Treatment for tinea versicolor

Topical (externally applied) medication is usually enough to get rid of tinea versicolor. It comes in the form of medicinal shampoo for your head and body, as well as special creams, gels and solutions. These products are available from pharmacies without a prescription.

The medications contain different types of substances that stop the growth of the fungus. Products that have been proven to help include the following:

• Shampoo containing selenium sulfide
• Shampoo containing a combination of sulfur and salicylic acid
• Shampoo containing zinc pyrithione
• Solutions and creams containing drugs known as azoles
• Creams containing the drug terbinafine

One difference between the products is how often and for how long they need to be used. Most of them are applied once or twice a day and used for a total of one to four weeks.

If the fungus is killed, the patches go away after a while too. That can take a while, though, even if the skin is healthy again.

Most of the scientific research on these treatments has focused on three azole drugs: ketoconazole, clotrimazole and bifonazole. The researchers looked at whether the fungus was still found on the skin after treatment.

An analysis of the scientific research on ketoconazole, for example, showed the following results after two to four weeks of treatment:

• Without ketoconazole: The fungus was found in about 90 out of 100 people.
• With ketoconazole: The fungus was still found in about 25 out of 100 people.

Some studies tested whether shampoo was more effective than creams or solutions. But no differences were found here. It is not clear whether some drugs are more effective than others. Only terbinafine was found to be somewhat less effective than other drugs.

Topical treatment with shampoo, gels or creams is usually well tolerated. These products sometimes cause side effects such as mild skin irritation. Shampoo containing selenium sulfide may also dry out the skin and smell a bit like sulfur (like rotten eggs).

If a very large area of skin is affected or topical treatment isn’t working, treatment with tablets may be considered. Tablets containing itraconazole are typically used here, and are usually taken for seven days at a dose of 200 mg per day. The tablets have to be prescribed by a doctor.

Tinea versicolor goes away in an estimated 75 out of 100 people who take itraconazole tablets. Because the tablets cause more side effects than topical treatments do, they are normally only used if creams, solutions or shampoo haven’t worked. The side effects of itraconazole include nausea, stomach ache and headache. It can also affect your liver. But because it's not 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 taken as an alternative to itraconazole. It is used for two to four weeks. The possible side effects of oral fluconazole include headaches, nausea, diarrhea and a skin rash.