Tinea Versicolor Treatment & Management
- Author: Craig G Burkhart, MD, MPH; Chief Editor: Dirk M Elston, MD more...
Patients should be informed that tinea versicolor is caused by a fungus that is normally present on the skin surface and is therefore not considered contagious. The condition does not leave any permanent scar or pigmentary changes, and any skin color alterations resolve within 1-2 months after treatment has been initiated. Recurrence is common, and prophylactic therapy may help reduce the high rate of recurrence.
Tinea versicolor can be successfully treated with various agents. Effective topical agents include selenium sulfide, sodium sulfacetamide, ciclopiroxolamine, as well as azole and allylamine antifungals.[18, 19, 20, 21, 22] Various regimens can be used. Selenium sulfide lotion is liberally applied to affected areas of the skin daily for 2 weeks; each application is allowed to remain on the skin for at least 10 minutes prior to being washed off. In resistant cases, overnight application can be helpful. Topical azole antifungals can be applied every night for 2 weeks. Weekly application of any of the topical agents for the following few months may help prevent recurrence. In patients with widespread disease, topical antifungal therapy can be expensive. Topical allylamines have been demonstrated to be clinically and mycologically effective.
While oral ketoconazole is contraindicated for the treatment of tinea versicolor, the topical foam may be useful in some patients. The risk of serious liver damage, adrenal gland problems, and harmful drug interactions with use of oral ketoconazole outweighs it benefit for fungal skin infections.
Oral therapy with other systemic antifungals is effective for tinea versicolor and is often preferred by patients because of convenience and oral administration is less time consuming than topical treatment. Of course, oral therapy can be used in consort with topical regimens. Fluconazole, and itraconazole are the preferred oral agents.[24, 25, 26] Various dosing regimens have been used. Fluconazole has been offered as a single 150- to 300-mg weekly dose for 2-4 weeks. Itraconazole is usually given at 200 mg/d for 7 days. Pramiconazole and sertaconazole have also been used in the management of tinea versicolor.[28, 29] A review suggested the following dosing regimens: 200 mg/d for 5 or 7 days of itraconazole, 300 mg/wk for 2 weeks of fluconazole, and 200 mg/d for 2 days of pramiconazole.
Oral therapy does not prevent the high rate of recurrence, and treatment with an oral or topical agent may need to be repeated intermittently throughout the year. Because tinea versicolor is a benign condition and oral therapy is not without risk, the decision to treat with an oral agent should be made only after a complete discussion of the risks involved. In the case of oral terbinafine, some subgroups of M furfur apparently are not clinically responsive, although in vitro studies suggest fungistatic activity. Also, a regimen of 1 tablet a month of fluconazole or itraconazole has been used successfully to prophylactically prevent recurrences.
Dietary alterations have not proved successful in the treatment of tinea versicolor.
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