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Folliculocentric tinea versicolor: a case report

Summary

A 46-year-old woman was diagnosed with an unusual presentation of tinea versicolor, a common fungal skin infection, where the fungus centered around hair follicles rather than appearing as typical patches. The condition was successfully treated with antifungal medications, though some changes persisted. The doctors noted that the patient’s history of keratosis pilaris (a common bumpy skin condition on the arms and thighs) may have contributed to this unusual follicle-focused presentation.

Background

Tinea versicolor is a common superficial fungal infection caused by Malassezia that typically presents as hypopigmented or hyperpigmented patches with mild scaling. Follicular presentation of tinea versicolor is a rare clinical manifestation that may be misdiagnosed as other dermatological conditions.

Objective

To report a case of folliculocentric tinea versicolor and propose that this particular presentation might be related to a patient’s history of keratosis pilaris.

Results

Fungal microscopy showed mycelium and spores in a ‘spaghetti and meatball’ pattern with PAS positive staining. Pathological examination revealed mycelium and spores in the stratum corneum with hyperkeratosis and keratosis pilaris-like features around hair follicles.

Conclusion

Follicular tinea versicolor is a rare manifestation, and patients with a history of keratosis pilaris may have a tendency to develop follicular centration in the course of other diseases. The patient responded well to antifungal treatment with itraconazole, terbinafine, and ketoconazole lotion.
  • Published in:Journal of Medical Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 39285486, DOI: 10.1186/s13256-024-04765-z
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