Atrophying Pityriasis Versicolor

A 30-year-old man presented with a 6-month history of depressed lesions on his back. Initially mistaken for scars, the patient denied prior acne, trauma, or burns. Exam revealed well-demarcated erythematous and atrophic plaques. Fluorescence staining of skin scrapings showed thick fungal hyphae and yeast cells, yielding the classic “spaghetti and meatballs” pattern consistent with Malassezia infection. The diagnosis: atrophying pityriasis versicolor, a rare variant of tinea versicolor. Although commonly manifesting as pigmented macules, the atrophic presentation is rare. After a 1-week course of itraconazole, the lesions resolved.

A 30-year-old man presented with a 6-month history of depressed lesions on his back. Initially mistaken for scars, the patient denied prior acne, trauma, or burns. Exam revealed well-demarcated erythematous and atrophic plaques. Fluorescence staining of skin scrapings showed thick fungal hyphae and yeast cells, yielding the classic “spaghetti and meatballs” pattern consistent with Malassezia infection. The diagnosis: atrophying pityriasis versicolor, a rare variant of tinea versicolor. Although commonly manifesting as pigmented macules, the atrophic presentation is rare. After a 1-week course of itraconazole, the lesions resolved.