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Tinea Versicolor Treatment & Management

  • Author: Craig G Burkhart, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Feb 08, 2016
 

Medical Care

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.[16] Effective topical agents include selenium sulfide, sodium sulfacetamide, ciclopiroxolamine,[17] 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.[23]  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.[37]

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.[30]

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.[31] In the case of oral terbinafine, some subgroups of M furfur apparently are not clinically responsive, although in vitro studies suggest fungistatic activity.[32] Also, a regimen of 1 tablet a month of fluconazole or itraconazole has been used successfully to prophylactically prevent recurrences.[33]

Reports describe successful treatment of tinea versicolor with photodynamic therapy.[34, 35]

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Diet

Dietary alterations have not proved successful in the treatment of tinea versicolor.

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Contributor Information and Disclosures
Author

Craig G Burkhart, MD, MPH Clinical Professor, Department of Medicine, Medical College of Ohio; Clinical Assistant Professor, Department of Medicine, Ohio University College of Osteopathic Medicine

Craig G Burkhart, MD, MPH is a member of the following medical societies: Association of Military Dermatologists, American College of Aesthetic and Cosmetic Physicians; American Society of Aesthetic/Cosmetic Physicians, Michigan Dermatological Society, Academy of Medicine of Toledo and Lucas County, Ohio Dermatological Association, American Academy of Dermatology, Ohio State Medical Association, Phi Beta Kappa

Disclosure: Nothing to disclose.

Coauthor(s)

Craig N Burkhart, MD MSBS, Assistant Professor, Department of Dermatology, University of North Carolina at Chapel Hill School of Medicine

Craig N Burkhart, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Kathryn Schwarzenberger, MD Associate Professor of Medicine, Division of Dermatology, University of Vermont College of Medicine; Consulting Staff, Division of Dermatology, Fletcher Allen Health Care

Kathryn Schwarzenberger, MD is a member of the following medical societies: Women's Dermatologic Society, American Contact Dermatitis Society, Medical Dermatology Society, Dermatology Foundation, Alpha Omega Alpha, American Academy of Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Lorie Gottwald, MD Chief, Division of Dermatology, Associate Professor, Department of Internal Medicine, Medical College of Ohio at Toledo

Lorie Gottwald, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Medical Association, American Medical Student Association/Foundation, and American Medical Women's Association

Disclosure: Nothing to disclose.

References
  1. Crespo-Erchiga V, Florencio VD. Malassezia yeasts and pityriasis versicolor. Curr Opin Infect Dis. 2006 Apr. 19(2):139-47. [Medline].

  2. Gaitanis G, Velegraki A, Alexopoulos EC, Chasapi V, Tsigonia A, Katsambas A. Distribution of Malassezia species in pityriasis versicolor and seborrhoeic dermatitis in Greece. Typing of the major pityriasis versicolor isolate M. globosa. Br J Dermatol. 2006 May. 154(5):854-9. [Medline].

  3. Morishita N, Sei Y, Sugita T. Molecular analysis of malassezia microflora from patients with pityriasis versicolor. Mycopathologia. 2006 Feb. 161(2):61-5. [Medline].

  4. Rincon S, Celis A, Sopo L, Motta A, Cepero de Garcia MC. Malassezia yeast species isolated from patients with dermatologic lesions. Biomedica. 2005 Jun. 25(2):189-95. [Medline].

  5. Krisanty RI, Bramono K, Made Wisnu I. Identification of Malassezia species from pityriasis versicolor in Indonesia and its relationship with clinical characteristics. Mycoses. 2009 May. 52(3):257-62. [Medline].

  6. Blaes AH, Cavert WP, Morrison VA. Malassezia: is it a pulmonary pathogen in the stem cell transplant population?. Transplant Infectious Disease. August, 2009. 11:313-317. [Medline].

  7. Muhammad N, Kamal M, Islam T, Islam N, Shafiquzzaman M. A study to evaluate the efficacy and safety of oral fluconazole in the treatment of tinea versicolor. Mymensingh Med J. 2009 Jan. 18(1):31-5. [Medline].

  8. He SM, Du WD, Yang S, et al. The genetic epidemiology of tinea versicolor in China. Mycoses. 2008 Jan. 51(1):55-62. [Medline].

  9. Suwattee P, Cham PM, Solomon RK, Kaye VN. Tinea versicolor with interface dermatitis. J Cutan Pathol. 2009 Feb. 36(2):285-6. [Medline].

  10. Burkhart CG, Dvorak N, Stockard H. An unusual case of tinea versicolor in an immunosuppressed patient. Cutis. 1981. 27(1):56-8. [Medline].

  11. Gulec AT, Demirbilek M, Seckin D, et al. Superficial fungal infections in 102 renal transplant recipients: a case-control study. J Am Acad Dermatol. 2003 Aug. 49(2):187-92. [Medline].

  12. Mendez-Tovar LJ. Pathogenesis of dermatophytosis and tinea versicolor. Clinics in Dermatology. 2010. 28:185-188. [Medline].

  13. Kilic M, Oguztuzum S, Karadag S, Cakir E, Aydin M, Ozturk L. Expression of GSTM4 and GSTT1 in patients with Tinea versicolor, Tinea inguinalis, and Tinea pedis infections: a preliminary study. Clinical Dermatology. 2011. 36:590-594. [Medline].

  14. Lim SL, Lim CS. New contrast stain for the rapid diagnosis of pityriasis versicolor. Arch Dermatol. 2008 Aug. 144(8):1058-9. [Medline].

  15. Janaki C, Sentamilselvi G, Janaki VR, Boopalraj JM. Unusual observations in the histology of Pityriasis versicolor. Mycopathologia. 1997. 139(2):71-4. [Medline].

  16. Gupta AK, Lyons DC. Pityriasis versicolor: an update on pharmacological treatment options. Expert Opin Pharmacother. 2014 Aug. 15(12):1707-13. [Medline].

  17. Gupta AK, Skinner AR. Ciclopirox for the treatment of superficial fungal infections: a review. Int J Dermatol. 2003 Sep. 42 Suppl 1:3-9. [Medline].

  18. Hull CA, Johnson SM. A double-blind comparative study of sodium sulfacetamide lotion 10% versus selenium sulfide lotion 2.5% in the treatment of pityriasis (tinea) versicolor. Cutis. 2004 Jun. 73(6):425-9. [Medline].

  19. Vermeer BJ, Staats CC. The efficacy of a topical application of terbinafine 1% solution in subjects with pityriasis versicolor: a placebo-controlled study. Dermatology. 1997. 194 Suppl 1:22-4. [Medline].

  20. Carrillo-Munoz AJ, Giusiano G, Ezkurra PA, Quindos G. Sertaconazole: updated review of a topical antifungal agent. Expert Rev Anti Infect Ther. 2005 Jun. 3(3):333-42. [Medline].

  21. Gold M, Bridges T, Avakian E, Plaum S, Pappert EJ, Fleischer AB, et al. An open-label study of naftifine hydrochloride 1% gel in the treatment of tinea versicolor. Skin Med. Sept 2011. 9:283-6. [Medline].

  22. Croxtall J, Plosker G. Sertaconazole: a reviw of its use in the management of superficial mycoses in dermatology and gynacology. Ingenta/Adis International. Jan 2009. 69:339-359. [Medline].

  23. Cantrell WC, Elewksi BE. Can pityriasis versicolor be treated with 2% ketoconazole foam?. J Drugs Dermatol. 2014 Jul 1. 13(7):855-9. [Medline].

  24. Hickman JG. A double-blind, randomized, placebo-controlled evaluation of short-term treatment with oral itraconazole in patients with tinea versicolor. J Am Acad Dermatol. 1996 May. 34(5 Pt 1):785-7. [Medline].

  25. Karakas M, Durdu M, Memisoglu HR. Oral fluconazole in the treatment of tinea versicolor. J Dermatol. 2005 Jan. 32(1):19-21. [Medline].

  26. Partap R, Kaur I, Chakrabarti A, Kumar B. Single-dose fluconazole versus itraconazole in pityriasis versicolor. Dermatology. 2004. 208(1):55-9. [Medline].

  27. Fernandez-Nava HD, Laya-Cuadra B, Tianco EA. Comparison of single dose 400 mg versus 10-day 200 mg daily dose ketoconazole in the treatment of tinea versicolor. Int J Dermatol. 1997 Jan. 36(1):64-6. [Medline].

  28. Wahab MA, Ali ME, Rahman MH, Chowdhury SA, Monamie NS, Sultana N, et al. Single dose (400mg) versus 7 day (200mg) daily dose itraconazole in the treatment of tinea versicolor: a randomized clinical trial. Mymensingh Med J. 2010 Jan. 19(1):72-6. [Medline].

  29. Faergemann J, Todd G, Pather S, et al. A double-blind, randomized, placebo-controlled, dose-finding study of oral pramiconazole in the treatment of pityriasis versicolor. J Am Acad Dermatol. 2009 Dec. 61(6):971-6. [Medline].

  30. Gupta AK, Lane D, Paquet M. Systematic review of systemic treatments for tinea versicolor and evidence-based dosing regimen recommendations. J Cutan Med Surg. 2014 Mar-Apr. 18(2):79-90. [Medline].

  31. Mellen LA, Vallee J, Feldman SR, Fleischer AB Jr. Treatment of pityriasis versicolor in the United States. J Dermatolog Treat. 2004 Jun. 15(3):189-92. [Medline].

  32. Leeming JP, Sansom JE, Burton JL. Susceptibility of Malassezia furfur subgroups to terbinafine. Br J Dermatol. 1997 Nov. 137(5):764-7. [Medline].

  33. Faergemann J, Gupta AK, Al Mofadi A, Abanami A, Shareaah AA, Marynissen G. Efficacy of itraconazole in the prophylactic treatment of pityriasis (tinea) versicolor. Arch Dermatol. 2002 Jan. 138(1):69-73. [Medline].

  34. Kim YJ, Kim YC. Successful treatment of pityriasis versicolor with 5-aminolevulinic acid photodynamic therapy. Arch Dermatol. 2007 Sep. 143(9):1218-20. [Medline].

  35. Qiao J, Li R, Ding Y, Fang H. Photodynamic therapy in the treatment of superficial mycoses: an evidence-based evaluation. Mycopathologia. 2010. 170:339-343. [Medline].

  36. Burkhart CG. Tinea versicolor. J Dermatol Allergy. 1983. 6:8-12.

  37. U.S. Food and Drug Administration. Nizoral (ketoconazole) oral tablets: Drug Safety Communication - Prescribing for unapproved uses including skin and nail infections continues; linked to patient death. FDA Medwatch. May 19, 2016. Available at http://www.fda.gov/safety/medwatch/safetyinformation/safetyalertsforhumanmedicalproducts/ucm502073.htm.

 
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In patients with lighter skin color, lesions frequently are light tan or salmon colored.
 
 
 
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