🍄 TOACS FCPS Station · Hypopigmented Rash on Neck (Tinea Versicolor)
📷 Clinical Photograph – Tinea Versicolor
🔍 Key clinical features:
- ✓ Hypopigmented or hyperpigmented macules – with fine scaling
- ✓ Commonly on neck, chest, back, and upper arms
- ✓ Asymptomatic or mildly pruritic
- ✓ Fine, adherent scale – easily scraped off
- ✓ May become more noticeable after sun exposure (lesions do not tan)
📋 Clinical scenario (examiner prompt)
A 16‑year‑old adolescent presents with light-colored patches on the neck and upper chest that have been present for several weeks. The patches are not painful or itchy, but the patient is concerned about the appearance. The rash is more noticeable after sun exposure (the patches do not tan). On examination, there are multiple, well-demarcated, hypopigmented macules with fine scaling on the neck, upper chest, and shoulders. The patient is otherwise healthy and has no other skin lesions.
🧑⚕️ Examiner tasks · TOACS
1. Identify the diagnosis from the clinical image and context.
2. Describe the clinical features (hypopigmented/hyperpigmented macules with fine scale, on trunk/neck, no tanning).
3. Explain the etiology and pathogenesis (Malassezia furfur/globosa, a lipophilic yeast that produces azelaic acid → hypopigmentation).
4. Discuss diagnosis and management (KOH prep, Wood lamp, topical/oral antifungals, recurrence).
🎯 Expected answers (for examiners)
- • Diagnosis: Tinea versicolor (pityriasis versicolor)
- • Clinical features: Hypopigmented or hyperpigmented, finely scaling macules; commonly on neck, chest, back, and upper arms; asymptomatic; more noticeable after sun exposure (lesions do not tan)
- • Etiology: Malassezia furfur (globosa) – a lipophilic yeast that is part of normal skin flora; overgrowth in warm, humid conditions
- • Pathophysiology: Yeast produces azelaic acid → inhibits tyrosinase → hypopigmentation; also can cause hyperpigmentation via inflammation
- • Diagnosis: Clinical appearance; KOH prep (short hyphae and spores – 'spaghetti and meatballs'); Wood lamp (yellow-gold fluorescence); fungal culture (not routinely needed)
- • Treatment: Topical: selenium sulfide 2% or ketoconazole 2% shampoo (apply 10 min then rinse); oral: fluconazole 300 mg weekly x 2-4 weeks or itraconazole 200 mg daily x 5-7 days for extensive/recurrent
- • Recurrence: Very common; maintenance topical therapy once weekly may help
• Organism: Malassezia furfur (lipophilic yeast)
• Appearance: Hypo- or hyperpigmented macules with fine scale
• Location: Neck, trunk, upper arms (sebaceous areas)
• KOH: 'Spaghetti and meatballs' (hyphae + spores)
• Wood lamp: Yellow-gold fluorescence
• Treatment: Topical selenium/ketoconazole or oral fluconazole/itraconazole
• Recurrence: Common; may need maintenance therapy
⚡ Quick FCPS‑style MCQ
A 16-year-old presents with hypopigmented, finely scaling macules on the neck and upper chest that become more noticeable after sun exposure. The most likely diagnosis is:
A. Vitiligo B. Tinea versicolor C. Pityriasis alba D. Tinea corporis📌 Topic summary · Tinea Versicolor
Malassezia furfur (lipophilic yeast)
Hypo- or hyperpigmented macules with fine scale
Neck, chest, back, upper arms
'Spaghetti and meatballs' (hyphae + spores)
Yellow-gold fluorescence
Topical selenium/ketoconazole or oral antifungals
| Feature | Tinea Versicolor |
|---|---|
| Etiology | Malassezia furfur (globosa) – lipophilic yeast |
| Age | Adolescents and young adults (sebaceous activity) |
| Clinical presentation | Hypo- or hyperpigmented, finely scaling macules on neck, trunk, and proximal extremities |
| Symptoms | Usually asymptomatic; mild pruritus in some |
| Diagnosis | Clinical; KOH prep (spaghetti and meatballs); Wood lamp (yellow-gold fluorescence) |
| Topical treatment | Selenium sulfide 2% shampoo (10 min x 1-2 weeks) or ketoconazole 2% shampoo (daily x 3 days) |
| Oral treatment | Fluconazole 300 mg weekly x 2-4 weeks; itraconazole 200 mg daily x 5-7 days |
| Prognosis | Excellent response; high recurrence rate; maintenance therapy weekly |