From the FDA Drug Label
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. 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 treatment for tinea versicolor is to apply selenium sulfide to the 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. For mild to moderate cases, topical treatments are usually the first choice, 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 published in the Journal of the American Academy of Dermatology 2
- Other effective topical options include clotrimazole, miconazole, or terbinafine creams applied twice daily for 2-4 weeks
For extensive or stubborn infections, 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)
- Ketoconazole (200mg daily for 7-10 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 hot, humid climates, maintenance therapy with selenium sulfide or ketoconazole shampoo used once or twice monthly can be effective, as suggested in a recent review published in Drugs in context 3. Tinea versicolor occurs when the yeast Malassezia, which normally lives on skin, overgrows and causes skin discoloration, so these treatments work by reducing the fungal population to normal levels.
The most recent and highest quality study, published in 2022, supports the use of topical antifungal therapy as the first-line treatment for tinea versicolor, due to its better safety profile and lower cost compared to systemic treatment 3. This study also highlights the importance of selecting antifungal agents based on factors such as efficacy, safety, and potential drug interactions.
In terms of specific treatment options, a study published in 1998 found that ketoconazole 2% shampoo was effective in treating tinea versicolor, with a clinical response rate of 73% at day 31 2. Another study published in 2002 compared the efficacy of fluconazole and ketoconazole in treating tinea versicolor, and found that both treatments were effective, with no significant differences in efficacy or safety 4.
Overall, the treatment of tinea versicolor should be individualized based on the severity of the infection, the patient's medical history, and the potential risks and benefits of different treatment options.