Abstract:
Pityriasis Versicolor (PV) is a widespread, chronic, and relapsing fungal infection affecting millions worldwide. Caused by the lipophilic yeast Malassezia, PV manifests as discolored, scaly patches on the skin, leading to significant cosmetic concerns and emotional distress. Despite its prevalence, PV remains poorly understood, with limited insights into its pathogenesis, diagnosis, and treatment. This review aims to provide a comprehensive overview of PV, including its epidemiology, clinical presentation, histopathological features, and current homoeopathic therapeutic options. A better understanding of PV is essential for developing effective homoeopathic management strategies and improving patient outcomes.
Keywords: Pityriasis Versicolor(PV), Malassezia, fungal infection, skin disease, homoeopathic therapeutics.
Introduction:
PV is a non-contagious, endogenous opportunistic persistent, superficial skin condition caused by various species of commensal yeast (Malassezia). Most commonly caused by Malassezia globosa and sometimes Malassezia sympadialis and Malassezia furfur. (1) (2)
Incidence: Occurs worldwide but most commonly in tropical climates. Recurrence is common.
Age- adolescents and young adults. In infants, it is less common due to immaturity of sebaceous gland. (1)
Conditions can be associated with other skin conditions such as folliculitis and seborrheic dermatitis.
Risk factors
Summer- warm and humid climate.
Hyperhidrosis.
Tropical location.
Chronic steroid use.
Cushing’s disease or syndrome.
Immunosuppression
Use of topical skin oils. (3)
Note – Not related to poor skin hygiene.
Pathophysiology
Malassezia furfur (any species) is a part of normal skin flora . but due to any risk factors, they transforms from yeast cells to pathogenic mycelial form which produce azelaic acid that initiates inflammatory reaction causing dysregulated melanin production that leads to alterations in pigmentations i.e. hypopigmentation in summer and hyperpigmentation in winter. (3)
Signs and Symptoms
Often asymptomatic.
Hypopigmented, hyperpigmented or erythematous skin lesions that coalesce into scaling macules, patches or thin plaques. Color can vary from brown to pink.
Eruptions are characterized by scaly, oval macules.
Sites affected trunk, proximal extremities, face and neck. Predilection for sebaceous glands as Malassezia fungi utilize lipids from sebaceous glands for nutrition. (5)
Diagnosis
Clinical- FLUFF test / scratch test/ Besnier’s sign.
Wood’s lamp- pigment shows yellow green fluorescence in lesions. (1)
Skin scrape microscopic view- KOH preparation shows “spaghetti and meatballs” hyphae (short cigar-butt hyphae and spores in cluster). (2)
Differential diagnosis
Pityriasis alba, Seborrheic dermatitis, Guttate psoriasis, Tinea corposis, Vitiligo, Leprosy, Progressive macular hypomelanosis. (1)
Homoeopathic Therapeutics–
Few glimpses on homoeopathic medicines are:
Sulphur– Skin affection after local medications. Dry, scaly, unhealthy skin. Itching and burning, worse scratching and washing. Excoriation especially in folds. Pruritis, especially from warmth in the evening, often recurs in spring time in damp weather.
Psorinum– Dirty, dingy look. Intolerable itching. Face pale, delicate. Sickly.
Tuberculinum– Itching intense, worse at night, dampness, early morning better open air.
Arsenic album – Intense itching, burning, papular eruption, dry, rough, scaly worse cold and scratching.
Natrum muriaticum – Dry eruptions especially on the margin of hairy scalp and bends of joints.
Bacillinum – Ringworm, pityriasis worse night, early morning cold air. (6)
References:
- Mehdi Karray WPM. National Library of Medicine. [Online].; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482500/.
- Davidson S. Davidson’s Principles and practice of medicine. 23rd ed. Ralston Stuart H. PID,SMWJ,HPR, editor.; 2018.
- National Library Of Medicine. [Online].; 2023. Available from:
https://pubmed.ncbi.nlm.nih.gov/36916255/#:~:text=The%20main%20differential%20diagnos es%20are,syndrome%20and%20diabetic%20foot%20infection.
- The calgary guide to understanding disease. [Online]. Available from:
https://calgaryguide.ucalgary.ca/pityriasis-tinea-versicolor/.
- Hill MG. Harrison’s principles of internal medicine. 21st ed. Loscalzo Joseph KDL,LDL,FAS,HSL,JJL, editor.
- Boericke W. Pocket Manual of Homoeopathic Materia Medica With Indian medicine & repertory.: Indian Books & Periodicals Publishers; 2017.
- Mehdi Karray WPM. National Library of Medicine. [Online].; 2024. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482500/.
- Davidson S. Davidson’s Principles and practice of medicine. 23rd ed. Ralston Stuart H. PID,SMWJ,HPR, editor.; 2018.
- National Library Of Medicine. [Online].; 2023. Available from:
https://pubmed.ncbi.nlm.nih.gov/36916255/#:~:text=The%20main%20differential%20diagnos es%20are,syndrome%20and%20diabetic%20foot%20infection.
- The calgary guide to understanding disease. [Online]. Available from:
https://calgaryguide.ucalgary.ca/pityriasis-tinea-versicolor/.
- Harrison. Harrison textbook of practice of medicine.
- Boericke W. Pocket Manual of Homoeopathic Materia Medica With Indian medicine & repertory.: Indian Books & Periodicals Publishers; 2017.
