It appears as whitish, 0.5-3 cm-sized patches on the skin. Sometimes, especially in the early stages, the patches may be more brownish/pinkish, but they usually turn whitish over time. The patches often have minimal scaling and are described as "cigarette paper-like." In some cases, the patches may merge and develop into more extensive, contiguous skin changes.
Common locations include the neck, trunk, and upper arms. The condition is most commonly seen in teenagers and young adults. It is slightly more common in males than females.
The fungal infection is caused by a yeast (type of fungus) called Malassezia furfur. This fungus is not harmful and is present on the skin of most individuals. Therefore, the condition is not contagious. The fungus thrives on warm and moist skin. Hence, the condition is more common among individuals who are physically active, sweat heavily, shower frequently, or reside in hot, humid climates. Under such conditions, the fungus becomes more active and can cause the characteristic pigmentation changes. These pigmentation changes result from reduced pigment production in the skin, where the fungus thrives.
Treatment is aimed at targeting the aforementioned fungus.
The most commonly used approach is the application of antifungal agents directly to the skin, such as selenium-containing shampoos or ketoconazole. There is also a range of antifungal creams, gels, and sprays available containing terbinafine. Propylene glycol is also used.
Pigmentation changes may persist for several months after treatment. This is because new pigment needs to be produced in the skin after the fungus is eradicated.
Recurrence is quite common, and therefore, maintenance treatment 1-2 times weekly for an extended period is recommended. The condition does not leave scars.
Oral antifungal treatment is considered if topical treatment fails, if there are extensive skin changes, or if there are frequent recurrences.
