describe nummular derm/tinea versicolor

Can you describe a clinical presentation for a patient with nummular dermititis and/or tinea versicolor?
How would you determine one over the other in clinical presentation? In physical exam and assessment what would help confirm or rule out either diagnosis.
Also, when looking at dermatology books I have not been able to find either pictured in African American skin.

Would they look similar or different in presentation?  

[vedadhar]

Taenia verisicolor or Pityriasis versicolor  is caused by Pityrosporum orbiculare infection usually on the trunk.Its clinical presentation is with
1.Pale macules-no tanning or hyperpigmented macules on trunk.
2.Velvety,tan,pink,whitish or brown macules that sacle with scraping on trunk
3.Microscopic fungal observation on scales on trunk.
These are the essentials of diagnoses.
Symptoms include itchy macules that vary 4-5 mm in dia. to large confluence.Distribution is on trunk,upperarms,neck,face,groins.
lab investigations include KOH clearence of scales and observation under low power objective.But culture may not be possible due species variation require special conditions.
Differentials with same presentation include Vitiligo,pseudoachromia,seborrheic dermatitis.
Confirmation can be done in physical examination itself because the clinical presentation of T.versicolor is by its distribution and differentiation of lesions by color from pink to brown.Most of the patients will be presented with non tanny lesion that scale on scraping.Confirmation is with KOH appliance.
In African skins such presentation can be easily figured out and differntiated from vitiligo and hyperpigmentation as the skin is dark colored.But in case of American skins Vitiligo can be difficult to observe but T.versicolor can be confirmed based on its distribution where vitiligo has total depigmentation.

[Bhupinder Kaur, MD]

Hello,

Nummular dermatitis is a type of eczema characterized by round-to-oval erythematous plaques most commonly found on the arms and legs. it is frequently accompanied by xerosis or dryness of skin. Lesions begin as purple papules which coalesce to form plaques which may show central clearing.

Tinea versicolor is a superficial cutaneous fungal infection usually characterized by hypopigmented or hyperpigmented macules and patches on the chest and the back. The color of each lesion varies from almost white to reddish brown or fawn colored. In African Americans, there may be loss of skin color (hypopigmentation) or an increase in skin color (hyperpigmentation).

I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[ashbash82]

Thank you for your expertise and clarification.

[ashbash82]

Thank you for your reply and expertise. Greatly appreciated.

[Bhupinder Kaur, MD]

You are welcome!