A 25-year-old black man was intermittently plagued with a mildly pruritic eruption on his chest and back only. This rash had involved the same areas almost every year since the patient's adolescence. His two sisters suffer from the same malady.
Review of systems and additional medical history were entirely unrevealing. On examination, innumerable small (1- to 2-mm) macular areas of hypopigmentation involving the upper, anterior chest and virtually the entire back were noted. In many sites, the macules became confluent to form larger hypopigmented regions.
In darker-toned skin, tinea versicolor presents as scaly patches that are either hypopigmented or hyperpigmented. In all ethnic groups, the lesions tend to begin around the orifices of hair follicles; this folliculocentric orientation is quite apparent in the small lesions seen on this patient. Over time, generally these tiny areas blend together to form more widespread patterns, which are also apparent in this patient.
The history given by this patient is quite typical, with multiple affected family members and seasonal recurrences in spring and summer. Such recurrences may be prevented by instructing the patient to wash the most typically affected area with a 5% to 10% benzoyl peroxide soap, once or twice weekly, at the beginning of each succeeding warm weather season following a treatment episode.