Summary

  • A superficial fungal infection of the stratum corneum, due to dimorphic yeasts of the genus Malassezia, leading to hypo- or hyperpigmented macular lesions on seborrheic areas of the trunk.
  • Eruption is most common in the summer months in adolescents. Often has a relapsing nature requiring frequent treatment or prophylaxis.
  • Primarily a clinical diagnosis that is confirmed by a KOH preparation demonstrating fungal elements with a characteristic spaghetti-and-meatballs appearance indicating the presence of both yeast and short hyphae.
  • Easily treated with either topical medications, including zinc pyrithione shampoo, selenium sulfide shampoo, or azole-class topical antifungal creams. More extensive disease may require systemic therapy with antifungal drugs.
  • After successful treatment, patients should be reminded that it may take up to 6 weeks before their normal skin pigmentation returns.
  • Recurrence of the disease is common, and prophylactic treatment with selenium shampoo and, for more extensive disease, systemic therapy with antifungal drugs may be necessary.

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