Pitiriasis versicolor


Durante el verano es frecuente que a algunos jóvenes les aparezcan unas manchas blancas en la espalda, sobre todo coincidiendo con la exposición solar, ¿qué les está ocurriendo?

¿Qué es la pitiriasis versicolor?
Es una infección de la piel, superficial, crónica y recurrente causada por un hongo tipo levadura llamado Malassezia.
¿Por qué se produce?
Este hongo forma parte de la flora de nuestra piel pero hay determinados factores que le permiten reproducirse y extenderse dando lugar a la infección.
Factores que favorecen la infección:

  • Ambiente caluroso y húmedo (meses de verano) y climas tropicales
  • Uso de ropa ajustada
  • Piel grasa
  • Uso de aceites corporales como aceite de coco, cacahuete o aguacate.
  • Hiperhidrosis (mucha sudoración)
  • Inmunosupresión (incluye uso de corticoides, SIDA, trasplante de órganos)
  • Desnutrición
  • Embarazo
  • Toma de anticonceptivos orales
  • Predisposición hereditaria

 ¿A quién afecta?
Sobre todo afecta a adolescentes y adultos jóvenes puesto que las hormonas sexuales aumentan las secreciones de las glándulas sebáceas de nuestro cuerpo. En niños pequeños y ancianos es muy poco frecuente.
 ¿Cuáles son los síntomas o signos?
Aparecen máculas despigmentadas (manchas blancas, sin melanina) con bordes delineados y escamas finas, localizándose sobre todo en el pecho, espalda, abdomen y zonas próximas al tronco. El color de las lesiones puede variar desde al blanco (más común) al rojizo-marronáceo.
Estas lesiones no se broncean con la luz del sol por lo que se pueden apreciar mejor en verano ya que hacen contraste con el resto de la piel morena. Por este motivo, es más frecuente que se consulte al médico en verano.
En algunos casos las lesiones pican pero no es una infección contagiosa puesto que como hemos explicado anteriormente, es un hongo habitual en nuestra piel.
Ante estos síntomas y signos, debe acudir al médico.
 ¿Cómo se diagnostica?
El diagnóstico es fundamentalmente clínico, siendo suficiente observar las lesiones características.
En casos dudosas el médico solicitará diferentes pruebas:

  • Un raspado de piel para examinar la muestra al microscopio con hidróxido potásico al 10-15% y visualizar la imagen típica de “espaguetis con albóndigas”.
  • Cultivo (poco útil porque el hongo también crece en piel normal).
  • Visualización de las lesiones con luz de Wood de color amarillo brillante o dorado.

 ¿Cuál es su tratamiento?
En primer lugar, evitar los factores favorecedores mencionados anteriormente.
En segundo lugar el médico le puede prescribir tratamiento farmacológico con antimicóticos. Habitualmente se usan por vía tópica pero en algunos casos pueden administrarse por vía sistémica.
Esta infección resulta fácil de tratar pero es conveniente advertir al paciente que:

  • La infección tiende a recurrir, por lo que los tratamientos suelen ser de larga duración.
  • La despigmentación (manchas blancas) puede persistir incluso meses después de un tratamiento eficaz puesto que el hongo inhibe la producción de melanina durante un tiempo.

Sara Leticia de la Fuente Ballesteros
Médico residente, MFyC, Centro de Salud Arturo Eyries, Valladolid

REFERENCIAS:

  • Vázquez Millán, Patricia S. “Guía clínica Pitiriasis Versicolor”. Fisterra. Actualización julio 2016 (acceso agosto 2017)
  • Olazábal Ulacia JC, Enríquez Gutiérrez EV, García Paniagua R, del Río Pérez P. Averroes. Manual de terapia en atención primaria. 2º ed. EviSciencie Publications; 2016: capítulo 15.

 
Revisado: junio 2019

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