Tinea Versicolor Treatment & Management

Updated: May 22, 2018
  • Author: Lauren N Crouse; Chief Editor: Dirk M Elston, MD  more...
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Treatment

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. [30] Effective topical agents include selenium sulfide, zinc-pyrithione, sodium sulfacetamide, ciclopirox olamine, [31] , tacrolimus, [32] as well as azole and allylamine antifungals. [33, 34, 35, 36, 37] 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. [38] 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. [39]

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. [40, 41, 42] 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. [43, 44] 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. [45]

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. [46] In the case of oral terbinafine, some subgroups of M furfur apparently are not clinically responsive, although in vitro studies suggest fungistatic activity. [47] Also, a regimen of 1 tablet a month of fluconazole or itraconazole has been used successfully to prophylactically prevent recurrences. [48]

Reports describe successful treatment of tinea versicolor with photodynamic therapy. [49, 50]

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Diet

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

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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.

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