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.
The treatment for tinea versicolor is Ketoconazole Cream 2% applied once daily to the affected area for two weeks 1.
- Drug Name: ketoconazole (TOP)
- Treatment Duration: two weeks
- Application Frequency: once daily
From the Research
Tinea versicolor is most effectively treated with oral fluconazole 300mg weekly for 2 weeks, as it has been shown to have a high cure rate and low incidence of side effects, according to the most recent and highest quality study 2. The treatment of tinea versicolor typically involves the use of antifungal medications, which can be applied topically or taken orally.
- Topical treatments are usually the first choice for mild to moderate cases, including:
- Selenium sulfide 2.5% lotion (like Selsun Blue) applied to affected areas for 10 minutes daily for 7 days
- Ketoconazole 2% shampoo applied for 5 minutes daily for 3 days, as shown to be effective in a study 3
- Other effective topical options include:
- Clotrimazole, miconazole, or terbinafine creams applied twice daily for 2-4 weeks
- For extensive or stubborn cases, oral antifungals may be prescribed, such as:
- Fluconazole 400mg as a single dose or 300mg weekly for 2-4 weeks, which has been shown to be effective in a study 2
- 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 as the skin tone gradually normalizes. 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, as suggested in a study 4. These treatments work by targeting the Malassezia yeast that causes the infection, disrupting its cell membrane or inhibiting essential fungal processes. A study comparing fluconazole and ketoconazole found that both treatments were effective, but fluconazole had a shorter treatment duration and lower incidence of side effects 5. Another study highlighted the importance of considering epidemiologic, clinical, and therapeutic aspects of tinea versicolor, including the use of oral ketoconazole as a prophylactic measure to prevent recurrence 6.