Skin Health Fungal, Bacterial & Viral Infections Best Treatments for Tinea Versicolor Skin Infection By Heather L. Brannon, MD Heather L. Brannon, MD, is a family practice physician in Mauldin, South Carolina. She has been in practice for over 20 years. Learn about our editorial process Heather L. Brannon, MD Medically reviewed by Medically reviewed by Casey Gallagher, MD on October 28, 2019 Casey Gallagher, MD, is board-certified in dermatology. He is a clinical professor at the University of Colorado in Denver, and co-founder and practicing dermatologist at the Boulder Valley Center for Dermatology in Colorado. His research has been published in the New England Journal of Medicine. Learn about our Medical Review Board Casey Gallagher, MD Updated on September 17, 2020 Print Table of Contents View All Table of Contents Symptoms Causes Treatment Prognosis If you have been diagnosed or believe you may have the fungal skin infection tinea versicolor, what treatments are available? Which therapies are most effective and how can you and your doctor make the choice about which treatment is best for you? Verywell / JR Bee Tinea Versicolor Symptoms Tinea versicolor is a common fungal skin infection which produces a characteristic rash. It is also known as pityriasis versicolor and is frequently confused with other skin rashes. While the rash is most common during adolescence and early adulthood, it can occur at any age. The rash usually appears as velvety hypopigmented (less pigment) or hyperpigmented macules (spots that are not raised) or plaques. The rash usually becomes much more visible with tanning. It is most common on the trunk, face, and shoulders and does not usually itch (though it can for some people). This photo contains content that some people may find graphic or disturbing. See Photo Pityriasis versicolor white. DermNet / CC BY-NC-ND This photo contains content that some people may find graphic or disturbing. See Photo Pityriasis versicolor pink. DermNet / CC BY-NC-ND This photo contains content that some people may find graphic or disturbing. See Photo Pityriasis versicolor brown. DermNet / CC BY-NC-ND Causes Tinea versicolor is caused by "yeast-like" fungi, Malassezia. The pathogenic fungus works by turning off the melanin-producing cells in the skin (the melanocytes). Since tinea versicolor is related to the overgrowth of normal (and even protective) fungi on the skin, it is not contagious. A skin scraping and stain can reveal the characteristic yeast under the microscope (which appears like spaghetti and meatballs). Treatment Options There are several different treatment approaches for getting rid of the tinea versicolor rash. Because the yeast inhabits the top layer of the skin, the epidermis, topical anti-fungal medications tend to be very effective, at least early on or during the first occurrence of the infection. If the rash is extensive, oral anti-fungal medications may be needed. Let's look at these different treatments individually. Because tinea versicolor has a recurrence rate of 80%, many people require repeat treatment or maintenance treatment to prevent the rash. Topical Antifungals Topical antifungal medications are the treatment of choice for tinea versicolor. A number of topical anti-fungal treatment regimens have been shown to produce a greater than 70% clinical response rate. This includes prescribing patients 2% Nizoral (ketoconazole) cream or foam to be applied once daily for 14 days. Alternatively, using a 2% ketoconazole shampoo regimen (lathered over affected and surrounding areas and left on for at least five minutes before rinsing) also helps when applied once daily for three consecutive days. In addition, 1% Lamisil (terbinafine) solution applied twice daily for one week has proven to be effective, as has a 1% Lotrimin (clotrimazole) solution applied once daily for one week. Oral Antifungals Oral anti-fungal medications can cause side effects such as nausea or reversible liver damage, but these side effects are uncommon with the short courses of therapy used for tinea versicolor. Oral griseofulvin and oral terbinafine are not effective treatments for tinea versicolor, and the oral ketoconazole should no longer be prescribed, but a variety of other oral treatments such as fluconazole have been shown to be effective. Dandruff Shampoos Until recently, dandruff shampoos were the mainstay of treatment for tinea versicolor. They are less effective than the anti-fungal medications and can cause skin irritation, but they are available over-the-counter and are less expensive. A number of regimens have been shown to be effective. This includes sulfur salicylic acid shampoo applied nightly as a lotion for one week or a zinc-pyrithione shampoo regimen (applied daily as a lotion and left on for five minutes before rinsing) for two weeks. In addition, Selsun Blue (selenium sulfide) 2.5% lotion regimen (applied daily as a lotion and left on for 10 minutes before rinsing) for one week has proven effective. How Long Does Tinea Versicolor Last? Tinea versicolor often responds readily to treatment, though recurrence is very likely as noted earlier. While the spots (macules) usually resolve shortly, the changes in pigmentation may take much longer to resolve as the melanocytes need to begin producing melanin again. A Word From Verywell If you have tinea versicolor, consult your doctor about the variety of treatment options available to you. You and your doctor can discuss the best treatment based on the extent of your rash, how long it has been present, and if it has recurred. Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Bamford JTM, Flores‐Genuino RNS, Ray S, et al. Interventions for the treatment of pityriasis versicolor. Cochrane Database Syst Rev. 2018;2018(6):CD011208. doi:10.1002/14651858.CD011208.pub2 Thayikkannu AB, Kindo AJ, Veeraraghavan M. Malassezia-can it be ignored?. Indian J Dermatol. 2015;60(4):332-9. doi:10.4103/0019-5154.160475 Gupta AK, Lyons DC. Pityriasis versicolor: an update on pharmacological treatment options. Expert Opin Pharmacother. 2014;15(12):1707-13. doi:10.1517/14656566.2014.931373 Gupta AK, Foley KA. Antifungal treatment for pityriasis versicolor. J Fungi (Basel). 2015;1(1):13-29. doi:10.3390/jof1010013 Additional Reading Weller, Richard P. J. B., Hamish J.A. Hunter, and Margaret W. Mann. Clinical Dermatology. Chichester (West Sussex): John Wiley & Sons Inc., 2015. Print.