• 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