Tinea Versicolor? please help

[anaboliQ]

About 2 summers ago, I had shaved my head and had small itchy lesions all over the place consistent with seborrhoeic dermatitis.  The rash spread across the back of my head between my ears underneath the area where the skull meets the spine to the lower part of my hairline on the neck.  I began using intensive treatment shampoo and have been free from itchy lesions since, yet the area is still a large red patch.  The area doesn't seem to be active with symptoms (not raised, itchy,scaly or dry) yet the pigmentation remains constantly.  It is not storkbite or an inherited pigment problem as it appeared when the dermatitis symptoms arose. Is it possible that this is tinea versicolor as a result of a fungal infection after the scratching?

[anaboliQ]

here is a photo of the affected area. Any thoughts or differential diagnoses? Any ideas will be greatly appreciated.

http://i286.photobucket.com/albums/ll96/justindizone/neck/neck2.jpg

[anaboliQ]

Thank you for the prompt reply.  I have been treating it with OTC azoles as described for the past few days.  My question is how will I know if it is working? Since the patch does not itch and the pigmentation takes time to subside after the fungus is killed off; how will I know if the treatment has efficacy? Will the patch begin to break and fade or is there another way I can tell if it is working?

[Bhupinder Kaur, MD]

Hello,
Without examination confirmation of a diagnosis is tough,but from the description ,it can be pityriasis versicolor.It is a common skin infection caused by the yeast Malassezia furfur. This skin disease commonly affects adolescents and young adults, especially in warm and humid climates.
Treatment involves topical and oral antifungal medicines. Most cases of fungal infections respond to over-the-counter products, which contain any of several basic ingredients: miconazole, tolnaftate, terbinafine,ketaconazole and clotrimazole.You can consult a pharmacist and get any cream or lotion containing these ingredients. Some of them are Lamisil, Monistat derm, Mycelex, and Nizoral.

In case the symptoms persist then pls consult a dermatologist.

Hope it helps.Take care and pls do keep me posted on how you are doing or if you have any additional doubts.Kind regards.