

 

Can pityriasis versicolor spread to other parts of the body?

 

Yes, it can spread to other areas of the body, particularly in warm and humid conditions.

 

Can pregnancy increase the risk of pityriasis versicolor?

 

Yes, hormonal changes during pregnancy can increase the risk of developing pityriasis versicolor.

 

Is pityriasis versicolor the same as vitiligo?

 

No, pityriasis versicolor is a fungal infection, while vitiligo is a condition characterised by the loss of skin pigment.

 

Does pityriasis versicolor cause hair loss?

 

It does not cause hair loss, but it may affect the scalp and cause dandruff-like flakes.

 

Can pityriasis versicolor cause scarring?

 

It typically does not cause scarring, but it may lead to temporary changes in skin pigmentation.

 

 

References

 

1. George A.O., Daramola O.O.M, Pityriasis Versicolor - Possible Genetic Basis - Probable Transmission From Commensalism To Parasitism And The Implication Of Treatment Approach. African Journal Of Clinical and Experimental Microbiology Jan.2004 AJCEM/2002118/2414. Available from: https://www.ajol.info/index.php/ajcem/article/view/7367/13745

2. Hafez M, el-Shamy S. Genetic susceptibility in pityriasis versicolor. Dermatologica. 1985;171(2):86-8. doi: 10.1159/000249397. PMID: 4043474. Available from: https://pubmed.ncbi.nlm.nih.gov/4043474/

3. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Overview: Tinea versicolor. [Updated 2022 Apr 5]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK293710/

4. Israili, Zafar H. MS, PhD. Antimicrobial Properties of Honey. American Journal of Therapeutics 21(4):p 304-323, July/August 2014. | DOI: 10.1097/MJT.0b013e318293b09b  Available from: https://journals.lww.com/americantherapeutics/abstract/2014/07000/antimicrobial_properties_of_honey.13.aspx

 

 

Related:

5 Common Skin Diseases in Africa

Tinea Infections in Africans: An Overview

10 Common HIV Skin Conditions in Africans And Their Treatment

 

 

Published: May 19, 2024

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