What is the treatment for Tinea versicolor?

Treatment of Tinea Versicolor

The first-line treatment for tinea versicolor is topical selenium sulfide 2.5% applied to affected areas daily for 7 days, allowing it to remain on the skin for 10 minutes before rinsing thoroughly. 1

Topical Treatment Options

• Selenium sulfide 2.5% lotion should be applied to affected areas, lathered with a small amount of water, left on for 10 minutes, then rinsed thoroughly, once daily for 7 days 1
• Topical azole antifungals such as clotrimazole 1% solution applied twice daily for 28 days are also effective for localized disease 2
• Tioconazole 1% lotion twice daily for 28 days has shown significant improvement in rash by the second week of treatment compared to clotrimazole 2

Oral Treatment Options

For extensive disease, recurrent cases, or when topical therapy fails:

• Itraconazole 200 mg daily for 5-7 days is highly effective with a total dose of 1000 mg required for treatment 3
  • 94% of patients treated with itraconazole show marked improvement or complete healing 4
  • 89% achieve mycological cure (negative potassium hydroxide examination) 4
• Fluconazole 400 mg as a single dose is effective for tinea versicolor 5
• Terbinafine is not recommended for tinea versicolor as it appears ineffective when taken orally for this condition 5

Treatment Selection Algorithm

1. For limited disease:

   • Start with selenium sulfide 2.5% applied daily for 7 days 1
   • Alternative: topical azole antifungals (clotrimazole, tioconazole) for 2-4 weeks 2

2. For extensive disease or treatment failures:

   • Itraconazole 200 mg daily for 5-7 days 4, 3
   • Alternative: Fluconazole 400 mg as a single dose 5

Important Considerations

• Clinical improvement may lag behind mycological cure, as dead organisms can remain in the stratum corneum for weeks 3
• Assessment of treatment efficacy should be done 3-4 weeks after completing therapy 3
• Recurrence is common with tinea versicolor, particularly in tropical climates 6
• Oral ketoconazole, while effective, carries a higher risk of hepatotoxicity compared to newer azoles like fluconazole and itraconazole 6

Prevention of Recurrence

• Avoid skin-to-skin contact with infected individuals 7
• Do not share personal items such as towels and clothing 7
• Consider prophylactic treatment with selenium sulfide or oral antifungals during warm months for patients with frequent recurrences 6