Just like the gut, the skin is abundant with a microbiome of bacteria, yeasts and fungi. One of these microbes is a fungus called Malassezia furfur – a cute name for a fungus that can overgrow and cause a condition called pityriasis versicolor (or tinea versicolor), characterised by scaly patches of white, tan, brown or pink colour on oily areas of the skin. This infection doesn't cause any other symptoms but it can be distressing as the discoloured patches can appear anywhere on the body, including the face.
What is Pityriasis Versicolor?
The Malassezia fungus produces allergens and lipase that can damage the integrity of the skin by triggering inflammation and immune responses [1]. This inflammation and immune activation can cause a depigmentation of the skin that could be mistaken for a rash.
In early stages, pityriasis versicolor presents as small oval or round spots of 1 – 3cm in size. As the spots grow, they can “spread” into each other and form large patches of discoloured skin. These patches can be pale, white, dark tan, or pink and may be scaly or flakey. Some people experience itching, tingling or stinging around the patches, but it is generally asymptomatic.
A doctor can diagnose pityriasis versicolor by taking a skin scraping sample, or by shining a black light on the patches. Malassezria fungi glow yellow-green or yellow under the blacklight! A very cool accessory if you attend dance rave parties.
Patches generally clear up within 1 – 2 months of treatment and the condition doesn’t leave any scarring of permanent pigment changes. Unfortunately, pityriasis versicolor is often a chronically recurring condition – some people experience it every summer as heat and humidity encourage fungal growth. It's also possible for people with light skin tone to only notice the patches in summer when the rest of their skin tans but the fungal lesions remain pale. [2]
Who is at Risk?
Most people diagnosed with pityriasis versicolor are teens and young adults, but can occur in any age group, race, and gender. Up to 50% of diagnoses occur in tropical areas – the fungus thrives on heat and humidity, oily skin and sweat. Genetics may play a role, but it pityriasis versicolor may skip multiple generations.
Because the Malassezia furfur fungus naturally occurs in the biome of healthy skin, pityriasis versicolor is not contagious. Most of the time, pityriasis versicolor occurs in people who are healthy but can be predisposed in those who have some level of immune suppression due to:
- Corticosteroid use
- Diabetes
- Pregnancy
- Poor nutrition
- HIV/AIDS
- Any medications that suppress the immune system [2]
Natural Therapies for Pityriasis Versicolor
IMPORTANT: Get a confirmed diagnosis of pityriasis versicolor (or tinea versicolor) from your doctor before self-prescribing any natural therapies. Pityriasis versicolor is easily confused for other skin conditions which require different treatments.
Aloe Vera Gel
The gooey insides of aloe vera leaves have been shown to have anti-fungal activity against a range of mycelium including Malassezia furfur in vitro [4][5].
Aloe contains polysaccharides that may be able to breakdown and digest the biofilm that Malassezia furfur produces to protect itself [2][3], rending it more susceptible to other anti-fungal natural therapies.
Aloe vera also has anti-inflammatory and immune-boosting actions that can help to improve healing time of pityriasis versicolor [6].
Lemon Grass Essential Oil
Lemon grass essential oil has been shown to have potent anti-fungal and anti-inflammatory actions when applied topically to the skin that can break down the fungal colonies within lesions and relieve any itching or tingling symptoms [7] [8]. A 2013 study showed that using creams and shampoos containing lemon grass essential oil for four weeks helped to resolve overgrowth of Malasezzia furfur and shrink the appearance of pityriasis versicolor patches [9].
CAUTION: Mix lemon grass essential oil with a carrier oil before applying directly to lesions – three drops to 1 tablespoon of carrier oil applied every 2 hours is a safe dose, but dilute further if you feel any irritation of the skin after application.
Honey, Olive Oil & Beeswax
This luscious mixture was used in a small open pilot study of 37 patients. A combination of 1:1:1 parts honey, olive oil and beeswax was applied directly to pityriasis versicolor patches, up to 3 times a day. Over 86% of the participants showed improvement in size of patches, with 75% experiencing complete resolution of the condition [10].
Honey has potent anti-fungal activity and has been shown to effectively treat other chronically recurring skin conditions such as dermatitis, psoriasis and dandruff [11].
Olive oil and beeswax have been shown to protect against fungal infections, strengthen skin integrity and speed up healing [12] [13].
Because olive oil is a fat, it may chaperone the active anti-fungal constituents of honey and beeswax into the cell lining of the Malassezia fungi, and it may strengthen the walls of healthy cells against infection.
Probiotics & Prebiotics
Remember – what happens in the gut is mirrored in the skin's microbiome. Feeding the beneficial bacteria in the gut can have a carry-over effect of reducing fungal overgrowth in the skin. Lactobacillus paracasei (ST11) supplementation has been shown to decrease Malassezia populations, and can improve skin healing [14]. Speak to a qualified nutritionist or naturopath for personalised advice on the best probiotic strains for your particular condition.
Feeding the good gut bugs with “prebiotics” is just as important – try increasing your prebiotic fibre intake by taking psyllium husk, green banana powder, or inulin.
Sunshine
The Malassezria furfur fungus produces a compound called “pityriacitrin” which protects the fungus from UV radiation. In areas of Malassezria overgrowth it is nearly impossible to get a sunburn – a hint that sunshine may be damaging to the fungus. In healthy skin, the compound also provides skin cells with some beneficial sun protection (thanks, furfur!). Exposing pityriasis versicolor infections to unfiltered sunlight for 10 – 20 minutes per day can help to keep reduce further fungal growth and may help to shrink lesions [15]. Check with a dermatologist if you have concerns about sun exposure.
References
[1] Findley, K. & Grice, E. A. (2014) The Skin Microbiome: A Focus on Pathogens and Their Association with Skin Disease. PLoS Pathog., 10:11, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231143/
[2] Aaron, D. M. (2017) Tinea Versicolor (Pityriasis versicolor). Merck Manual Online Database. http://www.msdmanuals.com/en-au/professional/dermatologic-disorders/fungal-skin-infections/tinea-versicolor
[3] Allen, H. B., et al. (2015) Biofilm Formation by Malassezia Furfur/Ovale as a Possible Mechanism of Pathogenesis in Tinea Versicolor. Journal of Clinical & Experimental Dermatology Research. https://www.omicsonline.org/open-access/biofilm-formation-by-malassezia-furfurovale-as-a-possible-mechanismof-pathogenesis-in-tinea-versicolor-2155-9554-10000311.php?aid=64444
[4] Saniasiaya, J. et al. (2017) Antifungal Effect of Malaysian Aloe vera Leaf Extract on Selected Fungal Species of Pathogenic Otomycosis Species in In Vitro Culture Medium. Oman Med J., 32:1, 41 – 46. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5187399/
[5] Vijayakumar, R., et al. (2006) Characterization of Malassezria Furfur by using plant extracts. Indian Journal of Dermatology, 51:2, 145 – 148. http://www.e-ijd.org/article.asp?issn=0019-5154;year=2006;volume=51;issue=2;spage=145;epage=148;aulast=Vijayakumar
[6] Surjushe, A., et al. (2008) ALOE VERA: A SHORT REVIEW. Indian J Dermatol., 53:4, 163 – 166. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763764/
[7] Boukhatem, M. N., et al. (2014) Lemon grass (Cymbopogon citratus) essential oil as a potent anti-inflammatory and antifungal drugs. Libyan J Med., 9, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4170112/
[8] Aldawsari, H. M., et al. (2015) Design and formulation of a topical hydrogel integrating lemongrass-loaded nanosponges with an enhanced antifungal effect: in vitro/in vivo evaluation. Int J Nanomedicine., 10, 893 – 902. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321607/
[9] Carmo, E. S., et al. (2013) Treatment of pityriasis versicolor with topical application of essential oil of Cymbopogon citratus (DC) Stapf - therapeutic pilot study. An Bras Dermatol., 88:3, 381 – 385. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3754369/
[10] Alwaili, N. (2004) An alternative treatment for pityriasis versicolor, tinea cruris, tinea corporis and tinea faciei with topical application of honey, olive oil and beeswax mixture: an open pilot study. Complementary Therapies in Medicine, 12, 45 – 47. https://www.ncbi.nlm.nih.gov/pubmed/15130571
[11] Al-Waili, N. (2003) Topical application of natural honey, beeswax and olive oil mixture for atopic dermatitis or psoriasis: partially controlled, single-blinded study. Complement Ther Med., 11, 226—234. https://www.ncbi.nlm.nih.gov/pubmed/15022655
[12] Lin, T., et al. (2018) Anti-Inflammatory and Skin Barrier Repair Effects of Topical Application of Some Plant Oils. Int J Mol Sci., 19:1, 70. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5796020/
[13] Frantini, F., et al. (2016) Beeswax: A minireview of its antimicrobial activity and its application in medicine. Asian Pac J Trop Med., 9:9, 839 – 843. https://www.ncbi.nlm.nih.gov/pubmed/27633295
[14] Gueniche, A., et al. (2011) Oral supplementation with probiotic Lactobacillus paracasei ST-11 improves dandruff condition. Int J Technology, 3:1, S22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171853/
[15] Patra, V., et al. (2016) The Skin Microbiome: Is It Affected by UV-induced Immune Suppression? Front Microbiol., 7, 1235. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979252/
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