A recently married 24-year-old black man was brought (reluctantly) by his wife for consultation regarding the perpetual dirt on his back. She had tried many soaps—all to no avail—in search of a way to eliminate this persistent eruption.
The patient worked as an accountant, spent very little time outdoors, and pursued no hobbies that might account for the appearance of his back (eg, working on cars). Except for mild hypertension, he was in excellent health. Examination disclosed a scaly hyperpigmentation that covered the lower two thirds of the back.
This patient also had tinea versicolor. Remember that versicolor means many colored, referring to the variety of hues the disorder may assume.
In this patient, the scaly eruption was hyperpigmented, resembling dirt. Following treatment with itraconazole, 200 mg daily for 1 week, the dyschromia totally resolved without use of bleaching agents.