What is the treatment for tinea versicolor?

Treatment of Tinea Versicolor

Selenium sulfide 2.5% lotion applied daily for 7 days is the first-line treatment for tinea versicolor. 1

First-Line Topical Treatments

• Selenium sulfide 2.5% lotion should be applied to affected areas, lathered with a small amount of water, left on the skin for 10 minutes, then thoroughly rinsed off. This procedure should be repeated once daily for 7 days. 1

• Ketoconazole 2% shampoo is highly effective as either a single application or daily for 3 days. Apply to affected areas, lather with water, leave for 5-10 minutes, then rinse thoroughly. 2

• Other effective topical antifungal agents include:

  • Tioconazole 1% lotion applied twice daily for 2-4 weeks 3
  • Clotrimazole 1% solution applied twice daily for 2-4 weeks 3

Oral Treatment Options

Oral antifungals are particularly useful for extensive disease, recurrent infections, or when topical treatments have failed:

• Fluconazole 400 mg as a single dose or 150 mg once weekly for 2-3 weeks 4, 5

• Itraconazole 200 mg daily for 5-7 days 4

• Ketoconazole 400 mg as a single dose repeated weekly for 2 weeks 5

Treatment Considerations

• Topical treatments are generally preferred for limited disease due to their effectiveness and safety profile 2, 3

• Oral treatments may be more practical for extensive disease covering large body surface areas 5

• Clinical improvement may be seen within 1-2 weeks, but complete resolution of pigmentary changes may take weeks to months after successful treatment 5

Follow-up and Prevention

• Patients should be advised that hypopigmentation or hyperpigmentation may persist for weeks to months after successful treatment 5

• Wood's lamp examination can be useful for monitoring treatment response 5

• Recurrence is common, especially in warm, humid environments. Prophylactic treatment with selenium sulfide or ketoconazole shampoo once or twice monthly may help prevent recurrence in susceptible individuals 2

Common Pitfalls

• Failure to distinguish between active infection and post-inflammatory pigmentary changes. Negative KOH preparation indicates successful treatment even if pigmentary changes persist 5

• Inadequate application of topical treatments to all affected areas may lead to treatment failure 1

• Jewelry should be removed before applying selenium sulfide as it may cause damage 1

• Patients should be counseled that resolution of pigmentary changes may take significantly longer than clearance of the fungal infection itself 5