Tinea Versicolor

Treatment Overview

Products applied to the skin (topical)—creams, shampoos, or solutions—are effective treatments against the fungus that causes tinea versicolor. But if the rash is severe, covers large areas of your body, returns often, or does not get better with topical treatment, you may need antifungal pills. While treatment kills the fungi quickly, the spots may take months to disappear. Your skin color will also need time to return to normal.

Treatment is usually needed to prevent the rash from spreading and to improve the appearance of your skin. But not everyone chooses to get treatment. If left untreated, tinea versicolor may linger until you are 50 or 60 years old, when the skin becomes less oily.

Generally, creams, shampoos, and solutions are thought to be safer than antifungal pills because they mostly affect only your skin. But topical treatments:

• Can be inconvenient and messy.
• May sting and smell bad.
• May be just as expensive as pills.
• Can take a long time to apply, especially if the rash covers a large area of your body.

For these reasons, people may not complete an entire course of treatment, and the rash may return.

Antifungal pills are often given because they are easier to use than the other products. They may also be more effective at curing the rash than topical products.

Healing continues after you have finished all the medicine. But it can take up to 6 months to know how your skin color will look after it heals.

Tinea versicolor is easily treated, but often returns within 1 to 2 years. This may be due to factors that you cannot change, such as your tendency to get the rash. If you tend to get tinea versicolor often, take measures to prevent it from returning.

• Apply an antifungal product to your skin at least once a month. Your dermatologist may recommend using an antifungal as often as once a week.
• Take a prescribed antifungal pill once a month.

Treatment choices

Topical products such as antifungal creams, shampoos, or solutions are effective treatments for tinea versicolor. But if the rash is severe, covers large areas of your body, returns often, or does not get better with topical treatment, antifungal pills may be prescribed.¹

How many times each topical product must be applied and how long it is left on varies. It is very important to closely follow your doctor's recommendations.

Shampoos

Antifungal shampoos are usually easier to apply than some antifungal creams and may cost less when applied to a large area of skin. Antifungal shampoos can be applied to your body as well as to your head.

An antifungal shampoo containing selenium sulfide (2.5%) is available by prescription. Selenium sulfide shampoos (example, Selsun Blue, Head and Shoulders) are also available without a prescription. But nonprescription shampoos may be less effective because they contain only 1% selenium sulfide. Selenium sulfide may irritate your skin.

Antifungal shampoo containing selenium sulfide should be applied once a day over most of your body from the ears to the knees, including the back. It can be rinsed off after 10 minutes. The shampoo should be used daily for 7 to 14 days or longer.

An antifungal shampoo containing ketoconazole (Nizoral) is available in different strengths with or without a prescription. Nonprescription shampoos may be less effective than prescription shampoos.

Other topical products

Antifungal creams and foam solutions are available with or without a prescription. These products can be applied to the body or face once or twice a day for 2 weeks. Examples include:

• Ketoconazole (Nizoral), available with a prescription.
• Clotrimazole (such as Lotrimin), available with or without a prescription in different strengths.
• Terbinafine (Lamisil), available with or without a prescription in different strengths.
• Butenafine (Mentax), available with a prescription.
• Naftifine (Naftin), available with a prescription. Naftifine also comes in a gel.
• Ciclopirox olamine (Loprox), available with a prescription as a cream, gel, or lotion. But it is fairly expensive, and you will need to apply large amounts to affected areas.

Terbinafine (Lamisil) 1% solution can also be used to treat tinea versicolor. Terbinafine is available with a prescription and comes in a pump spray.

Antifungal pills

Antifungal pills may be taken in a single dose or once a day for 5 to 10 days to treat tinea versicolor. The medicine in some antifungal pills comes to the surface of your skin through sweat. So you'll get the best results if you take an antifungal pill, exercise briskly and long enough to sweat, and then wait about 12 hours before you shower.

Antifungal pills available with a prescription include:

• Ketoconazole (Nizoral).
• Fluconazole (Diflucan).
• Itraconazole (Sporanox).

Griseofulvin, an antifungal used to treat other fungal skin infections, is not used to treat tinea versicolor.

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Author:	Maria G. Essig, MS, ELS	Last Updated: November 19, 2007
Medical Review:	Kathleen Romito, MD - Family Medicine Alexander H. Murray, MD, FRCPC - Dermatology
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