Skincare Case 109

Age: 20 years old
Gender: Female
Fitzpatrick: 3
Skin type: Normal
Main concern: Patchy dark spots on the back that worsen during summer.
History: She has had these dark spots for as long as she can remember. The spots get darker during summer.
The spots get better with prescription medication but never clear up completely.
The spots don’t like to be contagious as no one else close to her got such spots.
Homecare routine: She uses prescription shampoos and some other medication on and off but not on a continuous base.
Findings: Flat dark spots with definitive borders primarily on the back without any pain or irritation.
On the Wood’s lamp, the spots have sharp borders

Skincare Case 9
Case Discussion (Please click here)

This case involves a 20-year-old female with Fitzpatrick skin type III and normal skin, who presents with patchy dark spots on her back. She reports that these spots worsen during the summer and have been present for as long as she can remember. Despite treatment with prescription medication, the spots improve but never completely disappear. There is no evidence of contagion, as no one else close to her has developed similar spots. Her home care routine includes intermittent use of prescription shampoos and other medications. Physical examination reveals flat dark spots with definitive borders primarily on her back, without any associated pain or irritation. Examination under a Wood’s lamp confirms sharp borders of the spots.

Causes

The described condition appears to be Tinea Versicolor (also known as Pityriasis Versicolor), a common fungal infection of the skin caused by an overgrowth of the yeast Malassezia on the skin’s surface. This yeast is part of the normal skin flora but can overgrow in certain conditions, especially in warm, humid climates or in individuals with oily skin, leading to the characteristic patches or spots.

What is Done Wrong

  1. Inconsistent treatment: The patient is not using her prescription shampoos and other medications on a consistent basis. For a condition like Tinea Versicolor, regular and consistent use of prescribed treatments is essential to manage the condition effectively.

  2. Lack of prevention: Given the recurring nature of Tinea Versicolor, especially in warmer months, preventative measures should be taken, particularly during the summer.

  3. Sun exposure: Increased exposure to the sun during summer months can make the color contrast of the spots more apparent, exacerbating the appearance of the condition.

Office and Home Treatment Options

Office treatments:

  1. Prescription strength antifungal creams, lotions or shampoos.
  2. Oral antifungal medication: In severe or persistent cases, an oral antifungal medication may be prescribed.

Home treatments:

  1. Regular use of over-the-counter antifungal shampoos, creams or lotions containing ingredients such as selenium sulfide, ketoconazole or zinc pyrithione.
  2. Regular use of the prescribed shampoos and medication.

Preventions

  1. Regular use of antifungal products: Regular use, especially in the warm, humid months can help prevent recurrence.
  2. Avoidance of excessive sun exposure: This can help minimize the contrast between affected and unaffected skin.
  3. Wearing loose, breathable clothing: This can prevent excessive sweating and humidity close to the skin.

Home Care Daily Routine

Morning:

  1. Bathe with an over-the-counter antifungal shampoo or soap. Leave it on the skin for 5-10 minutes before rinsing.
  2. Apply a broad-spectrum sunscreen if the back will be exposed to the sun.

Evening:

  1. Bathe with the antifungal shampoo or soap again. Leave it on the skin for 5-10 minutes before rinsing.
  2. Dry skin thoroughly after bathing.

Weekly:

  1. Apply prescribed antifungal medication as directed by her healthcare provider.

Remember, consistency is key to managing Tinea Versicolor. It’s also important to consult with a dermatologist or healthcare provider regularly to monitor the condition and make any necessary adjustments to the treatment plan.