What is the treatment for Tinea versicolor?

Treatment for Tinea Versicolor

Topical antifungal medications are the first-line treatment for tinea versicolor, with selenium sulfide 2.5% lotion applied daily for seven days being the most effective and well-established treatment option. 1

First-Line Treatment Options

Topical Therapy

Topical therapy is the mainstay of treatment for tinea versicolor due to its favorable safety profile, lower cost, and effectiveness for most cases:

1. Selenium Sulfide 2.5% Lotion 1

   • Application: Apply to affected areas, lather with small amount of water
   • Leave on skin for 10 minutes
   • Rinse thoroughly
   • Repeat once daily for 7 days
   • Most accessible and FDA-approved specific treatment

2. Other Effective Topical Options 2, 3

   • Ketoconazole 2% shampoo or cream
   • Zinc pyrithione shampoo
   • Terbinafine cream

Second-Line Treatment (For Extensive or Recalcitrant Cases)

When topical therapy fails or when the infection is extensive, oral antifungal medications should be considered:

1. Oral Itraconazole 4, 3

   • Dosage: 200 mg once daily for 5-7 days
   • Highly effective with 89% mycological cure rate
   • Consider in patients with widespread disease or frequent recurrences

2. Oral Fluconazole 5, 3

   • Dosage: 400 mg as a single dose or 150 mg once weekly for 2-3 weeks
   • Good alternative when itraconazole is contraindicated

3. Important Note: Oral terbinafine is NOT effective for tinea versicolor 2, 5

Application Instructions for Selenium Sulfide 2.5% 1

1. Keep tightly capped and shake well before using
2. Remove jewelry before application (product may damage jewelry)
3. Apply to affected areas and lather with a small amount of water
4. Allow to remain on skin for 10 minutes
5. Rinse body thoroughly
6. Repeat this procedure once a day for seven days

Special Considerations

Precautions with Topical Selenium Sulfide 1

• Do not use when acute inflammation or exudation is present
• May cause skin irritation or sensitization
• Avoid contact with eyes and mucous membranes
• Use cautiously in genital areas and skin folds
• Pregnancy Category C: should not be used for tinea versicolor in pregnant women unless clearly needed
• Safety in infants not established

Maintenance Therapy for Recurrent Cases 3

• For patients with frequent recurrences, consider prophylactic therapy
• Options include monthly application of topical antifungals or intermittent oral therapy
• Selenium sulfide shampoo used once or twice monthly may help prevent recurrence

Clinical Pearls

• Pigmentary changes may persist for weeks to months after successful treatment
• Patients should be informed that color normalization may take time even after the fungus is eradicated
• Recurrence rates are high due to Malassezia being part of normal skin flora
• Treatment success should be evaluated by absence of scaling and negative KOH examination, not by pigment normalization

By following this treatment algorithm and considering the patient's specific circumstances, tinea versicolor can be effectively managed with high cure rates, though recurrences remain common.