Tinea versicolor is a rash that occurs after the normal skin yeasts, Pityrosporum orbiculare or Pityrosporum ovale, transform to a pathogenic form and turn off melanin-producing cells in the skin. Because the yeast inhabits the top layer of the skin, topical antifungal medications are very effective. If the rash is extensive, oral antifungal medications may be needed. Because tinea versicolor has a recurrence rate of 80% after 2 years, periodic use of medications may be needed to suppress the rash.
Treatment of Tinea Versicolor with Topical Antifungals
Topical antifungal medications are the treatment of choice for tinea versicolor. The following topical antifungal treatment regimens have been shown to produce a greater than 70% clinical response rate:
- 2% Ketoconazole cream applied once daily for 11-22 days
- 2% Ketoconazole shampoo regimen (lathered over affected and surrounding areas and left on for at least 5 minutes before rinsing) applied once daily for 3 consecutive days
- 1% Terbinafine solution applied twice daily for 1 week
- 1% Clotrimazole solution applied once daily for 1 week
Treatment of Tinea Versicolor with Oral Antifungals
Oral antifungal medications can cause side effects such as nausea or reversible liver damage, but these side effects are not common with the short courses of therapy used for tinea versicolor. Oral griseofulvin and oral terbinafine are not effective treatments for tinea versicolor. The following oral treatment regimens have been shown to produce a greater than 70% clinical response rate:
- Itraconazole 200mg every other day for 7 days
- Ketoconazole 400mg single dose
- Fluconazole 400mg single dose
- Fluconazole 150mg or 300mg weekly for 4 weeks
Treatment of Tinea Versicolor with Dandruff Shampoos
Until recently, dandruff shampoos were the mainstay of treatment for tinea versicolor. They are less effective than the antifungal medications and can cause skin irritation, but they are available over the counter and are less expensive. The following regimens have been shown to be effective:
- Sulfur-salicyclic acid shampoo applied nightly as a lotion for 1 week
- Zinc-pyrithione shampoo regimen (applied daily as a lotion and left on for 5 minutes before rinsing) for 2 weeks
- Selenium sulfide 2.5% lotion regimen (applied daily as a lotion and left on for 10 minutes before rinsing) for 1 week
