How to treat Tinea versicolor?

Treatment of Tinea Versicolor

For tinea versicolor, apply selenium sulfide to affected areas, lather with water, leave on for 10 minutes, then rinse thoroughly, repeating once daily for 7 days. 1

First-Line Treatment Options

Topical Treatments

• Selenium sulfide (2.5%):

  • Apply to affected areas, lather with water
  • Leave on skin for 10 minutes
  • Rinse thoroughly
  • Use once daily for 7 days 1
  • Highly effective with 85% cure rate 2

• Topical azole antifungals:

  • Miconazole or clotrimazole creams
  • Apply twice daily for 2-4 weeks 3
  • Ketoconazole 2% shampoo: Apply once weekly for 3 weeks (95% cure rate) 2

Second-Line Treatment Options

Oral Antifungal Therapy

For widespread, recurrent, or resistant cases:

• Itraconazole:

  • 100-200 mg daily for adults for 2-4 weeks 3
  • Superior efficacy (66% cure rate) compared to other oral antifungals 3
  • Side effects: primarily gastrointestinal, occasional cutaneous eruptions and headache

• Fluconazole:

  • Single dose of 400 mg can be effective 4
  • Can be used prophylactically in some cases to prevent recurrence
  • 42% cure rate in treatment-resistant cases 3

Diagnostic Considerations

• Confirm diagnosis through microscopic examination (KOH preparation) or fungal culture 3
  • Look for characteristic "spaghetti and meatballs" appearance under microscope 5
• Differential diagnosis includes:
  • Pityriasis rosea
  • Vitiligo
  • Seborrheic dermatitis
  • Pityriasis alba 6

Treatment Duration and Follow-up

• Continue treatment until clinical improvement (typically within 1-2 weeks)
• Treatment should continue for at least one week after clinical resolution 3
• Follow-up examination is recommended to confirm mycological clearance, especially in resistant or recurrent cases 3

Prevention of Recurrence

• Apply antifungal powders containing miconazole or clotrimazole to prevent reinfection 3
• For persistent cases, consider prophylactic treatment:
  • Selenium sulfide application monthly
  • Oral antifungal therapy during warm months when recurrence is more likely 4
• Avoid sharing personal items like clothing or towels 3

Special Considerations

• In dark-skinned individuals, tinea versicolor often presents as hypopigmented macules 6
• Recurrences are common, especially in tropical or humid climates 7
• Immunocompromised patients may require scheduled oral or topical therapy 6

Treatment Algorithm

1. Initial presentation: Start with topical selenium sulfide for 7 days
2. If inadequate response: Switch to topical azole antifungal for 2-4 weeks
3. For widespread or resistant cases: Use oral itraconazole 100-200 mg daily for 2-4 weeks
4. For prevention of recurrence: Consider monthly selenium sulfide or scheduled oral therapy during warm months

Remember that while cure rates are high with proper treatment, recurrences are common due to the persistent nature of the Malassezia fungus.