Tinea versicolor vs Vitiligo
How to tell Tinea versicolor and Vitiligo apart when a board question makes them look alike.
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Presence of fine scale with positive KOH fungal elements distinguishes tinea versicolor from vitiligo.
Side by side
Hypo- or hyperpigmented finely scaling macules on the trunk that become more noticeable after sun exposure suggest tinea versicolor.
Sharply demarcated depigmented patches without scale and with complete pigment loss indicate vitiligo.
Malassezia overgrowth disrupts normal melanocyte function and stratum corneum appearance, creating superficial pigment alteration with scale.
Autoimmune melanocyte destruction causes permanent depigmented patches and association with other autoimmune disease.
KOH prep from scale shows short hyphae and yeast forms in a spaghetti-and-meatballs pattern, and Wood lamp may show yellow-green fluorescence.
Vitiligo lacks fungal elements on KOH and under Wood lamp often shows bright chalk-white accentuation with complete depigmentation.
The trap
Hypopigmentation alone leads to mistaken antifungal treatment for vitiligo. The resolving clue is scale and KOH microscopy, not color change alone.
The repair move
Next best step: treat tinea versicolor with topical selenium sulfide 2.5% lotion or ketoconazole shampoo applied to affected skin for 1 to 2 weeks; oral azoles are reserved for extensive or recurrent disease. If lesions are non-scaling complete depigmentation with negative KOH, treat vitiligo with topical corticosteroid or calcineurin inhibitor and consider phototherapy for broader involvement.
Try a free question
CoreA 22-year-old woman has hypopigmented trunk macules that worsen in summer. Exam shows fine scale and KOH prep with short hyphae plus yeast forms. What is the most likely diagnosis?
Show answer and explanation
Answer: A. Tinea versicolor. Scaling hypopigmented lesions with characteristic KOH findings indicate tinea versicolor.
Why the other choices are tempting
- B. Vitiligo is depigmented and non-scaling with negative fungal microscopy.
- C. Pityriasis alba typically occurs in children with ill-defined facial patches and no fungal KOH pattern.
- D. Postinflammatory hypopigmentation lacks active fungal elements.
- E. Tinea corporis usually has annular plaques with peripheral advancement rather than diffuse trunk macules.
Flashcards
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What bedside feature most quickly separates tinea versicolor from vitiligo patches?
Fine superficial scale favors tinea versicolor, while vitiligo lesions are smooth and non-scaling.
Which microscopic finding confirms tinea versicolor?
KOH showing short hyphae and yeast forms in a spaghetti-and-meatballs pattern confirms tinea versicolor.
Quick answers
What is the fastest way to tell Tinea versicolor from Vitiligo?
Presence of fine scale with positive KOH fungal elements distinguishes tinea versicolor from vitiligo.
What is the key clue for Tinea versicolor?
Hypo- or hyperpigmented finely scaling macules on the trunk that become more noticeable after sun exposure suggest tinea versicolor.
What is the key clue for Vitiligo?
Sharply demarcated depigmented patches without scale and with complete pigment loss indicate vitiligo.
What is the common trap with Tinea versicolor vs Vitiligo?
Hypopigmentation alone leads to mistaken antifungal treatment for vitiligo. The resolving clue is scale and KOH microscopy, not color change alone.