History of Present Illness:
A 22 year old  college student presents to the dermatology clinic with complaints of multiple discolored patches on his upper chest, shoulders, and back. He first noticed the patches about three months ago but thought they were just dry skin. Over time, the spots became more noticeable, especially after sun exposure. The affected areas appear lighter than his normal skin tone, with mild itching but no pain.

He reports that he spends a lot of time outdoors playing soccer and often sweats excessively. He has no known allergies or history of similar skin conditions. Over-the-counter moisturizers and anti-itch creams have not helped.

Physical Examination:

• Multiple well-defined hypopigmented and hyperpigmented patches on the upper chest, shoulders, and back
• Slight scaling when the patches are scraped
• No redness, swelling, or open sores

Diagnosis:
Based on clinical examination and the characteristic appearance of the lesions, James is diagnosed with Tinea Versicolor (Pityriasis Versicolor), a superficial fungal infection caused by Malassezia species.

Management Plan:

• Topical antifungal treatment: Selenium sulfide shampoo or ketoconazole cream
• Oral antifungals: Fluconazole or itraconazole (if extensive or recurrent)
• Patient education:
  • The condition is not contagious
  • Recurrence is common, especially in warm, humid environments
  • Use antifungal shampoos periodically to prevent recurrence

The patient is reassured that while the patches may take some time to fade completely, treatment will help prevent further spread.