From the FDA Drug Label
DOSAGE & ADMINISTRATION SECTION Cutaneous candidiasis, tinea corporis, tinea cruris, tinea pedis and tinea (pityriasis) versicolor: It is recommended that Ketoconazole Cream 2% be applied once daily to cover the affected and immediate surrounding area Patients with tinea versicolor usually require two weeks of treatment.
- Treatment for tinea versicolor: Ketoconazole Cream 2% should be applied once daily to the affected area for two weeks 1.
- Key points:
- Apply Ketoconazole Cream 2% once daily
- Treat for two weeks
- Cover the affected and immediate surrounding area 1
From the Research
Tinea versicolor is best treated with topical antifungal medications for mild to moderate cases, and oral antifungals for extensive or recurrent cases, as recommended by the most recent and highest quality study 2.
Treatment Options
- For mild to moderate cases, topical treatments are first-line, including:
- Selenium sulfide 2.5% shampoo (applied to affected areas for 10 minutes daily for 7 days)
- Ketoconazole 2% shampoo (applied for 5 minutes daily for 3 days)
- Antifungal creams like clotrimazole, miconazole, or terbinafine (applied twice daily for 2-4 weeks)
- For extensive or recurrent cases, oral antifungals are recommended, such as:
- Fluconazole 400mg as a single dose or 300mg weekly for 2-4 weeks
- Itraconazole 200mg daily for 5-7 days
Important Considerations
- Patients should be aware that skin discoloration may persist for weeks or months after successful treatment as the skin needs time to repigment.
- To prevent recurrence, especially in hot, humid climates, maintenance therapy with selenium sulfide or ketoconazole shampoo once or twice monthly may be beneficial.
- Tinea versicolor is caused by overgrowth of Malassezia yeast, which is normally present on skin but proliferates under certain conditions like heat, humidity, and excessive sweating, producing acids that inhibit melanin production and cause characteristic discolored patches, as noted in 3 and 4.
- The choice of antifungal agent depends on several factors, including efficacy, safety, local availability, ease of administration, likelihood of compliance, and potential drug interactions, as discussed in 2 and 4.