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 pityriasis (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.
From the Research
Pityriasis versicolor is best treated with a single dose of 400 mg oral fluconazole, which has been shown to provide the best clinical and mycological cure rate with no relapse during twelve months of follow-up 2.
Treatment Options
- Topical antifungal medications such as ketoconazole 2% shampoo, selenium sulfide 2.5% shampoo, or clotrimazole 1% cream can be effective for limited lesions.
- For ketoconazole or selenium sulfide shampoos, apply to affected areas, leave on for 5-10 minutes, then rinse off daily for 1-2 weeks.
- Clotrimazole cream should be applied twice daily for 2-4 weeks.
Oral Antifungal Therapy
- For widespread or resistant cases, oral antifungal therapy may be necessary, typically fluconazole 400mg as a single dose 2.
- Itraconazole 200mg daily for 5-7 days can also be effective, but fluconazole has been shown to have a better cure rate and no relapse during twelve months of follow-up 2.
Maintenance Therapy
- After treatment, skin discoloration may persist for weeks to months even after the fungus is eliminated.
- Recurrence is common, so maintenance therapy with topical treatments once or twice monthly may be beneficial.
Cause and Mechanism
- Pityriasis versicolor is caused by Malassezia yeasts, which are normally present on skin but overgrow under certain conditions like heat, humidity, and excessive sweating.
- The antifungal medications work by disrupting the yeast cell membrane or inhibiting essential fungal enzymes, effectively reducing the fungal load on the skin.
Recent Studies
- A study published in 2014 showed that ketoconazole 2% foam can be an effective treatment for pityriasis versicolor, with improvement in clinical and microscopic evidence of the disease 3.
- However, the single dose of 400 mg oral fluconazole remains the most effective treatment option, with the best clinical and mycological cure rate and no relapse during twelve months of follow-up 2.