What is the treatment for Tinea versicolor?

Treatment of Tinea Versicolor

The first-line treatment for tinea versicolor is topical selenium sulfide applied to affected areas, lathered with water, left on for 10 minutes, and rinsed thoroughly once daily for 7 days. 1

Topical Treatment Options

• Selenium sulfide is FDA-approved for tinea versicolor and should be applied to affected areas, lathered with water, left on skin for 10 minutes, then thoroughly rinsed, repeated daily for 7 days 1
• Ketoconazole 2% shampoo is highly effective as either a single application or daily for 3 days (clinical response rates of 69% and 73% respectively) 2
• Application of topical agents should be initiated promptly to prevent pigmentary changes that can persist even after the infection is cleared 3

Oral Treatment Options (for extensive or resistant cases)

• Itraconazole 200 mg once daily for 7 days is effective with 94% of patients considered healed or markedly improved compared to 6% with placebo 4
• Fluconazole 300 mg (two 150 mg capsules) as a single weekly dose for 2 weeks shows similar efficacy to ketoconazole for tinea versicolor 5
• Ketoconazole 400 mg (two 200 mg tablets) as a single weekly dose for 2 weeks is effective but carries a higher risk of hepatotoxicity than newer azoles 6, 5

Treatment Selection Algorithm

1. For limited disease:

   • Start with topical selenium sulfide daily for 7 days 1
   • Alternative: ketoconazole 2% shampoo applied either once or daily for 3 days 2

2. For extensive disease or topical treatment failures:

   • Itraconazole 200 mg daily for 7 days 4
   • Alternative: Fluconazole 300 mg as a single weekly dose for 2 weeks 5

Follow-up and Monitoring

• Patients should be aware that pigmentary changes may persist for weeks to months after successful treatment of the infection 3
• Clinical improvement should be assessed 2-4 weeks after treatment completion 4
• Maximum cure rates are typically achieved at 8 weeks from the start of treatment 5

Prevention of Recurrence

• Tinea versicolor has a high recurrence rate, particularly in tropical and subtropical climates 2, 6
• Prophylactic treatment with topical agents during warm months may be beneficial for patients with frequent recurrences 6
• Avoid sharing personal items like towels and clothing with infected individuals 7

Important Caveats

• Hypopigmentation or hyperpigmentation may persist after successful treatment and should not be confused with treatment failure 5
• Wood's lamp examination can be useful in monitoring treatment response 5
• Patients should be advised to remove jewelry before applying topical selenium sulfide as it may damage jewelry 1
• Oral ketoconazole carries a higher risk of hepatotoxicity compared to newer azoles like fluconazole and itraconazole 6