Grzybica różowata
Leczenie

Grzybica różowata (Pityriasis versicolor) to powierzchowna infekcja grzybicza warstwy rogowej naskórka wywołana przez Malassezia, manifestująca się hipo- lub hiperpigmentowanymi plamistymi zmianami, głównie na tułowiu. Leczenie pierwszego rzutu opiera się na terapii miejscowej, obejmującej szampony przeciwgrzybicze z siarczkiem selenu (2,25-2,5%, stosowany codziennie przez 7-10 dni, pozostawiany na 10 minut), ketokonazolem (1-2%, codziennie przez 1 tydzień, następnie raz w tygodniu przez miesiąc, pozostawiany 5-15 minut) oraz pirytionianem cynku (1-2%, codziennie przez 5 minut przez 2 tygodnie). Dla mniejszych zmian stosuje się kremy lub żele zawierające azole (np. klotrimazol 1%, 1-2 razy dziennie przez 2-3 tygodnie), terbinafinę (1%, 1-2 razy dziennie przez 1-4 tygodnie) lub ciclopiroks olaminę (1%, 2 razy dziennie przez 2 tygodnie). Leczenie miejscowe cechuje się dobrym profilem bezpieczeństwa, choć może powodować podrażnienia skóry. Czas odpowiedzi wynosi zwykle kilka tygodni, a dłuższa terapia koreluje z wyższym odsetkiem wyleczeń.

  1. Grzybica różowata (Pityriasis versicolor) – leczenie i terapia
    1. Leczenie miejscowe
    2. Leczenie ogólnoustrojowe
    3. Alternatywne metody leczenia
    4. Leczenie w ciąży
    5. Leczenie profilaktyczne
    6. Oczekiwania co do wyników leczenia
    7. Podsumowanie schematów leczenia
    8. Podsumowanie
    9. Kolejne rozdziały

Grzybica różowata (Pityriasis versicolor) – leczenie i terapia

Grzybica różowata (łac. Pityriasis versicolor) to powierzchowna infekcja grzybicza warstwy rogowej naskórka wywołana przez drożdżakopodobne grzyby z rodzaju Malassezia, prowadząca do powstawania hipo- lub hiperpigmentowanych plamistych zmian skórnych, najczęściej zlokalizowanych na tułowiu. Choroba dobrze reaguje na leczenie, jednak charakteryzuje się częstymi nawrotami, co może wymagać zastosowania długoterminowej terapii profilaktycznej.12

Leczenie miejscowe

Terapia miejscowa stanowi pierwszą linię leczenia grzybicy różowatej i obejmuje zarówno niespecyficzne, jak i specyficzne preparaty przeciwgrzybicze.1 Miejscowe leki przeciwgrzybicze są zalecane dla większości pacjentów ze względu na ich skuteczność, lepszy profil bezpieczeństwa (mniej działań niepożądanych, mniej interakcji z innymi lekami) oraz niższy koszt w porównaniu do leczenia ogólnego.12

Szampony przeciwgrzybicze

Jedną z najczęściej stosowanych form miejscowego leczenia grzybicy różowatej są szampony przeciwgrzybicze, które zawierają następujące substancje czynne:12

  • Siarczek selenu (2,25-2,5%) – działa przeciwgrzybiczo głównie poprzez promowanie złuszczania zainfekowanej warstwy rogowej naskórka. Należy nakładać na skórę i pozostawić na 10 minut przed spłukaniem. Zalecany schemat to codzienne stosowanie przez 7-10 dni.12 W opornych przypadkach można stosować na noc.3
  • Ketokonazol (1-2%) – pierwszy szerokospektralny lek przeciwgrzybiczy stosowany w leczeniu grzybic powierzchownych i układowych. Szampon z ketokonazolem jest zwykle lekiem pierwszego wyboru ze względu na łatwość aplikacji i krótki czas leczenia.1 Należy nakładać na zmienione obszary i pozostawić na 5-15 minut przed spłukaniem. Zalecany jest schemat codziennego stosowania przez tydzień, a następnie raz w tygodniu przez miesiąc.12
  • Pirytionian cynku (1-2%) – stosowany codziennie przez 5 minut przez 2 tygodnie.12
Kremy i żele przeciwgrzybicze

W przypadku zajęcia mniejszych obszarów skóry można stosować preparaty w postaci kremów lub żeli, które zawierają m.in.:12

  • Azole (klotrimazol 1%, ekonazol, mikonazol, oksykonazol) – działają fungistatycznie poprzez hamowanie cytochromu P450-zależnej syntezy ergosterolu. Należy aplikować 1-2 razy dziennie przez 2-3 tygodnie.12
  • Terbinafina (1%) – allilomina hamująca epoksydazę skwalenu, przez co blokuje biosyntezę steroli i zmienia integralność błony komórkowej grzyba. Stosuje się 1-2 razy dziennie przez 1-4 tygodnie.12
  • Ciclopirox olamine (1%) – pochodna hydroksypirydonu o szerokim spektrum działania przeciwgrzybiczego, przeciwbakteryjnego i przeciwzapalnego. Aplikuje się 2 razy dziennie przez 2 tygodnie.12

Miejscowe leczenie jest zazwyczaj dobrze tolerowane, choć może powodować podrażnienie skóry lub kontaktowe zapalenie skóry. Czas odpowiedzi na leczenie wynosi zwykle kilka tygodni, a dłuższy czas leczenia koreluje z wyższym odsetkiem wyleczeń.1

Leczenie ogólnoustrojowe

Leczenie ogólnoustrojowe (doustne) jest zazwyczaj zarezerwowane dla pacjentów z grzybicą różowatą oporną na leczenie miejscowe, nawracającą często lub dla przypadków, gdzie zastosowanie terapii miejscowej jest utrudnione ze względu na rozległe zajęcie skóry.12 Doustne leki przeciwgrzybicze, choć skuteczne w leczeniu różnych infekcji, mogą być związane z poważnymi działaniami niepożądanymi, dlatego są uważane za leczenie drugiego rzutu.1

Preferowanymi doustnymi lekami przeciwgrzybiczymi dla pacjentów wymagających leczenia ogólnego są:12

  • Flukonazol – triazol przeciwgrzybiczy hamujący cytochrom P450-zależną syntezę ergosterolu podobnie jak itrakonazol i ketokonazol. Badania wykazały, że flukonazol jest równie skuteczny lub bardziej skuteczny niż doustny ketokonazol w leczeniu grzybicy różowatej.1 Zalecany schemat to 300 mg raz w tygodniu przez 2-4 tygodnie.12 Należy stosować ostrożnie u pacjentów z zaburzeniami czynności wątroby.1
  • Itrakonazol – triazol przeciwgrzybiczy wpływający na czynność komórek grzybów podobnie jak ketokonazol, poprzez hamowanie cytochromu P450-zależnej syntezy ergosterolu. Standardowy schemat leczenia to 200 mg dziennie przez 7 dni.12 Kapsułki należy przyjmować bezpośrednio po posiłku w celu maksymalnej absorpcji. Nie zaleca się stosowania u pacjentów z aktywną lub przewlekłą chorobą wątroby.1

Należy unikać stosowania doustnego ketokonazolu w leczeniu grzybicy różowatej ze względu na obawy dotyczące bezpieczeństwa. Obecnie nie jest on zalecany w leczeniu grzybic powierzchownych w Kanadzie, USA ani Europie.1 Również doustna terbinafina nie jest skuteczna w leczeniu grzybicy różowatej i nie powinna być stosowana.12

Doustne leki przeciwgrzybicze należy stosować ostrożnie, unikając ich w przypadku wywiadu w kierunku niewydolności serca lub niewydolności wątroby. Istnieje ryzyko ostrej niewydolności wątroby przy stosowaniu doustnych leków przeciwgrzybiczych. Leki doustne nie powinny być stosowane w okresie ciąży lub karmienia piersią.1

Alternatywne metody leczenia

W literaturze opisano również alternatywne metody leczenia grzybicy różowatej, które mogą być rozważane jako leczenie drugiego lub trzeciego rzutu, zwłaszcza w przypadkach opornych na standardową terapię:12

  • Fototerapia wąskopasmowa UVB – badania wykazały, że może być skuteczną metodą leczenia nawracającej grzybicy różowatej i sugerują jej stosowanie u pacjentów z niewystarczającą odpowiedzią na miejscowe i/lub doustne leki przeciwgrzybicze.1
  • Terapia fotodynamiczna z wykorzystaniem kwasu 5-aminolewulinowego lub błękitu metylenowego.1
  • Laser ekscymerowy 308 nm.1
  • Inhibitory kalcyneuryny – badania wykazały skuteczność takrolimusu w leczeniu grzybicy różowatej.1

Leczenie w ciąży

Leczenie grzybicy różowatej podczas ciąży wymaga stosowania wyłącznie preparatów miejscowych. Ciclopirox i klotrimazol 1% zostały uznane za bezpieczne i skuteczne w czasie ciąży.1 W przypadku bardzo małych obszarów zajętej skóry lub w ciąży można stosować kremy przeciwgrzybicze z grupy imidazoli, takie jak klotrimazol.1

Należy unikać stosowania azoli doustnych (i wszystkich doustnych leków z tej grupy) w ciąży.1

Leczenie profilaktyczne

Grzybica różowata charakteryzuje się wysokim wskaźnikiem nawrotów, który może sięgać nawet 80%.1 Nawroty są szczególnie częste podczas ciepłych i wilgotnych miesięcy.1 W związku z tym leczenie profilaktyczne jest często niezbędne, aby zapobiec nawrotom choroby.1

Strategie profilaktyczne mogą obejmować:12

  • Regularne stosowanie szamponów przeciwgrzybiczych – np. szampon z ketokonazolem lub siarczkiem selenu stosowany raz na 2-4 tygodnie może zmniejszyć częstość nawrotów.1
  • Profilaktyczne stosowanie szamponu z ketokonazolem raz dziennie przez 3 dni przed ekspozycją na ciepłe lub wilgotne środowisko.1
  • Okresowe przyjmowanie doustnych leków przeciwgrzybiczych – dla osób z częstymi nawrotami, np. flukonazol w schemacie jeden dzień w miesiącu.1
  • Stosowanie mydeł zawierających pirytionian cynku (np. Vanicream Z-Bar lub DermaZinc Zinc Therapy Soap), ketokonazol (Nizoral) lub siarczek selenu (Selsun Blue) – może pomóc zapobiec przyszłym infekcjom i przerostowi drożdżaków.1

U osób ze skłonnością do częstych nawrotów lekarz może zalecić przyjmowanie leków przeciwgrzybiczych w miesiącach letnich, kiedy grzybica różowata częściej nawraca.1

Oczekiwania co do wyników leczenia

Po skutecznym leczeniu grzybicy różowatej należy mieć na uwadze kilka istotnych aspektów:12

  • Zmiany w zabarwieniu skóry (hipo- lub hiperpigmentacja) mogą utrzymywać się przez kilka tygodni lub miesięcy po zakończeniu leczenia, mimo eliminacji grzyba. Skóra z czasem powróci do swojego normalnego koloru.12
  • Nawroty choroby są powszechne, zwłaszcza w ciepłych i wilgotnych warunkach klimatycznych, co może wymagać powtórzenia leczenia.1
  • Regularne stosowanie leczenia profilaktycznego jest często konieczne, aby zapobiec nawrotom.1

Pacjenci powinni być poinformowani, że grzybica różowata jest spowodowana przez grzyby normalnie występujące na powierzchni skóry i dlatego nie jest uważana za chorobę zakaźną. Choroba nie pozostawia trwałych blizn ani zmian pigmentacyjnych.1

Podsumowanie schematów leczenia

Lek Postać Dawkowanie Czas trwania terapii Uwagi
Ketokonazol Szampon 2% Raz dziennie 1-5 dni, następnie raz w tygodniu przez miesiąc Pozostawić na skórze na 5-15 minut przed spłukaniem
Siarczek selenu Szampon 2,25-2,5% Raz dziennie 7-10 dni Pozostawić na skórze na 10 minut przed spłukaniem
Pirytionian cynku Szampon 1% Raz dziennie 5 minut dziennie przez 2 tygodnie Można stosować profilaktycznie
Klotrimazol Krem 1% 2 razy dziennie 2-3 tygodnie Dla mniejszych obszarów skóry
Terbinafina Krem 1% 1-2 razy dziennie 1-4 tygodnie Dla mniejszych obszarów skóry
Ciclopirox Krem 1% 2 razy dziennie 2 tygodnie Alternatywa dla azoli
Flukonazol Tabletki doustne 300 mg raz w tygodniu 1-3 tygodnie Dla rozległej lub opornej choroby
Itrakonazol Kapsułki doustne 200 mg dziennie 7 dni Przyjmować po posiłku

Podsumowanie

Grzybica różowata zazwyczaj dobrze odpowiada na leczenie, ale nawroty są powszechne i mogą wymagać długoterminowej terapii profilaktycznej.1 Miejscowe leki przeciwgrzybicze stanowią pierwszą linię leczenia, a doustne leki przeciwgrzybicze są zarezerwowane dla rozległej lub opornej choroby.1

Przeglądy systematyczne i metaanalizy potwierdzają, że zarówno miejscowa, jak i doustna terapia przeciwgrzybicza jest lepsza od leczenia placebo, jednak nie ma wystarczających danych, aby ocenić skuteczność jednego leczenia w porównaniu do innego.2

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

  1. 09.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Pityriasis versicolor – Symptoms, diagnosis and treatment | BMJ Best Practice US
    https://bestpractice.bmj.com/topics/en-us/861
    Pityriasis versicolor is a superficial fungal infection of the stratum corneum, due to dimorphic yeasts of the genus Malassezia, leading to hypo- or hyperpigmented macular lesions on seborrheic areas of the trunk. […] Easily treated with either topical medications, including zinc pyrithione shampoo, selenium sulfide shampoo, or azole-class topical antifungal creams. More extensive disease may require systemic therapy with antifungal drugs. […] Recurrence of the disease is common, and prophylactic treatment with selenium shampoo and, for more extensive disease, systemic therapy with antifungal drugs may be necessary.
  • #1 Pityriasis Versicolor—A Narrative Review on the Diagnosis and Management
    https://www.mdpi.com/2075-1729/13/10/2097
    Topical therapies are the primary treatment for PV, encompassing non-specific antifungal agents like sulphur with salicylic acid, selenium sulphide 2.5%, and zinc pyrithione. Additionally, specific topical antifungal medications with either fungicidal or fungistatic properties may also be incorporated into the topical treatment regimen, such as imidazoles, allylamines, and ciclopirox olamine. […] Systemic therapies might occasionally be used. Patient education and the promotion of good personal hygiene are pivotal to reduce the risk of recurrence. In recurrent cases, particularly during warmer and more humid periods, prolonged prophylaxis with topical agents should be considered. […] Topical therapy is the treatment of choice for PV, including both specific and non-specific antifungal medications. Topical treatment durations for PV can span from a few days up to 4 weeks. Oral medications are utilised as a second-line treatment for extensive, severe, unresponsive, or recurrent disease.
  • #1 Tinea versicolor: an updated review – Drugs in Context
    https://www.drugsincontext.com/tinea-versicolor-an-updated-review/
    Most patients with tinea versicolor respond to topical antifungal therapy, which has a better safety profile (fewer adverse events, fewer drug interactions) and lower cost compared to systemic treatment and is therefore the treatment of choice. […] Oral antifungal therapy is typically reserved for patients with extensive disease, frequent recurrences or disease that is refractory to topical therapy. […] Long-term intermittent prophylactic therapy should be considered for patients with frequent recurrence of the disease. […] Selection of antifungal agents depends on several factors, including efficacy, safety, local availability, ease of administration, likelihood of compliance and potential drug interactions of the antifungal agent.
  • #1 Antifungal Treatment for Pityriasis Versicolor
    https://pmc.ncbi.nlm.nih.gov/articles/PMC5770013/
    Topical antifungal medications are the first-line treatment for PV, including zinc pyrithione, ketoconazole, and terbinafine. […] In cases of severe or recalcitrant PV, the oral antifungal medications itraconazole and fluconazole may be more appropriate, with pramiconazole a possible future option. […] Oral terbinafine is not effective in treating PV and oral ketoconazole should no longer be prescribed. […] Effective topical treatment for PV includes creams, lotions, and shampoos. […] Non-specific treatments shown to be effective in treating PV include selenium sulphide (lotion, cream, or shampoo), zinc pyrithione, propylene glycol, and Whitfields ointment. […] There are multiple topical medications, such as bifonazole, clotrimazole, and miconazole, that have direct fungistatic activity and are shown to be effective in treating PV.
  • #1 Tinea Versicolor Treatment & Management: Medical Care, Diet, Long-Term Monitoring
    https://emedicine.medscape.com/article/1091575-treatment
    Patients should be informed that tinea versicolor is caused by a fungus that is normally present on the skin surface and is therefore not considered contagious. The condition does not leave any permanent scar or pigmentary changes, and any skin color alterations resolve within 1-2 months after treatment has been initiated. Recurrence is common, and prophylactic therapy may help reduce the high rate of recurrence. […] Tinea versicolor can be successfully treated with various agents. First-line treatment includes topical agents include selenium sulfide, zinc-pyrithione, sodium sulfacetamide, ciclopirox olamine, tacrolimus, as well as azole and allylamine antifungals. […] Various regimens can be used. Selenium sulfide lotion is liberally applied to affected areas of the skin daily for 2 weeks; each application is allowed to remain on the skin for at least 10 minutes prior to being washed off. In resistant cases, overnight application can be helpful. Topical azole antifungals can be applied every night for 2 weeks. Weekly application of any of the topical agents for the following few months may help prevent recurrence.
  • #1 Tinea versicolor (pityriasis versicolor) – UpToDate
    https://www.uptodate.com/contents/tinea-versicolor-pityriasis-versicolor/print
    Tinea versicolor typically responds well to therapy, but recurrence is common and long-term prophylactic therapy may be necessary. […] Topical therapy is the treatment of choice. Oral therapy is generally reserved for scenarios in which adequate application of topical therapy is not feasible and for refractory or recurrent disease. […] High-quality comparative studies of treatments for tinea versicolor are limited, making the optimal approach to treatment unclear. […] Topical azole antifungal drugs have direct antifungal activity and are considered effective for tinea versicolor. […] Topical azole antifungal drugs are available in a variety of formulations, including shampoos, creams, foams, gels, and solutions. […] We frequently treat with ketoconazole 2% shampoo because of ease of application and the short course of treatment.
  • #1 Pityriasis Versicolor: Symptoms and Treatment | Doctor
    https://patient.info/doctor/pityriasis-versicolor-pro
    Pityriasis versicolor should be treated initially with topical antifungals, especially topical imidazoles – eg, clotrimazole, miconazole, econazole and ketoconazole in various formulations (creams or shampoos). […] Ketoconazole shampoo is usually first-line and should be applied on to affected areas and made into a lather; it should then be left for five to fifteen minutes before washing off. This should be repeated daily for a week and then weekly for a month. […] Selenium shampoo can be used as an alternative although unlicensed for this indication. It should be diluted with water (to reduce the likelihood of irritation), applied to affected areas for ten minutes and then rinsed off. This should be repeated daily for seven to ten days. This is contra-indicated in pregnancy. […] If very small areas are involved, or in pregnancy, antifungal imidazole creams such as clotrimazole may be used as an alternative. The cream should be applied twice a day for two to three weeks.
  • #1 Tinea Versicolor – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK482500/
    Pityriasis versicolor, or tinea versicolor, is a common, benign, superficial fungal skin infection. This activity reviews the evaluation and management of pityriasis versicolor and highlights the role of interprofessional team members in collaborating to provide well-coordinated care and enhance patient outcomes. […] Implement evidence-based treatment modalities for tinea versicolor. […] Medical treatment is effective for tinea versicolor; however, the condition often returns, so preventive medicine may be essential over a more extended period. […] Topical medications are the first-line therapy for tinea versicolor. Ketoconazole, 2% shampoo, is highly effective. […] Other acceptable topical alternatives are: selenium sulfide 2.25% to 2.5% shampoo or lotion applied for 10 minutes daily for 1 week, topical 1% terbinafine once or twice daily from 1 to 4 weeks, ciclopirox 1% applied twice daily for 2 weeks, zinc pyrithione 1% daily for 5 minutes for 2 weeks.
  • #1 Antifungal Treatment for Pityriasis Versicolor
    https://pmc.ncbi.nlm.nih.gov/articles/PMC5770013/
    Ketoconazole, an imidazole, was the first broad-spectrum antifungal used in the treatment of superficial and systemic mycoses. […] Multiple formulations have proved effective in treating PV, including cream, shampoo, and foam, with the most common regimen being once daily application of cream or foam for 14 days. […] Ketoconazole cream has been shown to be as effective as 1% clotrimazole and 1% terbinafine cream. […] Terbinafine acts by inhibiting squalene epoxidase, thereby blocking sterol biosynthesis and altering fungal cell membrane integrity. […] Oral, or systemic, antifungals are effective in treating a variety of infections, but can be associated with serious adverse events. […] Use of oral antifungals to treat PV are considered second line treatment and used for recalcitrant or severe infections.
  • #1 Tinea Versicolor (pityriasis versicolor) – Dermatology Advisor
    https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/tinea-versicolor-pityriasis-versicolor/
    3%-6% salicylic acid preparations, apply overnight for 1 to 2 weeks; usually effective but may be irritating. […] Typically, treatment is initiated with one of the topical modalities. The antifungal creams or the shampoos are roughly equally effective and the choice may be based on patient preference. Longer durations of treatment correlate with higher cure rates. […] Treatments are generally well tolerated but may cause skin irritation or contact dermatitis. Response to treatment should be within weeks. The eruption may recur and may be retreated in the same fashion. […] Any of the oral antifungal agents noted above are usually effective, but are used as second- or third-line treatment options because of the potential for hepatotoxicity (low) and concern regarding interactions with other drugs.
  • #1 Tinea versicolor (pityriasis versicolor) – UpToDate
    https://www.uptodate.com/contents/tinea-versicolor-pityriasis-versicolor
    Oral fluconazole and oral itraconazole are the preferred antifungal therapies for patients who require oral treatment. […] Various regimens for fluconazole have been utilized. […] Our preferred fluconazole regimen for tinea versicolor in adults is a single 300 mg dose taken once weekly for two weeks. […] Oral itraconazole is a reasonable alternative. […] Oral antifungal drugs to avoid include oral terbinafine, oral griseofulvin, and oral ketoconazole due to safety concerns. […] Additional topical therapies have been used for the treatment of tinea versicolor. […] Prophylactic therapy is an option for patients who experience frequent recurrences of tinea versicolor, particularly during warm seasons.
  • #1 Antifungal Treatment for Pityriasis Versicolor
    https://pmc.ncbi.nlm.nih.gov/articles/PMC5770013/
    Ketoconazole, once the gold standard for oral treatment of fungal infections, is no longer suggested for treatment of superficial mycoses, including PV, in Canada, the US, or Europe. […] Newer antifungals have been shown to have similar efficacy as oral ketoconazole in treating PV. […] Today, oral treatments include itraconazole, fluconazole, and pramiconazole. […] Itraconazole, a triazole antifungal, alters fungal cell function similarly to ketoconazole, through inhibition of cytochrome P450-dependent ergosterol synthesis. […] A 7-day course of treatment is the standard regimen for itraconazole. […] Fluconazole is a triazole antifungal, inhibiting cytochrome P450-dependent ergosterol synthesis similarly to itraconazole and ketoconazole. […] Studies have shown that fluconazole is equivalent to, or more effective than, oral ketoconazole in treating PV.
  • #1 Tinea Versicolor – Dermatologic Disorders – Merck Manual Professional Edition
    https://www.merckmanuals.com/professional/dermatologic-disorders/fungal-skin-infections/tinea-versicolor
    Tinea versicolor is skin infection with Malassezia furfur that manifests as multiple asymptomatic scaly patches varying in color from white to tan to brown to pink. […] Treatment is with topical or sometimes oral antifungals. […] Treatment of tinea versicolor is any topical antifungal. Examples include selenium sulfide shampoo 2.5% applied to the skin (in 10-minute applications daily for 1 week or 24-hour applications weekly for 1 month); topical azoles (eg, ketoconazole 2% daily for 2 weeks); and daily bathing with pyrithione zinc soap 2% or sodium thiosulfate/salicylic acid shampoo 2% applied to the skin for 1 to 2 weeks. […] Fluconazole 150 mg/week orally for 2 to 4 weeks is indicated for patients with extensive disease and those with frequent recurrences. […] Recurrence is almost universal after treatment because the causative organism is a normal skin inhabitant. Fastidious hygiene, regular use of pyrithione zinc soap, or once-monthly use of topical antifungal therapy lowers the likelihood of recurrence. […] Treat with topical or oral antifungals.
  • #1 Pityriasis versicolor / Tinea versicolor
    https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/skin-soft-tissue/pityriasis-versicolor-tinea-versicolor/
    For smaller areas. […] Pityriasis versicolor: 2nd choice options (Adults) […] Oral therapy is reserved for patients with disease refractory to topical therapy or widespread disease that makes the application of topical therapy difficult. […] Fluconazole* (for extensive disease) […] 300mg once weekly […] 1-3 weeks […] Use with caution in patients with hepatic dysfunction. […] Avoid fluconazole (and all oral azoles) in pregnancy. […] Itraconazole** (for resistant disease or second line treatment) […] 200mg every 24 hours […] 7 days […] Capsules should be taken immediately after a meal for maximal absorption. […] Not recommended in patients with active or chronic liver disease.
  • #1 Pityriasis Versicolor: Symptoms and Treatment | Doctor
    https://patient.info/doctor/pityriasis-versicolor-pro
    In widespread or resistant cases, prescribe itraconazole 200 mg daily for seven days (although terbinafine is active against dermatophytes (eg, tinea), it actually has little effect on yeast infections). Alternatively, fluconazole may be used – 50 mg daily for two to four weeks, or 300-400 mg weekly for one to three weeks. […] Oral treatments should be avoided with a history of heart failure or liver failure. There is a risk of acute liver failure with use of oral antifungal treatments. Oral treatments should not be used if pregnant or breastfeeding. […] Patients should be advised that it can take several months for the skin colour to return to normal. […] Antifungal treatment should be repeated when the scaly component of pityriasis versicolor recurs. […] Recurrences of pityriasis versicolor are common.
  • #1 Pityriasis Versicolor—A Narrative Review on the Diagnosis and Management
    https://www.mdpi.com/2075-1729/13/10/2097
    Managing PV during pregnancy requires topical treatments. Ciclopirox and 1% clotrimazole have been found to be safe and efficacious during pregnancy. […] A practical problem associated with the use of topical medications is the difficulty in applying the creams on large body surfaces. […] Considering the oral medications, only azolic drugs play a role. Itraconazole and fluconazole are preferred, whereas oral ketoconazole is no longer recommended, due to its unfavourable safety profile. […] In cases of resistant or persistent infection, a combination of oral and topical therapy might be considered. […] Narrow-band ultraviolet phototherapy appears to be a promising alternative as a second- or third-line therapy in PV. […] The recurrence rate is high (up to 80%), with a higher morbidity noted among the individuals with a positive family history of PV. […] Prolonged prophylaxis with topical agents should be considered in recurrent cases, especially during warmer and more humid months.
  • #1 Tinea Versicolor Treatment & Management: Medical Care, Diet, Long-Term Monitoring
    https://emedicine.medscape.com/article/1091575-treatment
    Second-line oral therapy with systemic antifungals is effective for tinea versicolor. Oral therapy can be used with topical regimens. Off-label use of fluconazole or itraconazole are the preferred oral agents. […] Oral therapy does not prevent the high rate of recurrence, and treatment with an oral or topical agent may need to be repeated intermittently throughout the year. […] Reports describe successful treatment of tinea versicolor with photodynamic therapy. A single study presented narrowband ultraviolet B phototherapy as an effective treatment method for recurrent tinea versicolor and suggests it for use in patients with inadequate response to topical and/or oral antifungals. […] Dietary alterations have not proved successful in the treatment of tinea versicolor. […] Tinea versicolor has a high rate of recurrence, and prophylactic treatment with topical or oral therapy on an intermittent basis is necessary to prevent recurrences in most cases.
  • #1 Tinea Versicolor – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK482500/
    Oral therapy is reserved for patients with tinea versicolor resistant to topical treatment or with widespread disease that makes topical drug application problematic. […] The preferred oral agents are itraconazole 200 mg daily for seven days and fluconazole 300 mg weekly for 2 weeks. […] Patients with recurrent tinea versicolor, particularly immunocompromised individuals, can prevent recurrences with topical or oral preventive therapy, especially during warm temperatures. […] A limited number of studies have demonstrated the efficacy of the 308-nm excimer laser, narrow-band ultraviolet UV-B phototherapy, 5-5-aminolevulinic acid- and methylene blue photodynamic therapy in treating tinea versicolor. […] Oral and topical antifungal agents are effective; however, disease recurrence is common and may impact a patient’s quality of life.
  • #1
    https://link.springer.com/article/10.1007/s12281-018-0328-7
    This study paves the use of calcineurin inhibitors as alternatives in the treatment of pityriasis versicolor. […] Comparative efficacy of topical application of tacrolimus and clotrimazole in the treatment of pityriasis versicolor: a single blind, randomized clinical trial. […] Successful treatment of pityriasis versicolor with 5-aminolevulinic acid photodynamic therapy. […] Treatment of pityriasis versicolor with photodynamic therapy. […] Narrow-band UV-B phototherapy: an effective and reliable treatment alternative for extensive and recurrent pityriasis versicolor.
  • #1 Tinea Versicolor: Symptoms, Causes & Treatments
    https://my.clevelandclinic.org/health/diseases/17719-tinea-versicolor
    If your symptoms are severe, your healthcare provider may also prescribe oral antifungals such as: Fluconazole (Diflucan), Itraconazole (Onmel or Sporanox). […] There are several options for treating tinea versicolor yourself. The most common (and economical) is using a dandruff shampoo containing selenium. […] Healthcare providers dont recommend most natural or at-home remedies because their effects arent well studied. […] Tinea versicolor is generally easy to treat. Your skin may stay lighter or darker for several weeks or months, but it should return to its usual color eventually. Mild cases of tinea versicolor respond well to over-the-counter treatments, but some people need stronger medication from their healthcare provider. Tinea versicolor can return, especially in the summer months. Some people may need to use medication several times a year to manage skin discoloration.
  • #1 Pityriasis Versicolor (Tinea Versicolor): Causes, Symptoms, and Treatment
    https://patient.info/skin-conditions/pityriasis-versicolor-tinea-versicolor
    If you are prone to develop recurrent episodes in the sun then it may be advisable to use ketoconazole shampoo once a day for three days prior to going on holiday to the sun. This will help to prevent recurrence when you are away. […] Note: after treatment, skin colour usually takes 2-3 months to return to normal. It sometimes takes even longer. As long as the rash is not scaly, this does not mean the treatment has not worked. […] One option is to apply one of the above shampoos to your skin every 2-4 weeks. This may keep the germ away, or prevent the numbers building up, which will prevent the rash from recurring. Alternatively, if you have frequent recurrences then you may be advised to take antifungal tablets for one day each month as a preventative measure.
  • #1 Pityriasis Versicolor: Symptoms and Treatment | Doctor
    https://patient.info/doctor/pityriasis-versicolor-pro
    For those who are prone to develop recurrent episodes in warm or humid environments, they can be advised to use ketoconazole shampoo prophylactically once a day for three days prior to any exposure. […] Ketoconazole or selenium sulfide shampoo may be applied for five to ten minutes one to four times monthly for those who have frequent recurrences.
  • #1 Tinea Versicolor: Symptoms, Causes & Treatments
    https://my.clevelandclinic.org/health/diseases/17719-tinea-versicolor
    If you have a history of tinea versicolor, your healthcare provider may recommend you use soap containing zinc pyrithione (like Vanicream Z-Bar or DermaZinc Zinc Therapy Soap), ketoconazole (Nizoral) or selenium sulfide (Selsun Blue). This type of soap may help prevent future infections and yeast overgrowth. Your healthcare provider may also recommend using prescriptions medications during summer months when tinea versicolor is more likely to return. […] Using medicated soap a couple of times each week or month can reduce recurrences of tinea versicolor. […] Tinea versicolor can be a nuisance and make you feel insecure. Luckily, the discoloration it creates on your skin is highly treatable with over-the-counter antifungal creams or shampoos. Using them daily for several weeks can help you manage the infection. Your healthcare provider can also prescribe stronger antifungal medications for more severe tinea versicolor or recurring infections.
  • #1 Pityriasis versicolor
    https://www2.hse.ie/conditions/pityriasis-versicolor/
    Pityriasis versicolor can be treated with antifungal medicines. These are available as shampoos, creams and tablets. […] Antifungal shampoos are often the first treatment recommended for pityriasis versicolor. […] They are available to buy over the counter from pharmacies, or your GP can prescribe them. […] Lather the antifungal shampoo on the affected area and leave it for 5 to 10 minutes before rinsing. You may need to repeat this every day for 5 to 7 days. […] If only small areas of skin are affected, your GP may prescribe an antifungal cream. […] If a large area of skin is affected or other treatments have not helped, you may be prescribed antifungal tablets. […] After treatment, it can take several weeks or months for your skin to return to its normal colour. In more serious cases, treatment may need to be repeated. […] It’s common for pityriasis versicolor to come back after treatment. […] But you can reduce the risk of it coming back by regularly using antifungal shampoos. […] Your GP may prescribe antifungal tablets to take a few times a month to stop it coming back.
  • #1 Pityriasis versicolor. Tinea versicolor
    https://dermnetnz.org/topics/pityriasis-versicolor
    Reapplication of a topical treatment such as selenium sulfide shampoo every month once the rash has cleared will usually prevent recurrence. […] Pityriasis versicolor generally clears satisfactorily with treatment but often recurs when conditions are right for malassezia to proliferate. Regular use of topical treatment minimises this risk.
  • #1 Antifungal Treatment for Pityriasis Versicolor
    https://www.mdpi.com/2309-608X/1/1/13
    Fluconazole is a triazole antifungal, inhibiting cytochrome P450-dependent ergosterol synthesis similarly to itraconazole and ketoconazole. […] Pramiconazole is a relatively new triazole that disrupts ergosterol synthesis in fungal cells. […] PV is one of the most common cutaneous dermatologic conditions worldwide. […] Topical therapy is the first line of treatment for PV and may include selenium sulphide, zinc pyrithione, ketoconazole, and terbinafine. […] When topical treatment is not feasible or desired, itraconazole and fluconazole are viable options, with pramiconazole a potential new therapy. […] Systematic reviews and meta-analyses confirm that both topical and oral antifungal therapy is superior to placebo treatment; however, there is not sufficient data to assess the efficacy of one treatment over another.
  • #2 Pityriasis versicolor – Symptoms, diagnosis and treatment | BMJ Best Practice
    https://bestpractice.bmj.com/topics/en-gb/861
    Pityriasis versicolor is a superficial fungal infection of the stratum corneum, due to dimorphic yeasts of the genus Malassezia, leading to hypo- or hyperpigmented macular lesions on seborrhoeic areas of the trunk. […] Easily treated with either topical medications, including zinc pyrithione shampoo, selenium sulfide shampoo, or azole-class topical antifungal creams. More extensive disease may require systemic therapy with antifungal drugs. […] Recurrence of the disease is common, and prophylactic treatment with selenium shampoo and, for more extensive disease, systemic therapy with antifungal drugs may be necessary.
  • #2 Tinea versicolor (pityriasis versicolor) – UpToDate
    https://www.uptodate.com/contents/tinea-versicolor-pityriasis-versicolor
    Tinea versicolor typically responds well to therapy, but recurrence is common and long-term prophylactic therapy may be necessary. […] For most patients with tinea versicolor, we suggest treatment with a topical azole antifungal drug, topical terbinafine, or topical selenium sulfide, rather than other therapies. […] Topical azole antifungal drugs have direct antifungal activity and are considered effective for tinea versicolor. […] Topical azole antifungal drugs are available in a variety of formulations, including shampoos, creams, foams, gels, and solutions. […] Topical terbinafine is an allylamine antifungal drug. […] Topical selenium sulfide exerts antifungal activity primarily through the promotion of shedding of the infected stratum corneum. […] Oral antifungal therapy is typically reserved for tinea versicolor that is refractory to topical therapy, recurs frequently, or is associated with a scenario in which adequate application of topical therapy is not feasible.
  • #2 Pityriasis versicolor / Tinea versicolor
    https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/skin-soft-tissue/pityriasis-versicolor-tinea-versicolor/
    Pityriasis versicolor responds well to medical therapy, but recurrence is common and prophylactic therapy sometimes may be necessary. […] After treatment, skin might not go back to its normal colour for several months. This does not mean the treatment didn’t work. It just takes time for the skin to heal. […] Pityriasis versicolor: 1st choice options […] Ketoconazole 2% shampoo […] Once every 24 hours […] 1-5 days […] Leave preparation on for 35 minutes before rinsing. […] Selenium sulphide shampoo (Selsun) […] Once every 24 hours […] 7 days […] Apply to the affected area and leave on for 10 minutes before rinsing off. […] Clotrimazole 1% cream […] Every 8 to 12 hours […] 7-14 days […] For smaller areas. […] Terbinafine 1% cream […] Every 12 to 24 hours […] 14 days
  • #2 Pityriasis Versicolor: Symptoms and Treatment | Doctor
    https://patient.info/doctor/pityriasis-versicolor-pro
    Pityriasis versicolor should be treated initially with topical antifungals, especially topical imidazoles – eg, clotrimazole, miconazole, econazole and ketoconazole in various formulations (creams or shampoos). […] Ketoconazole shampoo is usually first-line and should be applied on to affected areas and made into a lather; it should then be left for five to fifteen minutes before washing off. This should be repeated daily for a week and then weekly for a month. […] Selenium shampoo can be used as an alternative although unlicensed for this indication. It should be diluted with water (to reduce the likelihood of irritation), applied to affected areas for ten minutes and then rinsed off. This should be repeated daily for seven to ten days. This is contra-indicated in pregnancy. […] If very small areas are involved, or in pregnancy, antifungal imidazole creams such as clotrimazole may be used as an alternative. The cream should be applied twice a day for two to three weeks.
  • #2 Pityriasis versicolor. Tinea versicolor
    https://dermnetnz.org/topics/pityriasis-versicolor
    Mild pityriasis versicolor is treated with topical antifungal agents. […] Selenium sulfide shampoo […] Topical azole cream/shampoo (econazole, ketoconazole) […] Terbinafine gel. […] The medicine should be applied widely to the skin from the jawline down and left on the skin for 5-15 minutes before rinsing off in the shower. This should be done daily for one week then weekly for one month. […] Oral antifungal agents, itraconazole and fluconazole, are used to treat pityriasis versicolor when extensive or if topical agents have failed. […] Vigorous exercise an hour after taking the medication may help sweat it onto the skin surface, where it can effectively eradicate the yeast. Bathing should be avoided for a few hours. A few days’ treatment will clear many cases of pityriasis long term, or at least for several months.
  • #2 Tinea Versicolor: Symptoms, Causes & Treatments
    https://my.clevelandclinic.org/health/diseases/17719-tinea-versicolor
    If you have a history of tinea versicolor, your healthcare provider may recommend you use soap containing zinc pyrithione (like Vanicream Z-Bar or DermaZinc Zinc Therapy Soap), ketoconazole (Nizoral) or selenium sulfide (Selsun Blue). This type of soap may help prevent future infections and yeast overgrowth. Your healthcare provider may also recommend using prescriptions medications during summer months when tinea versicolor is more likely to return. […] Using medicated soap a couple of times each week or month can reduce recurrences of tinea versicolor. […] Tinea versicolor can be a nuisance and make you feel insecure. Luckily, the discoloration it creates on your skin is highly treatable with over-the-counter antifungal creams or shampoos. Using them daily for several weeks can help you manage the infection. Your healthcare provider can also prescribe stronger antifungal medications for more severe tinea versicolor or recurring infections.
  • #2 Pityriasis Versicolor (Tinea Versicolor): Causes, Symptoms, and Treatment
    https://patient.info/skin-conditions/pityriasis-versicolor-tinea-versicolor
    Selenium sulfide shampoo: This is an alternative treatment. It is not strictly licensed for the treatment of this rash; however, it works. You can buy it from pharmacies or it is also available on prescription. Apply the shampoo to the affected areas and leave to dry for ten minutes and then rinse off. This should be repeated daily for a week. […] Antifungal creams: These may be used if only a very small area of skin is affected. Clotrimazole (Canesten) cream is one example. It should be applied twice a day for two or three weeks. […] Antifungal tablets: Antifungal tablets may very occasionally be prescribed if the rash is over a large area of your skin, or is not cleared by the above treatments. The ones used are usually itraconazole or fluconazole. […] Antifungal treatment may need to be repeated if this rash comes back (recurs) and becomes scaly again.
  • #2 Antifungal Treatment for Pityriasis Versicolor
    https://pmc.ncbi.nlm.nih.gov/articles/PMC5770013/
    Ketoconazole, an imidazole, was the first broad-spectrum antifungal used in the treatment of superficial and systemic mycoses. […] Multiple formulations have proved effective in treating PV, including cream, shampoo, and foam, with the most common regimen being once daily application of cream or foam for 14 days. […] Ketoconazole cream has been shown to be as effective as 1% clotrimazole and 1% terbinafine cream. […] Terbinafine acts by inhibiting squalene epoxidase, thereby blocking sterol biosynthesis and altering fungal cell membrane integrity. […] Oral, or systemic, antifungals are effective in treating a variety of infections, but can be associated with serious adverse events. […] Use of oral antifungals to treat PV are considered second line treatment and used for recalcitrant or severe infections.
  • #2 Tinea Versicolor – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK482500/
    Pityriasis versicolor, or tinea versicolor, is a common, benign, superficial fungal skin infection. This activity reviews the evaluation and management of pityriasis versicolor and highlights the role of interprofessional team members in collaborating to provide well-coordinated care and enhance patient outcomes. […] Implement evidence-based treatment modalities for tinea versicolor. […] Medical treatment is effective for tinea versicolor; however, the condition often returns, so preventive medicine may be essential over a more extended period. […] Topical medications are the first-line therapy for tinea versicolor. Ketoconazole, 2% shampoo, is highly effective. […] Other acceptable topical alternatives are: selenium sulfide 2.25% to 2.5% shampoo or lotion applied for 10 minutes daily for 1 week, topical 1% terbinafine once or twice daily from 1 to 4 weeks, ciclopirox 1% applied twice daily for 2 weeks, zinc pyrithione 1% daily for 5 minutes for 2 weeks.
  • #2 Pityriasis Versicolor—A Narrative Review on the Diagnosis and Management
    https://www.mdpi.com/2075-1729/13/10/2097
    Three main drug classes are topically used in PV: imidazoles, allylamines and ciclopirox olamine. […] Imidazoles exhibit a fungistatic action via the inhibition of lanosterol 14-α-demethylase in the ergosterol synthesis pathway. […] Allylamines act via ergosterol synthesis inhibition at the squalene epoxidase level, which results in the simultaneous intracellular toxicity of accumulated squalene and the fungistatic loss of ergosterol. […] Ciclopirox olamine is a hydroxypyridone derivative, being a broad-spectrum antifungal, antibacterial, and anti-inflammatory agent. […] Non-specific antifungal topicals (e.g., selenium sulphide 2.5%, zinc pyrithione, propylene glycol, sulphur combined with salicylic acid) can be used to eliminate dead corneocytes and thwart further infection in the stratum corneum.
  • #2 Pityriasis versicolor / Tinea versicolor
    https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/skin-soft-tissue/pityriasis-versicolor-tinea-versicolor/
    For smaller areas. […] Pityriasis versicolor: 2nd choice options (Adults) […] Oral therapy is reserved for patients with disease refractory to topical therapy or widespread disease that makes the application of topical therapy difficult. […] Fluconazole* (for extensive disease) […] 300mg once weekly […] 1-3 weeks […] Use with caution in patients with hepatic dysfunction. […] Avoid fluconazole (and all oral azoles) in pregnancy. […] Itraconazole** (for resistant disease or second line treatment) […] 200mg every 24 hours […] 7 days […] Capsules should be taken immediately after a meal for maximal absorption. […] Not recommended in patients with active or chronic liver disease.
  • #2 Tinea Versicolor – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK482500/
    Oral therapy is reserved for patients with tinea versicolor resistant to topical treatment or with widespread disease that makes topical drug application problematic. […] The preferred oral agents are itraconazole 200 mg daily for seven days and fluconazole 300 mg weekly for 2 weeks. […] Patients with recurrent tinea versicolor, particularly immunocompromised individuals, can prevent recurrences with topical or oral preventive therapy, especially during warm temperatures. […] A limited number of studies have demonstrated the efficacy of the 308-nm excimer laser, narrow-band ultraviolet UV-B phototherapy, 5-5-aminolevulinic acid- and methylene blue photodynamic therapy in treating tinea versicolor. […] Oral and topical antifungal agents are effective; however, disease recurrence is common and may impact a patient’s quality of life.
  • #2 Tinea versicolor (pityriasis versicolor) – UpToDate
    https://www.uptodate.com/contents/tinea-versicolor-pityriasis-versicolor
    Oral fluconazole and oral itraconazole are the preferred antifungal therapies for patients who require oral treatment. […] Various regimens for fluconazole have been utilized. […] Our preferred fluconazole regimen for tinea versicolor in adults is a single 300 mg dose taken once weekly for two weeks. […] Oral itraconazole is a reasonable alternative. […] Oral antifungal drugs to avoid include oral terbinafine, oral griseofulvin, and oral ketoconazole due to safety concerns. […] Additional topical therapies have been used for the treatment of tinea versicolor. […] Prophylactic therapy is an option for patients who experience frequent recurrences of tinea versicolor, particularly during warm seasons.
  • #2 Pityriasis Versicolor: Symptoms and Treatment | Doctor
    https://patient.info/doctor/pityriasis-versicolor-pro
    In widespread or resistant cases, prescribe itraconazole 200 mg daily for seven days (although terbinafine is active against dermatophytes (eg, tinea), it actually has little effect on yeast infections). Alternatively, fluconazole may be used – 50 mg daily for two to four weeks, or 300-400 mg weekly for one to three weeks. […] Oral treatments should be avoided with a history of heart failure or liver failure. There is a risk of acute liver failure with use of oral antifungal treatments. Oral treatments should not be used if pregnant or breastfeeding. […] Patients should be advised that it can take several months for the skin colour to return to normal. […] Antifungal treatment should be repeated when the scaly component of pityriasis versicolor recurs. […] Recurrences of pityriasis versicolor are common.
  • #2
    https://link.springer.com/article/10.1007/s12281-018-0328-7
    This study paves the use of calcineurin inhibitors as alternatives in the treatment of pityriasis versicolor. […] Comparative efficacy of topical application of tacrolimus and clotrimazole in the treatment of pityriasis versicolor: a single blind, randomized clinical trial. […] Successful treatment of pityriasis versicolor with 5-aminolevulinic acid photodynamic therapy. […] Treatment of pityriasis versicolor with photodynamic therapy. […] Narrow-band UV-B phototherapy: an effective and reliable treatment alternative for extensive and recurrent pityriasis versicolor.
  • #2 Tinea versicolor: Diagnosis and treatment
    https://www.aad.org/public/diseases/a-z/tinea-versicolor-treatment
    Anti-fungal pills: A dermatologist may prescribe these pills if the tinea versicolor covers a large area of the body, is thick, or often returns after it is treated. These pills are taken for a short time. During this time, your dermatologist will monitor you. […] With treatment, the yeast is easy to kill. However, the skin may stay lighter (or darker) for weeks or months. The skin will eventually return to its normal color. […] Tinea versicolor can return. When the air outdoors is warm and humid, the yeast can quickly grow out of control. Some people who live in a tropical climate may need to use a medicated cleanser year round to prevent the yeast from overgrowing. People who live in an area that becomes warm and moist each spring may see tinea versicolor return every year.
  • #2 Pityriasis versicolor | nidirect
    https://www.nidirect.gov.uk/conditions/pityriasis-versicolor
    Pityriasis versicolor can be treated with antifungal medicines. These are available as shampoos, creams and tablets. Your GP will help you decide what treatment is best for you. […] Antifungal shampoos are often the first treatment recommended for pityriasis versicolor. […] If only small areas of skin are affected, your GP may prescribe an antifungal cream. […] If a large area of skin is affected or other treatments haven’t helped, you may be prescribed antifungal tablets by your GP. […] Overall, antifungal shampoos, creams and tablets are effective in killing the yeast that causes pityriasis versicolor. […] It’s common for pityriasis versicolor to come back after treatment. […] If you develop pityriasis versicolor again after treatment, you can try treating it yourself with antifungal shampoo or see your GP for advice and alternative treatments. […] If you have frequent and severe episodes of pityriasis versicolor, your GP may consider prescribing antifungal tablets to take a few times a month to prevent the condition recurring.
  • #2 Pityriasis Versicolor (Tinea Versicolor): Causes, Symptoms, and Treatment
    https://patient.info/skin-conditions/pityriasis-versicolor-tinea-versicolor
    If you are prone to develop recurrent episodes in the sun then it may be advisable to use ketoconazole shampoo once a day for three days prior to going on holiday to the sun. This will help to prevent recurrence when you are away. […] Note: after treatment, skin colour usually takes 2-3 months to return to normal. It sometimes takes even longer. As long as the rash is not scaly, this does not mean the treatment has not worked. […] One option is to apply one of the above shampoos to your skin every 2-4 weeks. This may keep the germ away, or prevent the numbers building up, which will prevent the rash from recurring. Alternatively, if you have frequent recurrences then you may be advised to take antifungal tablets for one day each month as a preventative measure.
  • #2 Antifungal Treatment for Pityriasis Versicolor
    https://www.mdpi.com/2309-608X/1/1/13
    Fluconazole is a triazole antifungal, inhibiting cytochrome P450-dependent ergosterol synthesis similarly to itraconazole and ketoconazole. […] Pramiconazole is a relatively new triazole that disrupts ergosterol synthesis in fungal cells. […] PV is one of the most common cutaneous dermatologic conditions worldwide. […] Topical therapy is the first line of treatment for PV and may include selenium sulphide, zinc pyrithione, ketoconazole, and terbinafine. […] When topical treatment is not feasible or desired, itraconazole and fluconazole are viable options, with pramiconazole a potential new therapy. […] Systematic reviews and meta-analyses confirm that both topical and oral antifungal therapy is superior to placebo treatment; however, there is not sufficient data to assess the efficacy of one treatment over another.
  • #3 Tinea Versicolor Treatment & Management: Medical Care, Diet, Long-Term Monitoring
    https://emedicine.medscape.com/article/1091575-treatment
    Patients should be informed that tinea versicolor is caused by a fungus that is normally present on the skin surface and is therefore not considered contagious. The condition does not leave any permanent scar or pigmentary changes, and any skin color alterations resolve within 1-2 months after treatment has been initiated. Recurrence is common, and prophylactic therapy may help reduce the high rate of recurrence. […] Tinea versicolor can be successfully treated with various agents. First-line treatment includes topical agents include selenium sulfide, zinc-pyrithione, sodium sulfacetamide, ciclopirox olamine, tacrolimus, as well as azole and allylamine antifungals. […] Various regimens can be used. Selenium sulfide lotion is liberally applied to affected areas of the skin daily for 2 weeks; each application is allowed to remain on the skin for at least 10 minutes prior to being washed off. In resistant cases, overnight application can be helpful. Topical azole antifungals can be applied every night for 2 weeks. Weekly application of any of the topical agents for the following few months may help prevent recurrence.

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