What is the treatment for tinea versicolor?

Treatment for Tinea Versicolor

Topical selenium sulfide is the first-line treatment for tinea versicolor, applied to affected areas daily for 7 days. 1

First-Line Treatment Options

Topical Treatments

• Selenium sulfide 2.5% lotion/shampoo:

  • Apply to affected areas, lather with water
  • Leave on skin for 10 minutes
  • Rinse thoroughly
  • Repeat once daily for 7 days 1
  • Advantages: Effective, readily available, inexpensive
  • Disadvantages: May cause skin irritation, has unpleasant odor

• Other effective topical options:

  • Ketoconazole 2% shampoo
  • Clotrimazole cream
  • Ciclopirox olamine cream

Oral Treatment Options (for extensive disease or recurrent cases)

Itraconazole

• Dosing options:
  • 200 mg daily for 5-7 days 2, 3
  • OR 400 mg single dose 4
  • Total effective dose is 1000 mg 2
• Efficacy: 89% mycological cure rate at follow-up 3
• Advantages: Short treatment duration, high patient compliance
• Disadvantages: Drug interactions (warfarin, antihistamines, antipsychotics, anxiolytics, digoxin, ciclosporin, statins) 5

Fluconazole

• Dosing: 300 mg once weekly for 2 weeks 6
• Efficacy: 77.5% mycological cure rate at 4 weeks 6
• Advantages: Convenient dosing, well-tolerated
• Disadvantages: Slightly lower cure rate than itraconazole

Treatment Algorithm

1. For limited disease:

   • Start with topical selenium sulfide 2.5% daily for 7 days 1

2. For extensive disease, recurrent cases, or treatment failures:

   • Use oral therapy:
     • Itraconazole 200 mg daily for 7 days OR 400 mg single dose 2, 3, 4
     • OR Fluconazole 300 mg once weekly for 2 weeks 6

3. For maintenance/prevention of recurrence:

   • Consider prophylactic use of selenium sulfide shampoo once or twice monthly

Important Clinical Considerations

• Assessment of cure: Evaluate both clinically and mycologically 3-4 weeks after treatment, as organisms may persist on skin even when dead 2

• Recurrence prevention: Tinea versicolor has high recurrence rates, particularly in tropical climates 7

• Common pitfalls:

  1. Stopping treatment too early based on clinical improvement alone
  2. Failing to warn patients about possible persistent hypopigmentation/hyperpigmentation even after successful treatment
  3. Not addressing risk factors for recurrence (excessive sweating, occlusive clothing, humid environments)

• Safety considerations:

  • Oral azoles generally have low risk of hepatotoxicity except for ketoconazole 7
  • Itraconazole is better tolerated than selenium sulfide by many patients 2

The evidence strongly supports that both topical and oral treatments are effective for tinea versicolor, with the choice depending on extent of disease, patient preference, and history of recurrence.