Spaghetti and meat ball appearance is seen in
Pityriasis versicolor (nea versicolor)

Tinea versicolor is a misnomer as it is not caused by a dermatophyte; it is caused by a nondermatophyc fungus called Pitvrosporum ovale (Malassezia furfur}. Usually affects young adults.

Clinical features

There are multiple scaly hypopigmented (more common) or hyperpigmented macules.
Scaling is furfuraceous or rice powder like. Macules start around the hair follicles and they merge with each other to form large areas.
Affects trunk and shoulders (mainly chest and back). There may be loosening of scales with fingernails- coupled only or stroke of the nail.
Lesions are recurrent in nature. Diagnosis

1. Examination of scales in 10% KOH shows short hyphae and round spores (s phage and meatball appearance).

Wood's lamp show's apple green fluorescence(blue-green fluorescence).

2. Skin surface biopsy - a cyanoacrylate adhesive is used to separate the layer of stratum comeum on a glass slide and then stained with PAS reagent. Treatment
1. Systemic agentssystemic azoles provide convenient therapeuc opon. Drugs used are ketokonazole, fluconazole or iatroconazole
2. Topical anfungals used are - a. Azolesclotrimazole, econazole, miconazole, ketoconazole
b. Others selenium sulphide, sodium thiosulphate, whitefield's ointment (3% salicylic acid + 6% benzoic acid).
Pityriasis versicolor
Aspergillus
Candida
Dermatophytes