Chronic Abdominal Skin Discoloration in a 38-Year-Old Male

Case at a Glance

A 38-year-old Caucasian male presents with a one-year history of asymptomatic red-brown splotches on his abdomen that vary in color intensity and have gradually increased in number over time.

Patient's Story

The patient, accompanied by his spouse, reports the appearance of red splotches on his abdominal skin approximately one year ago. The lesions are completely asymptomatic, causing no pain, itching, or discomfort. The patient and his wife have observed that the lesions vary in appearance - sometimes appearing more brown and faded, while other times presenting as more prominently red. They have also noted a gradual increase in the number of lesions over the past year. The patient maintains good general health with no significant medical history.

Initial Assessment

Physical examination revealed multiple hyperpigmented and hypopigmented macules distributed across the abdominal region. The lesions varied in color from light brown to reddish-brown, consistent with the patient's description of color variation. No scaling, inflammation, or other associated skin changes were noted. The patient appeared otherwise well with no systemic symptoms.

The Diagnostic Journey

Given the characteristic appearance of the lesions - multiple hyperpigmented macules with color variation on the trunk of a healthy adult male - the differential diagnosis included pityriasis versicolor (tinea versicolor), post-inflammatory hyperpigmentation, and other pigmentary disorders. The chronic nature, asymptomatic presentation, and typical distribution pattern strongly suggested a fungal etiology.

Final Diagnosis

Pityriasis versicolor (tinea versicolor) - a superficial fungal infection of the skin caused by Malassezia species, characterized by hyperpigmented and hypopigmented macules that commonly affect the trunk area.

Treatment Plan

Topical antifungal therapy was recommended as first-line treatment. The patient was advised to use over-the-counter ketoconazole (Nizoral) shampoo or cream, or alternative topical antifungals such as terbinafine or clotrimazole typically marketed for athlete's foot or jock itch. Application as directed on the package labeling was recommended, usually twice daily for 2-4 weeks.

Outcome and Follow-up

The patient was counseled that pityriasis versicolor is a common, benign condition that responds well to topical antifungal treatment. He was advised that pigmentation changes may persist for several months after successful treatment of the fungal infection. Follow-up was recommended if the condition did not improve with over-the-counter treatment or if new symptoms developed. The patient was also educated about the potential for recurrence, especially in warm, humid conditions.