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. For treatment of tinea versicolor: Apply to affected areas and lather with a small amount of water. Allow product to remain on skin for 10 minutes, then rinse the body thoroughly. Repeat procedure once a day for 7 days.
The recommended treatments for pityriasis versicolor are:
- Ketoconazole Cream 2%: apply once daily for two weeks 1
- Selenium sulfide: apply and lather for 10 minutes, then rinse, once a day for 7 days 2
From the Research
The recommended treatment for pityriasis versicolor includes topical antifungal medications, with selenium sulfide 2.5% shampoo or zinc pyrithione being effective options, as well as specific topical antifungal medications like imidazoles, allylamines, and ciclopirox olamine, as stated in the most recent study 3.
Treatment Options
- Topical antifungal medications are the primary treatment for pityriasis versicolor, with options including:
- Selenium sulfide 2.5% shampoo applied for 10 minutes daily for 7 days
- Zinc pyrithione shampoo
- Imidazoles
- Allylamines
- Ciclopirox olamine
- For widespread or recurrent cases, oral antifungal therapy may be necessary, with options including:
- 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, even though the fungus has been eliminated.
- Recurrence is common, so prophylactic treatment with topical antifungals once or twice monthly during warm months may be beneficial for those with frequent relapses.
- The condition is caused by Malassezia yeasts that normally live on skin but overgrow in certain conditions, particularly in warm, humid environments or in individuals with excessive sweating, as noted in 4 and 3.
Additional Information
- A study from 2004 5 compared the efficacy of single-dose fluconazole and itraconazole in treating pityriasis versicolor, finding that fluconazole was more effective.
- Another study from 2010 6 compared topical clotrimazole and single-dose oral fluconazole, finding that topical clotrimazole had a higher rate of complete resolution at 4 weeks, but oral fluconazole had a lower recurrence rate at 12 weeks.
- However, the most recent and highest-quality study 3 provides the most up-to-date guidance on the treatment of pityriasis versicolor.