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.^[36]Effective topical agents include selenium sulfide, zinc-pyrithione, sodium sulfacetamide, ciclopirox olamine,^[37], tacrolimus,^[38]as well as azole and allylamine antifungals.^{[39, 40, 41, 42, 43]}Even if a small area of skin is involved, treating with topicals from the neck to the knees may make treatment more successful.^[14]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, some topical antifungal therapy can be expensive. Over-the-counter shampoo formulations of selenium sulfide, zinc-pyrithione, and ketoconazole are low-cost options that are widely available and can easily be used to cover large surface areas. Topical allylamines have been demonstrated to be clinically and mycologically effective. Tacrolimus 0.03% applied topically has been shown to provide a mycologically effective treatment; however, it is not effective in speeding the reduction in appearance of hypopigmentation associated with tinea versicolor.

While oral ketoconazole is contraindicated for the treatment of tinea versicolor, the topical foam may be useful in some patients.^[44]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.^[45]

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.^{[46, 47, 48]}Various dosing regimens have been used. Fluconazole has been offered as a single 150- to 300-mg weekly dose for 2-4 weeks and is the safest oral agent. Itraconazole is usually given at 200 mg/d for 7 days. Pramiconazole and sertaconazole have also been used in the management of tinea versicolor.^{[49, 50]}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.^[51]

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.^[52]In the case of oral terbinafine, some subgroups of M furfur apparently are not clinically responsive, although in vitro studies suggest fungistatic activity.^[53]Also, a regimen of 1 tablet a month of fluconazole or itraconazole has been used successfully to prophylactically prevent recurrences.^[54]

Reports describe successful treatment of tinea versicolor with photodynamic therapy.^{[55, 56]}A single study presented narrowband ultraviolet B phototherapy as an effective treatment method for recurrent tinea versicolor and suggests it for use in patients with inadequate response to topical and/or oral antifungals.^[57]

Diet

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

Long-Term Monitoring

Tinea versicolor has a high rate of recurrence, and prophylactic treatment with topical or oral therapy on an intermittent basis is necessary to prevent recurrences in most cases.

Medication

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Media Gallery

In patients with lighter skin color, lesions frequently are light tan or salmon colored.
Hyperpigmented macules forming some confluent patches on the abdomen. While scale is not readily apparent, it is easily provoked with light scratching. On dark skin, affected areas may be hypopigmented or hyperpigmented.

of 2

Author

Christopher Sayed, MD Clinical Assistant Professor of Dermatology, Clinician Educator, Director of Medical Student Education, Director of Hidradenitis Suppurativa Clinic, University of North Carolina at Chapel Hill School of Medicine

Christopher Sayed, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, Medical Dermatology Society, North Carolina Dermatology Association, Society for Investigative Dermatology, Society for Pediatric Dermatology

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Abbvie, Inc.

Coauthor(s)

Maria Del Mar Melendez-Gonzalez, MD Resident Physician, Centro Médico Episcopal San Lucas, Ponce School of Medicine, Puerto Rico

Maria Del Mar Melendez-Gonzalez, MD is a member of the following medical societies: American Medical Association, American Medical Women's Association

Disclosure: Nothing to disclose.

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

Craig N Burkhart, MD, MSBS 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 Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

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

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.

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.

Lauren N Crouse The Brody School of Medicine at East Carolina University

Lauren N Crouse is a member of the following medical societies: Alpha Omega Alpha, American Medical Association

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.