Pityriasis Versicolor: Symptoms, Causes, and Treatment in the UK

Pityriasis versicolor, sometimes referred to as tinea versicolor, is a common and harmless fungal infection of the skin. Unlike many other fungal infections, it is not caused by poor hygiene and is not contagious. It occurs when a type of yeast called Malassezia, which lives naturally on everyone's skin, begins to grow uncontrollably.

According to NHS guidelines, this yeast typically causes no issues, but certain factors like humid weather, oily skin, or hormonal changes can trigger an overgrowth. This results in small, scaly patches that interfere with the normal pigmentation of the skin. In the UK, it is most frequently seen in teenagers and young adults, often becoming more noticeable after sun exposure because the affected patches do not tan.

The most distinctive symptom of pityriasis versicolor is the appearance of oval or round patches on the skin. These patches are most common on the back, chest, and upper arms, though they can occasionally appear on the neck and face.

Appearance of the Patches

• Colour: The patches may be lighter (hypopigmented), darker (hyperpigmented), or pink/red. In people with pale skin, they often look darker or pink; in those with darker skin, they usually appear lighter.
• Texture: The skin may look slightly scaly or dry.
• Sensation: Most patients do not experience pain, but the patches can occasionally feel itchy, especially when the body gets hot.
• Sunlight: The patches do not tan, making them stand out significantly against surrounding skin during the summer months.

The Malassezia yeast thrives in warm, moist environments. While the UK is not a tropical climate, pityriasis versicolor cases often spike during the summer or in individuals who exercise frequently. NICE clinical knowledge summaries suggest several common triggers:

• Warm and humid weather.
• Excessive sweating (hyperhidrosis).
• Oily skin types.
• A weakened immune system.
• Hormonal changes, which is why it is more prevalent in adolescents.

It is important to remember that this yeast is a normal part of the skin's flora. You cannot 'catch' it from someone else, nor can you give it to others through skin-to-skin contact or by sharing towels.

The goal of treatment is to reduce the yeast population to normal levels. While the infection itself clears up quickly with treatment, the skin discolouration can persist for weeks or months as the pigment slowly recovers.

Antifungal Shampoos and Creams

For most mild cases, a pharmacist in the UK may recommend over-the-counter antifungal shampoos containing ketoconazole (such as Nizoral) or selenium sulphide (such as Selsun). These are often used as a body wash for a few days or weeks depending on the severity.

Prescription Treatments

If the infection covers a large area of the body or does not respond to pharmacy treatments, a GP may prescribe:

• Ketoconazole 2% cream: Applied directly to the patches.
• Terbinafine cream: Another effective topical antifungal.
• Antifungal tablets: Such as itraconazole or fluconazole, reserved for severe or recurring cases.

If you have noticed persistent, discoloured patches on your skin, you may want to speak to a GP online for a formal diagnosis. Many skin conditions, such as vitiligo, pityriasis alba, or eczema, can look similar to pityriasis versicolor but require different management.

An online doctor can review clear photos of the affected area and discuss your symptoms via video consultation. This is a convenient way to access treatment for fungal skin infections in the UK without waiting weeks for an in-person appointment. If the diagnosis is confirmed, the doctor can issue a private prescription for the appropriate antifungal treatment, which can be sent to a local pharmacy of your choice.

Pityriasis versicolor is known for its high recurrence rate, with many patients finding the patches return every summer. To manage this, NICE suggests preventative measures for those prone to the condition:

• Using an antifungal shampoo as a body wash once every two to four weeks during the warmer months.
• Wearing loose-fitting, breathable cotton clothing to reduce sweat accumulation.
• Avoiding oily skincare products that may encourage yeast growth.
• Applying high-factor sunscreen, as protecting the surrounding skin from tanning can make the patches less obvious.