What is the treatment for tinea versicolor?

Treatment for Tinea Versicolor

For tinea versicolor, topical therapy with selenium sulfide or ketoconazole shampoo is first-line treatment, with oral azoles (fluconazole or itraconazole) reserved for extensive or recurrent disease.

Topical Treatment Options (First-Line)

Selenium Sulfide

• Apply to affected areas, lather with small amount of water, allow to remain on skin for 10 minutes, then rinse thoroughly 1
• Use once daily for 7 consecutive days 1
• Remove jewelry before application as product may cause damage 1

Ketoconazole 2% Shampoo

• Single application achieves 69% clinical response rate at 31 days 2
• Three daily applications achieve 73% clinical response rate (not significantly different from single application) 2
• Apply to affected areas, lather, leave on skin for several minutes, then rinse 2
• Both regimens are significantly more effective than placebo (P < 0.001) with excellent safety profile 2

Terbinafine 1% Cream

• Apply once daily for 1-2 weeks to affected areas 3
• Effective topical alternative 3

Systemic Treatment Options (For Extensive or Recurrent Disease)

Fluconazole (Preferred Oral Agent)

• 400 mg as a single dose is effective 4
• Alternative: 150 mg once weekly for 2 weeks 5
• Achieves similar efficacy to ketoconazole with comparable safety profile 5
• Maximal cure rate achieved at 8 weeks from treatment start 5

Itraconazole

• 200 mg daily for 5-7 days 4
• Comparable efficacy to fluconazole 4

Ketoconazole (Oral)

• 200 mg tablets, two tablets as single dose repeated weekly for 2 weeks 5
• Important caveat: Associated with hepatotoxicity risk, leading to withdrawal in some countries 3
• Should not be first-line oral choice given safety concerns 3

Terbinafine (Oral)

• Appears ineffective for tinea versicolor and should not be used 4
• This is a critical pitfall to avoid, as terbinafine is effective for dermatophyte infections but not for this Malassezia infection 4

Prevention of Recurrence

• Complete drying of affected areas after bathing is essential 3
• Use separate towels for affected areas versus other body parts to reduce contamination 3
• Prophylactic treatment regimen is mandatory to avoid recurrence 6
• Consider periodic maintenance therapy with topical agents in patients with frequent recurrences 6

Important Clinical Considerations

Hypopigmentation persistence: Lack of correlation exists between mycological cure and resolution of hypopigmentation at end of treatment 5. Patients should be counseled that skin color changes may persist for weeks to months after successful eradication of the organism.

Wood's lamp utility: Useful for detecting cure of tinea versicolor and monitoring treatment response 5

Treatment endpoint: Mycological cure should be confirmed, not just clinical appearance 5