Tinea versicolor (pityriasis versicolor) on Black skin

Key cue: Oval hypo- (sometimes hyper-) pigmented patches with fine scale on upper trunk, shoulders, neck. KOH prep ('spaghetti and meatballs') confirms and rules out vitiligo.

Tinea versicolor is a superficial yeast infection caused by Malassezia furfur. It's common, benign, and mostly a cosmetic issue — but on Black skin it is often mistaken for vitiligo, post-inflammatory hypopigmentation, or pityriasis alba, which drives unnecessary anxiety and ineffective treatment.

What it actually looks like

Textbook says

Textbook: oval macules and patches with fine powdery scale, usually on the upper back, chest, shoulders, and neck. Colour varies: pink/tan on white skin, hypo- or hyperpigmented on darker skin ('versicolor' = varied colour).

On Black skin

On Black skin tinea versicolor most commonly appears as:

Hypopigmented oval patches — typically on the chest, upper back, shoulders, and sides of the neck — with very fine powdery scale that's best seen by scratching the lesion lightly (the 'evoked scale' sign).
Less commonly, hyperpigmented patches (more in inflammatory or post-treatment phases).
Summer predominance — the yeast suppresses melanocyte function, so untanned skin is revealed after sun exposure of the surrounding skin, making hypopigmented patches more visible in summer.
KOH prep of scale shows short hyphae and spores ('spaghetti and meatballs') — quick, inexpensive confirmation that distinguishes versicolor from vitiligo and hypopigmented sarcoidosis. Wood's lamp may show yellow-green fluorescence.
Treatment: topical antifungals (selenium sulphide, ketoconazole, terbinafine), occasionally oral fluconazole or itraconazole for widespread disease. Recurrence is common; weekly prophylactic ketoconazole shampoo reduces it.
Re-pigmentation takes months after the fungus is cleared — this is expected. Patients should know that the white patches will not immediately match surrounding skin even after successful treatment.

What to look for

Oval lighter-than-surrounding patches on the upper back, chest, shoulders, and neck — usually multiple.
Fine powdery scale, best seen by lightly scratching the lesion.
Appearance or worsening in warmer months or with sweating.
Usually asymptomatic — no significant itch or pain.

When to seek care

Routine primary-care or dermatology visit. A KOH prep takes a minute in the clinic and confirms the diagnosis. Topical treatment is first-line; see dermatology for widespread or recurrent disease.

Common misdiagnosis

Versicolor on Black skin is most often confused with vitiligo (chalk-white, usually symmetric, no scale), hypopigmented sarcoidosis (palpable induration), pityriasis alba (children's face, history of atopy), and leprosy (rare; anaesthetic patches).

See it for yourself — curated external imagery

We don't host clinical photos here. The links below go to peer-reviewed or open-access sources (Mind the Gap, DermNet NZ, PubMed Central, and similar). Each opens in a new tab.

DermNet NZ — Pityriasis versicolor — image set including Black-skin hypopigmented pattern and KOH microscopy.
Mind the Gap handbook.
Skin of Color Society — Tinea versicolor.

References

Framil VM, Melhem MS, Szeszs MW, Zaitz C. New aspects in the clinical course of pityriasis versicolor. An Bras Dermatol. 2011;86(6):1135-40. PMID: 22281905.
Gupta AK, Foley KA. Antifungal treatment for pityriasis versicolor. J Fungi (Basel). 2015;1(1):13-29. PMID: 29376897.

Medical disclaimer

Educational content only. This is not a substitute for in-person evaluation. If you are worried about yourself or someone you love, see a clinician — and if you are concerned about an emergency sign described here, call 911 or your local emergency number. We do not host clinical imagery; the external references are for reader self-education and are not owned by or affiliated with Black Health.