Dear Doctor
I have those white dots (In image, red square on left) all across my body.
I have a contour of color change on my belly (In image, arrow pointing on border).
I contacted local dermatologist but he said its normal. It affecting me mentally.
I sick your help if you can guide me what exactly it is and is there a cure for it.
PS. My father and brother have this kind of skin too. My mother has normal skin.
Dear Patient
The white dots in the red square are suggestive of Tinea Versicolor which was formerly known as Pityriasis versicolor.
This is a fungal skin infection that is caused by Malassezia furfur.
The diagnosis can be confirmed by having test known as KOH skin prep. In this investigation the skin from the white patches is gently scraped and sent to the lab where it is mixed with potassium hydroxide (KOH). It is examined under a microscope and if a spaghetti and meatballs appearance of the fungal spores and mycelium is seen, it confirms the diagnosis of Tinea versicolor.
I therefore that you have this test done.
Tinea/Pityriasis Versicolor Treatment
A. Non-Prescription Products
Non-prescription over the counter products that are used to treat Tinea versicolor include those which contain selenium sulfide like Selsun Blue Shampoo. Selenium sulfide shampoos can be used for 10 days and should be left for 10 minutes until they dry on the skin before being rinsed off.
Nizoral shampoo which contains the antifungal ketoconazole can be applied on the affected area for 5 days and should be left for 5 minutes on the skin before being rinsed off.
Products containing pyrithione zinc like Noble Formula Pyrithione Zinc Soap can also be used.
B. Antifungal Creams
Antifungal creams used to treat Tinea versicolor include Clotrimazole cream which can be applied daily for 2 weeks. Miconazole cream can also be used.
Depending on where you live some of these antifungal creams can be obtained over the counter without a prescription.
C. Antifungal Tablets
Antifungal tablets used to treat this fungal skin infection include ketoconazole, fluconazole and itraconazole.
After completing your medication understand that the skin discoloration or white patches can take from 1 to 3 months before they return to your normal skin color. To make the discolaration less apparent, ensure that you apply sunscreen each day since it prevents the normal skin from tanning.
D. Recurrence Prevention
Since the Malassezia furfur which causes Tinea/ Pityriasis versicolor normally lives on the skin, these skin lesions tend to recur. To prevent recurrence you can:
1. Use the non-prescription shampoos and soaps weekly or fortnightly.
2. Use the non-prescription shampoos and soaps for three days before you leave for a vacation in a sunny area or any place where you will be spending a lot of time in the sun sweating.
3. Take prescribed antifungal tablets once a month.
Family Menbers with Tinea Versicolor
Tinea versicolor can affect many members of one family because of the following reasons:
1. Genetic predisposition – more than 20% of patients with Tinea versicolor have a family member who has suffered from the same condition.
2. Hot and humid environment – these fungi love hot and humid climates and the fact that they normally live on the skin can increase the chances of members of one family who are living together in a hot place developing it.
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