Whether over the counter or prescription, tinea versicolor treatments come in two basic forms: topical or oral. Topical applications for tinea versicolor are available in both prescription and over-the-counter (OTC) antifungal creams or shampoos. Oral applications are available by prescription only.
A fungal infection, tinea versicolor is caused by a yeast known as Malassezia furfur, which is found in normal adult skin. It presents as a light or dark discoloration of the skin. Areas of discoloration most commonly appear on the shoulders, back, and chest. Sometimes patches appear under the breasts, in the groin area, or the underarms.
This kind of infection mainly affects adolescents and young adults, and it can become more visible in high humidity or in cases where immune or hormone abnormalities are present. Tinea versicolor is not contagious, although it does often recur within one to two years. Once treated, discoloration can take from several weeks to six months to fade away.
There are several OTC tinea versicolor treatments, including 1% topical cream solutions such as clotrimazole or miconazole, which are applied twice a day for 10-14 days, as well as 1% shampoo solutions that are used daily. Topical creams usually come in smaller tubes and are less effective on larger areas. Shampoos containing 1% selenium sulfide such as Selsun Blue® are also available, but they can be irritating and may miss hard to reach spots. Antifungal creams and shampoos are also available in 2.5% prescription strength, although the same problems listed above still apply. Topical treatments are considered safer than antifungal pills because they only affect the skin.
Antifungal pills, however, are considered much easier tinea versicolor treatments. Three different prescription-strength medications are available: ketoconazole, itraconazole, and fluconazole. Ketoconazole (brand name Nizoral®) usually only takes a single dose. Itraconazole (brand name Sporanox®) is taken in five daily doses, and the dosage for Fluconazole (brand name Diflucan®) varies depending on the severity of the fungal infection. As with any medication, there are potential drug interactions, so patients need to tell their doctor about any medications they are on.
While tinea versicolor treatments get rid of the fungus, they may not get rid of the skin discoloration immediately. Brown patches may disperse quickly within a few days to weeks. Lighter patches may take up to six months to even out. Skin discoloration caused by tinea versicolor is not permanent.