Pityriasis%20(tinea)%20versicolor Treatment

Treatment

Pharmacotherapy

Treatment is usually effective but may have to be repeated due to recurrence of infection in susceptible individuals
- Prophylactic treatment is recommended for patients at risk of recurrence on exposure to sunlight or warm humid conditions

Skin discoloration may take several weeks to resolve after complete treatment
- If mycology is negative, persisting pale patches do not necessarily warrant additional treatment

Topical agents can be very effective & are safer than systemic medications, especially in children

Initial Therapy

May use Selenium sulfide or Ketoconazole shampoo
Antifungal cream is advised for small areas of skin involvement
- Imidazole creams may be used in both children & adults

If initial therapy fails, confirm adherence to treatment
- May consider repeat topical treatment before starting systemic therapy
Other topical agents such as Whitfield ointment, Sulfur-Salicylic acid shampoo, Propylene glycol, & Benzoyl peroxide may be considered but patient should be informed about possible adverse effects prior to use

Topical Antifungals

Used as initial treatment
Desirable properties: High efficacy, favorable adverse effects profile, fewest possible daily applications, shortest duration of therapy, low relapse rate & cost-effectiveness
Ciclopirox
- Topical application is proven effective when used twice daily for 2 weeks
Terbinafine
- Efficacy of topical application is comparable & may even surpass effect of imidazoles against tinea infections
Selenium sulfide & Zinc pyrithione
- Proven to be effective & safe; inexpensive for 1st-line therapy
- May be used as maintenance regimen (apply on the 1st and 3rd day of each month and leave on for 5 minutes before rinsing)
Imidazoles
- Highly effective, safe & fairly inexpensive
Combined steroid/imidazole agents
- High-potency steroid combination is not indicated for treating Pityriasis (tinea) versicolor due to the absence of significant inflammation in this condition & the potential of the steroid component to induce atrophy

Oral Antifungals

Indicated in cases of severe or widespread skin involvement, recurrent infections, & failure of topical therapy

Systemic Therapy

Indicated in cases of severe or widespread skin involvement, recurrent infections, & failure of topical therapy
Oral antifungal agents Itraconazole & Fluconazole are preferred
Oral Itraconazole is also used for prophylaxis of recurrences

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