Pityriasis%20(tinea)%20versicolor Diagnosis

Diagnosis

Assessment

Considerations for a Dermatology referral:

Negative microscopy and unclear diagnosis
Extensive and severe infection
Treatment failure in primary care setting
Consideration of oral antifungal therapy in children <12 years old
Immunocompromised patients
Consideration of long-term antifungal prophylaxis

Laboratory Tests

Lab testing is not usually needed for the diagnosis
Consider doing microscopy if:
- Diagnosis is unclear
- Infection is unresponsive to the regular topical antifungals
- Planning oral antifungal treatment

Microscopy

Potassium hydroxide (KOH) examination of skin scrapings should confirm the diagnosis
- Scales or debris are examined under light microscope after adding a drop of 10-20% KOH solution
- Short stubby hyphae and yeast cells will appear as the typical “spaghetti and meatballs” appearance

Calcofluor may be used but this technique requires utilization of fluorescence microscope
Malassezia species also stain well with periodic acid-schiff (PAS) or methenamine silver

Culture

Unnecessary for routine diagnosis
Difficult to grow Malassezia in standard mycological media

Wood’s Light Exam

May be used to detect subclinical lesions
However, yellowish to white fluorescence is indicative only in approximately ¹/₃ of cases

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