Treatment of Tinea Versicolor for 41-Year-Old Male with Chest and Back Involvement
For tinea versicolor on the chest and back, prescribe oral itraconazole (Itrasys/Canditral) 200 mg daily for 7 days along with topical clotrimazole (Candid) cream to be applied twice daily for 2-4 weeks. 1
Prescription Details
Oral Medication
- Itraconazole (Itrasys/Canditral) 200 mg tablet
- Dosage: 1 tablet daily
- Duration: 7 days
- Take with food to enhance absorption
- Avoid antacids within 2 hours of taking this medication
Topical Medication
- Clotrimazole (Candid) cream 1%
- Apply thin layer to affected areas on chest and back
- Frequency: Twice daily (morning and night)
- Duration: 2-4 weeks (continue for 1 week after visible clearing)
- Wash and dry the area before application
Cleansing Agent
- Ketoconazole (Ketocip/Ketoz) shampoo 2%
- Use as a body wash on affected areas
- Apply to wet skin, lather for 5 minutes, then rinse thoroughly
- Frequency: Every other day for 2 weeks
- Can be used prophylactically once weekly after resolution
Treatment Rationale
Tinea versicolor (pityriasis versicolor) is a superficial fungal infection caused by Malassezia species. For extensive involvement of the chest and back, a combination of systemic and topical therapy provides optimal results 1, 2.
The British Journal of Dermatology recommends oral itraconazole for stubborn or extensive fungal infections, with dosing of 100-200 mg daily for adults 1. Itraconazole has demonstrated superior efficacy (66% cure rate) compared to other antifungals in treatment-resistant cases 1.
Adding topical therapy as an adjunct improves outcomes and helps prevent recurrence. Clotrimazole is readily available in India as Candid cream and is effective against Malassezia species 1, 3.
Follow-up and Prevention
- Schedule follow-up in 4 weeks to assess clinical response
- Continue treatment for at least one week after clinical resolution
- For prevention of recurrence:
- Apply antifungal powder (Candid powder) to susceptible areas during hot, humid weather
- Use ketoconazole shampoo (Ketocip/Ketoz) as a body wash once weekly
- Wear loose-fitting, cotton clothing to reduce sweating
- Avoid sharing personal items like towels and clothing
Important Considerations
- Tinea versicolor has high recurrence rates, especially in tropical climates 2, 4
- Oral itraconazole may interact with certain medications; verify no contraindications
- Clinical improvement should be visible within 1-2 weeks of starting treatment 1
- Pigmentary changes may persist for weeks to months after successful treatment of the infection
- If no improvement after 2 weeks of treatment, consider alternative diagnosis or resistant infection
This treatment approach combines the efficacy of systemic therapy for rapid clearance with topical agents for local control and prevention, addressing both the acute infection and reducing recurrence risk.