What is the treatment and management for pityriasis versicolor?

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 Clinical improvement may be seen fairly soon after treatment is begun; however, candidal infections and tinea cruris and corporis should be treated for two weeks in order to reduce the possibility of recurrence. Patients with tinea versicolor usually require two weeks of treatment. INDICATIONS & USAGE SECTION Ketoconazole Cream 2% is indicated for the topical treatment of tinea corporis, tinea cruris and tinea pedis caused by Trichophyton rubrum, T. mentagrophytes and Epidermophyton floccosum; in the treatment of tinea (pityriasis) versicolor caused by Malassezia furfur (Pityrosporum orbiculare); The treatment for pityriasis versicolor (also known as tinea versicolor) is the application of Ketoconazole Cream 2% once daily to the affected and surrounding area for two weeks 1. The management of this condition involves applying the cream as directed to reduce the possibility of recurrence. Ketoconazole Cream 2% is indicated for the topical treatment of tinea (pityriasis) versicolor caused by Malassezia furfur 1.

• Key points:
  • Apply Ketoconazole Cream 2% once daily
  • Treat for two weeks
  • Reduce the possibility of recurrence
  • Indicated for topical treatment of tinea (pityriasis) versicolor caused by Malassezia furfur 1, 1

From the Research

Treatment for tinea vesicular, also known as pityriasis versicolor, primarily involves topical antifungal medications, with ketoconazole 2% foam being a highly effective option, as shown in a study published in 2014 2. The most effective treatment approach typically involves:

• Topical antifungal medications such as selenium sulfide 2.5% shampoo applied to affected areas for 10 minutes daily for 7 days, or ketoconazole 2% shampoo left on for 5 minutes daily for 3 days
• Alternatively, topical antifungal creams like clotrimazole 1%, miconazole 2%, or terbinafine 1% can be applied twice daily for 2-4 weeks
• For widespread or resistant cases, oral antifungal therapy may be necessary, with fluconazole 400mg as a single dose or 300mg weekly for 2-4 weeks being most common, as compared to ketoconazole in a study published in 2007 3
• Itraconazole 200mg daily for 5-7 days is another effective option Patients should be advised that skin discoloration may persist for weeks or months after successful treatment, as this represents post-inflammatory changes rather than active infection. To prevent recurrence, maintenance therapy with selenium sulfide or ketoconazole shampoo used once or twice monthly is recommended, especially during warm, humid months, as suggested in a study published in 1993 4 and 2000 5. Patients should also avoid excessive sweating, wear loose-fitting clothing, and promptly change out of wet clothes, as the Malassezia yeast that causes this condition thrives in warm, moist environments. It's worth noting that a study published in 1996 6 compared the effectiveness of 2% ketoconazole and 1% clotrimazole in the treatment of pityriasis versicolor, but the most recent and highest quality study 2 supports the use of ketoconazole 2% foam as a highly effective treatment option.