Tinea Versicolor

Tinea Versicolor is a very common superficial fungal/yeast infection mainly affecting young people. The yeast organism that is responsible for this disorder is normally found in the hair follicles and sweat glands of most people. However, for uncertain reasons, it is much more prone to overgrow in some individuals. Warm weather (and heat in general) often aids in this overgrowth process, but Tinea Versicolor can be encountered year round. It usually affects the shoulders, back and neck but can be occasionally found on other areas of the body. The rash appears to be brownish, pink or white and is sometimes lightly scaly. Itching is occasionally present.

Treatment

There are a number of treatment approaches and your provider will determine which will work best for your individual case. Several possible options are included below.

1. Oral Ketoconazole or Oral Fluconazole is often used as follows: The patient takes two (2) 200 mg pills (total of 400 mg) at a single dose. He/She then waits about 1-2 hours and then participates in some activity that will generate significant sweat (e.g. playing tennis/basketball, jogging, washing the car etc.). The medicine is preferentially released onto the skin through the sweat glands and hair follicles. Once sweat is on the body, the patient allows the sweat to dry in place and leaves it on overnight. The patient then showers off the following AM. The exact same procedure is done one week later. This will basically eliminate the yeast for an extended time (several months usually). This process works reasonably well even without the sweating/drying aspect, but the sweating/drying element seems to augment the effectiveness. Side effects from either of these meds are rare but can occur. Let your provider know if you experience anything unusual.
2. Topical antifungal/yeast preparations (e.g.Clotrimazole (which is OTC), Econazole, Ketoconazole, Oxistat) can be used as well. The cream is applied twice daily to the involved areas for 3 weeks and as needed thereafter.
3. With any method, a strategy must be utilized to help limit recurrences which are quite common with this entity. Two methods can be employed. One involves once monthly application of Ketoconazole (Nizoral) 2% Shampoo. This can be applied from the neck to the thighs in the shower and left in place for 10 minutes before rinsing off OR it can be applied once monthly at bedtime and left on overnight (rinsing off in the AM).
4. In some patients particularly prone to having multiple, recurrent episodes, oral Fluconazole (Diflucan) can be used TWICE A MONTH to help limit recurrences.
5. Finally, it is important to realize that the yeast involved in Tinea Versicolor tends to “bleach” or lighten the skin color temporarily. It can take weeks to months before your normal skin tone/color returns, but it will once the condition is treated.

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