From the FDA Drug Label
Ketoconazole Cream 2% is indicated for the topical treatment of ... tinea (pityriasis) versicolor caused by Malassezia furfur (Pityrosporum orbiculare);
DOSAGE & ADMINISTRATION SECTION ... tinea (pityriasis) versicolor: It is recommended that Ketoconazole Cream 2% be applied once daily to cover the affected and immediate surrounding area ... Patients with tinea versicolor usually require two weeks of treatment.
Treatment of Pityriasis Versicolor: Ketoconazole Cream 2% is indicated for the topical treatment of tinea (pityriasis) versicolor caused by Malassezia furfur. The recommended treatment is to apply the cream once daily to the affected area for two weeks 1.
From the Research
Pityriasis versicolor should be treated with fluconazole 300 mg per week combined with ketoconazole 2% twice a week for 2 weeks, as this regimen has been shown to be the most effective in achieving clinical cure and preventing recurrence, as demonstrated in the most recent and highest quality study 2.
Treatment Options
The treatment of pityriasis versicolor involves the use of antifungal medications, which can be topical or oral. Topical treatments include:
- Ketoconazole 2% shampoo, applied to affected areas for 5 minutes daily for 3 days
- Selenium sulfide 2.5% lotion, applied for 10 minutes daily for 7 days
- Clotrimazole cream, applied twice daily for 2-4 weeks For widespread cases, oral antifungal therapy with fluconazole may be prescribed, with a single dose of 300-400mg or 150mg weekly for 2-4 weeks.
Efficacy of Treatment Options
Studies have compared the efficacy of different treatment options for pityriasis versicolor. A study published in 2001 found that a single dose of 400 mg oral fluconazole provided the best clinical and mycological cure rate with no relapse during twelve months of follow-up 3. Another study published in 2007 found that fluconazole was more effective than ketoconazole in treating extensive pityriasis versicolor, with an improvement rate of 81.5% compared to 87.9% for ketoconazole, although the difference was not significant 4.
Prevention of Recurrence
To prevent recurrence, maintenance therapy with topical treatments once or twice monthly is recommended, especially in warm, humid climates. The condition occurs when the normally present Malassezia yeast overgrows on the skin, often triggered by factors like heat, humidity, excessive sweating, oily skin, or immunosuppression.
Key Points
- Pityriasis versicolor is a common fungal skin infection caused by Malassezia yeasts
- Treatment involves topical antifungal medications or oral antifungal therapy with fluconazole
- The most effective regimen is fluconazole 300 mg per week combined with ketoconazole 2% twice a week for 2 weeks, as demonstrated in the most recent and highest quality study 2
- Maintenance therapy with topical treatments is recommended to prevent recurrence, especially in warm, humid climates.