From the FDA Drug Label
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. For treatment of tinea versicolor: Apply to affected areas and lather with a small amount of water. Allow to remain on skin for 10 minutes. Rinse body thoroughly. Repeat this procedure once a day for 7 days.
The treatment for Tinea versicolor is to apply selenium sulfide (TOP) to affected areas, lather with a small amount of water, and allow it to remain on the skin for 10 minutes before rinsing thoroughly. This procedure should be repeated once a day for 7 days 1 1.
- Key points:
- Apply to affected areas
- Lather with a small amount of water
- Remain on skin for 10 minutes
- Rinse body thoroughly
- Repeat once a day for 7 days
From the Research
Tinea versicolor is best treated with topical antifungal therapy, which has a better safety profile and lower cost compared to systemic treatment, and is therefore the treatment of choice. The most recent and highest quality study, published in 2022 2, recommends topical antifungal therapy as the first-line treatment for tinea versicolor. This is because topical treatments have fewer adverse events, fewer drug interactions, and lower cost compared to systemic treatment.
Some effective topical options include:
- Selenium sulfide 2.5% lotion, applied to affected areas for 10 minutes daily for 7 days
- Ketoconazole 2% shampoo, applied for 5 minutes daily for 3 days
- Clotrimazole, miconazole, or terbinafine creams, applied twice daily for 2-4 weeks
For extensive or resistant cases, oral antifungals may be prescribed, such as:
- Fluconazole 400mg as a single dose or 300mg weekly for 2-4 weeks
- Itraconazole 200mg daily for 5-7 days
It's essential to note that even after successful treatment, skin discoloration may persist for weeks or months until the skin regains its normal pigmentation. To prevent recurrence, especially in humid climates or for those who sweat heavily, maintenance therapy with selenium sulfide or ketoconazole shampoo used once or twice monthly can be effective. Tinea versicolor responds well to these treatments because they target the Malassezia yeast that causes the infection by disrupting its cell membrane or inhibiting ergosterol synthesis, which is essential for fungal cell growth.
The 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. Long-term intermittent prophylactic therapy should be considered for patients with frequent recurrence of the disease. According to a study published in 2010 3, single dose and 7-day daily dose of itraconazole can be effective in the treatment of tinea versicolor, but single dose appears to be better for improving compliance and decreasing the cost of treatment. Another study published in 2005 4 found that oral fluconazole given at 300 mg once weekly for two weeks is effective and safe in the treatment of tinea versicolor. However, the most recent study 2 still recommends topical antifungal therapy as the first-line treatment.