What is the treatment for pityriasis versicolor?

Treatment of Pityriasis Versicolor

Topical ketoconazole cream 2% applied once daily for two weeks is the first-line treatment for pityriasis versicolor. 1

First-Line Treatment Options

• Topical ketoconazole 2% cream should be applied once daily to cover the affected and immediate surrounding areas for two weeks 1
• Other effective topical options include:
  • Zinc pyrithione shampoo 2
  • Selenium sulfide 2, 3
  • Terbinafine cream (applied once daily for 1-2 weeks) 4
  • Ciclopiroxamine 2

Treatment Algorithm

For Limited Disease:

1. Start with topical ketoconazole 2% cream applied once daily for two weeks 1
2. Clinical improvement may be seen fairly soon after treatment begins, but complete the full two-week course to reduce the possibility of recurrence 1
3. If inadequate response after two weeks, consider alternative topical agents or systemic therapy 2

For Extensive or Recalcitrant Disease:

1. Consider oral antifungal therapy with one of the following regimens:
   • Fluconazole 400 mg as a single dose 5, 6
   • Itraconazole 200 mg daily for 5-7 days 3, 6
   • Note: Oral terbinafine is not effective for pityriasis versicolor 3, 6

Efficacy Comparison

• In comparative studies, single-dose fluconazole (400 mg) showed higher cure rates (65%) compared to single-dose itraconazole (400 mg) with only 20% culture-negative results at 8 weeks 5
• Relapse rates were higher with itraconazole (60%) compared to fluconazole (35%) 5
• Topical terbinafine emulsion gel applied once daily for 7 days demonstrated 75% cure rates compared to 14% with placebo 4

Important Considerations

• Pityriasis versicolor is caused by Malassezia species (formerly known as Pityrosporum orbiculare), which is part of normal skin flora, making recurrence common 2, 3
• High temperatures and humidity are important exogenous factors that explain why pityriasis versicolor is more common in tropical climates 2
• Important endogenous factors include greasy skin, hyperhidrosis, hereditary factors, corticosteroid treatment, and immunodeficiency 2

Prevention of Recurrence

• Prophylactic treatment regimens are recommended to avoid recurrence 2
• Maintenance therapy with periodic use of topical antifungals may be useful, though research evaluating the efficacy of prophylactic treatment is limited 3
• Addressing predisposing factors such as excessive sweating and humid environments may help reduce recurrence 2

Monitoring Response

• Clinical improvement is typically seen soon after treatment begins 1
• Complete the full treatment course even if symptoms improve early to reduce the possibility of recurrence 1, 2
• If no clinical improvement is observed after the treatment period, reconsider the diagnosis 1