pityriasis%20(tinea)%20versicolor
PITYRIASIS (TINEA) VERSICOLOR
Pityriasis (Tinea) versicolor is a fungal infection caused by Malassezia furfur. It is benign, superficial, and localized to the stratum corneum.
It may present as chronic or recurrent infection and may occur in healthy individuals.
It is more common in summer than winter months.
It presents with multiple well-demarcated macules or patches and finely scaled plaques with hypopigmentation or hyperpigmentation, hence the term "versicolor".
Lesions are usually found on the upper trunk, chest, back and shoulders, and may extend toward the neck, face and arms.

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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