What is the treatment for Tinea versicolor?

Treatment of Tinea Versicolor

Start with topical terbinafine 1% cream applied once daily for 1-2 weeks as first-line therapy for localized disease, or use selenium sulfide lotion for 10 minutes daily for 7 days as an equally effective alternative. 1, 2

Topical Treatment Options (First-Line)

Terbinafine 1% cream:

• Apply once daily for 1-2 weeks to affected areas 1
• Highly effective for localized tinea versicolor 1

Selenium sulfide lotion:

• Apply to affected areas, lather with small amount of water, and leave on skin for 10 minutes 2
• Rinse thoroughly and repeat once daily for 7 days 2
• Remove jewelry before application as product may cause damage 2

Ketoconazole 2% shampoo:

• Single application or daily for 3 consecutive days both achieve 69-73% clinical response rates 3
• Apply to affected areas, leave on for several minutes, then rinse 3
• Significantly more effective than placebo with excellent safety profile 3

Systemic Treatment Options (For Extensive or Resistant Disease)

Itraconazole (preferred systemic agent):

• Use 50-100 mg daily for 2-4 weeks for extensive disease or cases resistant to topical therapy 4
• Consider as second-line when topical agents fail 4

Fluconazole:

• Two 150 mg capsules in a single dose, repeated weekly for 2 weeks achieves similar efficacy to ketoconazole 5
• Maximal cure rate achieved at 8 weeks from treatment start 5

Avoid oral ketoconazole:

• Associated with significant hepatotoxicity risk and has been withdrawn in some countries 1
• Despite historical use, safer alternatives now available 1, 6

Essential Adjunctive Measures

Hygiene practices to prevent recurrence:

• Completely dry affected areas after bathing 1
• Use separate towels for affected areas versus other body parts to reduce contamination 1
• Clean contaminated combs and brushes properly 4

Follow-Up Strategy

Clinical and mycological assessment required:

• Follow-up should include both clinical examination and mycological testing 4
• Wood's lamp examination useful for detecting cure 5
• Note that hypopigmentation may persist after mycological cure at 2 weeks, which does not indicate treatment failure 5

Common Pitfalls

• Hypopigmentation persistence: Skin discoloration often remains after successful mycological cure and does not correlate with treatment failure 5
• Recurrence is common: This is a chronically recurring infection, especially in tropical and humid climates 3, 6
• Large surface area application: Topical agents can be difficult to apply over extensive body surface areas, making systemic therapy more practical for widespread disease 5