Tinea Versicolor in a Three-Month Infant: A Case Report and Literature Review

Tinea versicolor (TV) is a superficial fungal disease caused by Malassezia furfur, most commonly affecting adolescents and adults. TV is uncommon among newborns, particularly those aged under one year. Poor hygiene and perspiration, immunosuppression, the use of oils and greasy lotions, hyperhidrosis, and corticosteroids may all contribute to the appearance of the condition. It is clinically distinguished by hypopigmentation or hyperpigmentation. Most often, it occurs over the trunk. Treatment for TV usually begins with the use of a topical antifungal. This case report presents a rare TV in a three-month-old boy who exhibited multiple hypopigmented macules on his trunk without pruritus. Examination of the wood lamp showed bright yellow fluorescent lesions. The potassium hydroxide (KOH) preparation revealed yeast and short mycelial forms, confirming the diagnosis of TV. The baby was given a clotrimazole solution for topical use twice a day. KOH preparation was negative, and the lesions had improved at the time of the two-month follow-up. This case highlights the importance of considering TV as a potential diagnosis in infants with atypical skin manifestations, although it is more commonly seen in older individuals.


Introduction
Tinea versicolor (TV) is a superficial fungal infection of the skin caused by Malassezia furfur, which most commonly occurs in adolescents and adults. However, it is believed that TV can happen to younger children in tropical areas [1]. Several factors, including poor hygiene and sweating, immunosuppression, diabetes mellitus, the use of oils and oily creams, hyperhidrosis, and corticosteroids, have been established to contribute to the appearance of the disease [2]. Hypopigmented or hyperpigmented macule patches clinically distinguish them. Most often, it occurs over the trunk. In infants, the manifestation of TV is relatively rare due to the immaturity of the sebaceous glands and the lower production of sebum, which serves as a source of Malassezia [3]. However, infant and newborn cases have been reported, with clinical presentations that differ from those observed in adolescents and adults [4]. TV in infants tends to be more inflammatory, and lesions usually spread rapidly and are more challenging to treat [5]. The use of a topical antifungal is the initial therapy for the treatment of TV [6].

Case Presentation
A three-month-old boy was presented to our dermatology clinic with multiple hypopigmented macules on his trunk for two weeks without pruritus. He was delivered by normal vaginal delivery at 39 weeks gestational age and weighed 3.6 kg. Due to physiological jaundice, he was kept in the nursery for three days. Neither steroids nor antibiotics were used. He was not using a central venous catheter or total parenteral nutrition (TPN). On physical examination, multiple hypopigmented macules were covered with fine scales on the back (Figure 1), chest (Figure 2), and abdomen ( Figure 3).
Examination with a wood lamp showed bright-yellow fluorescent lesions. A potassium hydroxide (KOH) examination revealed yeast and short mycelial forms that resemble ziti and meatballs, supporting the diagnosis of TV. The mother was advised to apply a 1% clotrimazole solution twice daily, and follow-up after two months showed negative KOH preparation and improvement of the lesions.

Discussion
TV rarely occurs in childhood. However, it is believed that TV can happen to younger children in tropical areas [1]. Several factors, including poor hygiene and sweating, immunosuppression, diabetes mellitus, the use of oils and oily creams, hyperhidrosis, and corticosteroids, have been established to contribute to the appearance of the disease [2] and clinically distinguished by hypopigmentation or hyperpigmentation, most commonly on areas of skin that are sebum-rich, such as the upper arms, trunk, neck, and shoulders. Although facial involvement is rare in adults, it is common in children and may be the only site affected.
TV should be diagnosed clinically, and a KOH preparation test can be used to identify clusters and many short, stubby hyphae [5]. A topical antifungal for four to six weeks is the initial therapy for TV treatment.
Topical antifungal therapy has a lower cost, fewer drug-drug interactions, a higher efficacy, a safer profile, and greater compliance when treating TV in comparison to oral antifungal, laser, and photodynamic therapies, which are reserved for refractory and recurrent cases [2].
To our knowledge, there are only 11 case reports of TV in infants [1,2,[7][8][9]. Here, we report cases of hypopigmented TV and review the literature.
In 1984, the first TV case was reported in childhood [10], and subsequently, more cases have been reported since then [1,2,[7][8][9]. Eight of the 11 cases were males; two had a positive family history of TV. Regarding the medical history, one case is known to have atopic dermatitis, and another patient was born prematurely with low birth weight (LBW) on TPN and required admission to the intensive care unit (ICU) and antibiotic therapy. Although others do not have a significant medical history, almost six cases had negative KOH tests, and most patients had favorable responses to topical antifungal treatments (

Disclosures
Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.