The FP considered the diagnoses of vitiligo and tinea versicolor. He performed a potassium hydroxide (KOH) preparation and saw the “spaghetti and meatballs” pattern of Malassezia furfur. (See a video on how to perform a KOH preparation.) The “spaghetti” or “ziti” is the short mycelial form of M furfur and the “meatballs” are the round yeast form (Pityrosporum).
This was definitive proof that the patient had tinea versicolor caused by M furfur, a lipophilic yeast that can be found on healthy skin. Tinea versicolor starts when the yeast that normally colonizes the skin changes from the round form to the pathologic mycelial form and then invades the stratum corneum. M furfur thrives on sebum and moisture and tends to grow on the skin in areas where there are sebaceous follicles secreting sebum. Patients with tinea versicolor present with skin discolorations that are white, pink, or brown.
The patient in this case chose a single oral dose of 400 mg fluconazole to be repeated one week later. The condition cleared and the patient's skin color returned to normal in the following months.
Photos and text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. This case was adapted from: Usatine R. Tinea versicolor. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw-Hill; 2013:566-569.
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