From the Research
Fluconazole shampoo is not typically recommended for treating tinea versicolor, and instead, oral fluconazole or topical treatments like selenium sulfide, ketoconazole, or zinc pyrithione shampoos are preferred. The most effective topical treatments for tinea versicolor are selenium sulfide shampoos (like Selsun Blue 2.5%), ketoconazole shampoo (Nizoral 2%), or zinc pyrithione shampoos, which should be applied to affected areas, left on for 5-10 minutes, then rinsed off, and used daily for 1-2 weeks 1, 2, 3. For more extensive cases, oral antifungal medications like fluconazole (taken as a pill, typically 400mg once weekly for 2-4 weeks) may be prescribed, but fluconazole is not commonly formulated as a shampoo for this purpose 4, 5. Tinea versicolor is caused by an overgrowth of Malassezia yeast that normally lives on the skin, and these recommended treatments work by either killing the yeast or preventing its growth. Even after successful treatment, the skin discoloration may take weeks or months to resolve completely, and recurrence is common, especially in warm, humid weather, so preventive treatment may be needed periodically 2, 3.
Some key points to consider when treating tinea versicolor include:
- The condition is difficult to cure and has a high chance of relapse or recurrent infections due to the presence of Malassezia in the normal skin flora 2
- Topical antifungal medications are the first-line treatment for tinea versicolor, with oral antifungal therapy reserved for patients with extensive disease, frequent recurrences, or disease that is refractory to topical therapy 3
- Long-term intermittent prophylactic therapy may be useful in preventing recurrent infection, but more research is needed to evaluate the efficacy of prophylactic antifungal treatment 2, 3
- Selection of antifungal agents depends on several factors, including efficacy, safety, local availability, ease of administration, likelihood of compliance, and potential drug interactions of the antifungal agent 3