Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2022;12(2):e2022057 1

Dermoscopy to the Rescue in an Annular Enigma: 
A Rare Case of Annular Pityriasis Versicolor 

Presenting in an Unusual Location
Farida Kapadia1, Vidya Kharkar1, Tejas Vishwanath1

1 Dermatology Department, KEM Hospital, Mumbai, India

Citation: Kapadia F, Kharkar V, Vishwanath T. Dermoscopy to the Rescue in an Annular Enigma: A Rare Case of Annular Pityriasis 
Versicolor Presenting in an Unusual Location. Dermatol Pract Concept. 2022;12(2):e2022057. DOI: https://doi.org/10.5826/dpc.1202a57

Accepted: August 22, 2021; Published: April 2022

Copyright: ©2022 Rejeb et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: All authors have contributed significantly to this publication

Corresponding author: Dr. Tejas Vishwanath, MD Dermatology, Fellow at Kem Hospital, Mumbai, Acharya Dhonde Marg, Parel East, 
Mumbai, India. E-mail: tejasvishwanath.igs@gmail.com

Case Presentation

A 29-year-old female presented with asymptomatic an-

nular plaques solely over the medial thighs since 1 month 

(figure 1A, inset, 1B). Considering annular lichen planus and 

porokeratosis, dermoscopy (polarized, Otiez dermoscope) 

was performed. It revealed attenuated central pigmentary 

network and white scales and peripheral brown peripheral 

scales with accentuation in skin creases (Figure 1C). Scales 

disappeared after wiping with spirit swab (Figure 1D). On 

Woods lamp examination- yellowish fluorescence was seen 

(Figure 1E). On potassium hydroxide mount with Chicago 

Sky Blue, hyphae and spores were evident (Figure 1F). Thus, 

a diagnosis of pityriasis versicolor was made. 

Teaching Point

Pityriasis versicolor presents with varied color tones and 

morphologies.1,2 The annular variant noted in the present 

case has not yet been described. Therefore, the diagnosis 

was not clinically suspected. Dermoscopy was the game 

changer since it gave telltale clues: scales in skin creases 

along with pigment dilution. Peripheral brown scales with-

out accentuation in the creases constitute an unusual feature 

probably due to retention parakeratosis since it disappeared 

on swabbing.



2 Image Letter | Dermatol Pract Concept. 2022;12(2):e2022057

Figure 1. (A,B) Multiple discrete scaly annular patches with peripheral rim of hyperpigmentation and central hypopigmentation over bilat-

eral thighs. (C) Dermoscopy (captured with polarized dermoscopy, magnification x 10) revealed brown scales at the periphery of the lesion 

with white fine scales at the center within the skin creases. (D) On wiping the lesion with an alcohol swab, dermoscopic analysis showed 

complete disappearance of brown scales in the periphery with pigment dilution in the center. (E) Yellowish green fluorescence seen at Woods 

lamp examination (F) KOH mount shows fungal spores and hyphae (spaghetti and meatball appearance). 



Image Letter | Dermatol Pract Concept. 2022;12(2):e2022057 3

References

1. Acharya R, Gyawalee M. Uncommon presentation of Pityri-

asis versicolor; hyper and hypopigmentation in a same pa-

tient with variable treatment response. Our Dermatol Online. 

2017;8(1):43-45. DOI:10.7241/ourd.20171.11

2. Varada S, Dabade T, Loo DS. Uncommon presentations of 

tinea versicolor.  Dermatol Pract Concept. 2014;4(3):93-96. 

DOI: 10.5826/dpc.0403a21. PMID: 25126470. PMCID: 

PMC4132011.