Pityriasis versicolor or bran fungus lichen

Pityriasis versicolor (also called bran fungus lichen or tinea versicolor) is a common skin infection caused by yeasts (fungi) of the genus Malassezia that live on the skin and scalp.

Pityriasis is a kind of scaly skin and versicolor means mottled.

Malassezia yeasts:

  • feed on fatty acids, which are located in the sebum produced by the sebaceous glands of the skin;
  • produce dicarboxylic acids, especially azelaic acid, and deposit them on the skin.

The white color of the spots of bran fungus lichen is explained as follows:

  • Azelaic acid inhibits tyrosinase: an enzyme that controls melanin synthesis.
  • According to some authors, lipidic material accumulates in the stratum corneum (outermost layer of the epidermis), which blocks the sun’s rays.

The cause of the dark spots that form in some cases is unknown; Assumptions are:

  • Keratin layer of the skin becomes thicker.
  • Inflammatory response that stimulates melanin production.

The yeasts are not the same in this disease:


Where does pityriasis versicolor develop?

The affected skin zones are usually:

  • Shoulder
  • Back
  • Breast.

Sometimes skin folds may be affected, such as:

  • Armpits
  • skin under the breast,
  • Groin area.

Only the face is left out, even if in small children the face may be affected, especially at the hairline.
There may be few or very many spots. In this case, the aspect of the affected skin may seem normal, while the (unchanged) skin around the area seems to have a problem.Causes of pityriasis versicolor

Malassezia mushrooms are present on the skin of all healthy people.
If the fungus multiplies excessively, then an infection develops.

The infection can occur for one of the following reasons:

1. oily skin, 2. warm and humid climate, 3. excessive sweating, 4. weak immune system, for example due to AIDS,

5. pregnancy (the hormonal fluctuations change the pH of the skin).

Since yeast develops naturally on the skin, tinea versicolor is not contagious.
This condition can affect people of any skin color. It mainly affects young people.

Signs and symptoms of tinea versicolor

Yeast growth on the skin provokes the formation of areas of different coloration compared to the surrounding skin.
The following may arise:

  • individual points,
  • Stains.

Specific signs and symptoms of infection include:

  1. Spots that can be white, pink, red or brown and that can have a much lighter or darker color than the surrounding skin.
  2. Spots that do not tan with the rest of the skin.
  3. Spots that can appear anywhere on the body, especially on the neck, chest, back, and arms.
  4. Sometimes you feel itching in the affected areas.

The stains:

  • can disappear again in cool weather,
  • aggravate when the climate is warm and humid.

The skin may be:

How is the diagnosis of pityriasis versicolor made?

  • The doctor may make the diagnosis of tinea versicolor based on the appearance of the skin.
  • Scratch sign or Besnier’s sign – Because the fungus attacks the stratum corneum of the skin, it will be scraped off by a doctor to observe the fine scaling. This test makes it possible to distinguish bran fungus lichen from other skin diseases.
  • The doctor can use ultraviolet rays (Wood lamp) that change the color of the affected areas.
    If the spots are caused by tinea versicolor, the UV rays cause them to fluoresce yellow-green.
  • The doctor may take a sample by scraping off a piece of skin and scales from that area for examination under a microscope.
    The sample can be applied directly to a slide and subjected to histological analysis.

Differential diagnosis
Pityriasis versicolor can be confused with the following diseases:
1. Discoid eczema or dermatitis nummularis is an irritation of the trunk and/or limbs.
2. Psoriasis consists of red, scaly plaques, the psoriatic skin lesions can occur anywhere.
3. Hypomelanosis guttate idiopathica affects the shins and forearms.
4. Pityriasis alba causes large spots on the upper arms and face. It mainly affects small children on dry and dehydrated skin areas.
5. Pityriasis rosea has a short course and a rapid onset.
6. Post-inflammatory hypo- or hyperpigmentation causes an uneven pattern of distribution from a previous inflammatory episode.
7. Tinea corporis spreads slowly, forming spots in the form of rings.
8. Vitiligo causes asymmetric white spots.

Is pityriasis versicolor a serious disease?
No, the only side effect is that these rashes are annoying when sunbathing, because they remain as bright spots on the skin.

Is pityriasis versicolor contagious?

No, transmission of this disease to another person is not possible.
The yeast that causes this rash on the skin also usually colonizes the skin and usually doesn’t hurt.
For unexplained reasons, yeast seems to grow more easily on some people’s skin.

What is the therapy for pityriasis versicolor?

The type of treatment may depend on the location of the rash or whether the patient has had this condition before.

The treatment options are as follows:

Antifungal agents Local and oral antifungal drugs (antifungal agents
) are used to treat pityriasis versicolor.
Among these are:

  • Propylene glycol;
  • sodium thiosulfate solution;
  • selenium sulfide;
  • topical azoles (cream, powder or cutaneous solution), including:
    • clotrimazole (Canesten ® ),
    • miconazole (mycotine ®),
    • Econazole (Pevaryl ®),
    • Terbinafine (Lamisil ® ,
    • Fenticonazole (Fenizolan ® ),
    • Bifonazole (Bifon),
    • Ketoconazole (Nizoral ®).
  • Tablets of the following antifungal drugs:
    • itraconazole (Sempera ®, Sporanox ®),
    • Fluconazole (Diflucan ®) for one/two consecutive weeks.
  • terbinafine gel;
  • Ciclopirox (Ciclocutan ®) cream or solution.

Shampoo and antifungal cleansers

Shampoo with ketoconazole (Nizoral ®) is often recommended.
You can get it at the pharmacy and it is available on prescription.
Ketoconazole kills the germs that cause this rash.

  • Apply the hair shampoo to the affected areas.
  • Wash off after three to five minutes.
  • Repeat the application every day for five days.

The doctor may recommend a shampoo with ketoconazole to those who often develop recurrences after sun exposure.
It is important to use the shampoo once a day for a total of three days before you go on holiday and stay in the sun.
This helps to reduce the risk of pityriasis versicolor.

Shampoo with selenium sulfide is an alternative treatment.
You can get it at the pharmacy and it’s prescription

  • Dilute 50% with water (half water, half shampoo).
  • Apply the diluted shampoo to the affected areas.
  • Leave on for 10 minutes.
  • Erode.
  • The application should be repeated every day for a week.

Antifungal tablets may be prescribed if:

  • the rash is greatly expanded,
  • does not pass through the treatments described above.

Antifungal treatment can be repeated if:

  • the skin infection recurs (repeats),
  • the skin flakes again.

This usually happens under certain conditions, for example:

Note: After the treatment, the color of the affected skin will return to normal after about 3-6 months.

Natural remedies for pityriasis versicolor

water and bicarbonate can be applied directly to the skin areas affected by pityriasis versicolor to reduce the extent of the rash.
Other home remedies with bactericidal and antifungal effects applied to pityriasis versicolor are:
1. Sulfur soap
2. Aloe vera gel
3. Tea tree oil

Prevention of pityriasis versicolor

  • It is advisable to avoid very fatty skin care products.
  • Use sunscreens with a high protection factor (30-50). The tanning emphasizes the pityriasis versicolor more.

Nutrition for pityriasis versicolor

A balanced diet helps to maintain healthy skin.
Mushrooms grow and thrive in an environment rich in organic waste.
A poor diet can cause toxins to accumulate:

  • in the blood,
  • in the skin.

Common sense is required when choosing food. So it should be dispensed with:

  • fried foods,
  • red meat,
  • alcoholic beverages
  • Sweet
  • Fast food
  • ready-made sauces,
  • Dairy products.

How long does bran fungus lichen take? Do I have to expect recurrences?

As a rule, pink or brown pityriasis versicolor heals under treatment, but the rash is often recurrent if the conditions for Malassezia furfur are met.
Antifungal treatment must be repeated if pityriasis versicolor recurs.
Oral antifungal treatment may be prescribed preventively for one to three days a month in people who are at increased risk of recurrence.

Usually, the cure of pale pityriasis versicolor takes place within two weeks under treatment. As a result, the skin tans normally again when exposed to sunlight.
Nevertheless, the white spots sometimes persist for a long time for unknown reasons:

  • after scaling,
  • after the yeast infection has healed.

In such cases, antifungal treatment may be useless.

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