How is tinea versicolor treated?
Tinea versicolor can usually be treated effectively using topical (externally applied) medications. These contain a substance that stops the fungus from growing or kills it. But even with treatment, it can take several months for the skin to look normal again.
Tinea versicolor is a skin condition that affects about 1% of the population in countries that have a moderate climate. The typical symptoms include light or dark patches of skin, mainly on the upper body. It is caused by a type of yeast (fungus) that is found on most people’s skin. Tinea versicolor is not contagious.
What kinds of treatments are used directly on the skin?
Topical (externally applied) medication is usually effective enough to get rid of tinea versicolor. It comes in the form of medicinal shampoos for your head and body, as well as special creams, gels and solutions. These products are available from pharmacies without a prescription.
They contain different types of substances that stop the growth of the fungus. Products that have been proven to be effective include the following:
- Shampoo containing selenium sulfide
- Shampoo containing a combination of sulfur and salicylic acid
- Shampoo containing zinc pyrithione
- Products containing drugs known as azoles
- Products containing the drug terbinafine
One of the main differences between the products is how often and for how long they need to be put on. Most of them are applied once or twice a day and are used for a total of one to four weeks.
How effective are these products in the treatment of tinea versicolor?
Most of the research on these treatments has focused on three azole drugs: ketoconazole, clotrimazole and bifonazole. All of the studies looked at whether the fungus was still found on the skin after treatment. If the fungus is killed, the discolored patches go away after a while too.
An analysis of the research on ketoconazole, for example, showed the following results after two to four weeks of treatment:
- Without ketoconazole: Tinea versicolor was detected in about 90 out of 100 people.
- With ketoconazole: The fungus was only detected in about 25 out of 100 people.
In other words, treatment with ketoconazole made the fungus disappear in about 65 out of 100 people.
Some studies tested whether shampoos were more effective than creams or lotions. No difference was found, though. It’s not clear whether some drugs are more effective than others. Only terbinafine has been shown to be somewhat less effective than other drugs.
Topical treatment with shampoos, gels or creams is usually well tolerated. These products sometimes cause side effects such as mild skin irritation. Shampoos containing selenium sulfide may also dry out the skin and smell a bit like sulfur (like rotten eggs).
What can you do if topical treatment isn’t enough?
If a very large area of skin is affected or topical treatment isn’t working, treatment with tablets may be considered. The tablets have to be prescribed by a doctor. They usually contain the drug itraconazole, and are typically taken for seven days at a dose of 200 mg per day.
Itraconazole tablets have been shown to work well: Tinea versicolor goes away in an estimated 75 out of 100 people who take them. Because the tablets cause more side effects than topical treatments do, they are usually only used if other treatments haven’t worked. The side effects of itraconazole include nausea, stomach ache and headache. It can also affect your liver. But because it isn’t used for long when treating tinea versicolor, the risk of liver problems is very low: Fewer than 1 out of 10,000 people who take itraconazole end up having this side effect.
Fluconazole is sometimes used as an alternative to itraconazole. It is taken for two to four weeks. The possible side effects of fluconazole include headache, nausea, diarrhea and a skin rash.
Choi FD, Juhasz ML, Atanaskova Mesinkovska N. Topical ketoconazole: a systematic review of current dermatological applications and future developments. J Dermatolog Treat 2019 [Epub ahead of print]: 1-12.
Hu SW, Bigby M. Pityriasis versicolor: a systematic review of interventions. Arch Dermatol 2010; 146(10): 1132-1140.
Renati S, Cukras A, Bigby M. Pityriasis versicolor. BMJ 2015; 350: h1394.
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