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Background: Pityriasis versicolor (tinea versicolor) is a common skin disorder due to Malassezia usually affecting adolescents and young adults, more frequently in the tropics. Facial involvement, isolated or not, is not frequent in white adults. Objective: Here, we report a possible atypical hyperkeratotic form of dermatosis of the face, in two young immunocompetent Caucasian patients, particularly recalcitrant to therapy. Results: Skin scrapings grew yeasts belonging to the genus Malassezia, including both M. globosa and M. sympodialis. This unusual variant needs long-term therapy with systemic and topical imidazoles together with facial cleansing. Conclusion: We propose the name hyperkeratotic head and neck Malassezia dermatosis for this distinctive clinical entity. This variant of pityriasis versicolor should be considered in the differential diagnosis of seborrheic dermatitis and dermatitis neglecta. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]