Tinea Versicolor Treatments and Medications

You find a discolored spot on your skin. It's bigger than a mole but not inflamed like a rash. Soon, several other spots form around it. What are you dealing with? Your first thoughts might take you back to a day at the beach or an afternoon bike ride, but don't shake your fist at the sun just yet. In some cases, patches of skin discoloration are a result of the fungus-induced tinea versicolor instead. And if you're unsure what that entails, don't worry—this guide will cover everything you need to know, from diagnosis to treatments to home remedies.

What is tinea versicolor?

Tinea versicolor (AKA pityriasis versicolor) is a fungal skin infection caused by an overabundance of Malassezia furfur, a natural yeast that lives on the surface of your skin. Normally, Malassezia is innocuous, but in large quantities, it can cause skin discoloration. Appearing as white, pink, red, or brown patches commonly on the trunk, shoulders, and/or upper arms, tinea versicolor might look worrisome, but it's actually quite harmless (other than its appearance) and there are numerous topical, oral, and natural treatments available.

Because Malassezia is part of your natural skin flora and it often clears up with basic home or over-the-counter antifungal treatments, there's little cause for concern. However, even after successfully treating the infection, skin discoloration caused by tinea versicolor can linger for weeks or months.

How is tinea versicolor diagnosed?

Tinea versicolor appears across skin colors, genders, and age groups. That said, there are certain risk factors that can make you more susceptible. Warm and humid weather, for example, is more conducive to Malassezia growth, as tinea versicolor has a 50% prevalence rate in tropical countries, compared to a 1.1% rate in cold climates. It also thrives on sweaty or oily skin, so adolescents and young adults are often at a higher risk.

Other than skin discoloration, pityriasis versicolor is asymptomatic. Even though it's technically a rash, it doesn't often itch, burn, or crack like other skin diseases. It's characterized by patches that are lighter (hypopigmented) or darker (hyperpigmented) than the surrounding skin. These patches might also be dry and/or scaly. Given this distinct manifestation, a dermatologist can usually diagnose it on sight. Marie V. Hayag, MD, a board-certified dermatologist in New York City, gathers contextual information by asking questions like:

• How long have you had it?

• Has it been recurring?

• Do you sweat a lot?

• Do you live in a hot climate?

• Have you had hormonal changes?

• Are you immunocompromised?

• Have you tried treating the rash? With what?

This information is usually plenty, but sometimes the condition can look similar to vitiligo, psoriasis, ringworm, or eczema. So, if your healthcare provider has any doubt, sending skin scrapings for further analysis can yield more definite results. During this test, your dermatologist will "scrape some of the scales and look under the microscope for the classic 'spaghetti and meatballs' presentation," says Tanya Kormeili, MD, a board-certified dermatologist in Santa Monica. "In general, TV starts off as pink to salmon-colored, scaled dots that leave your skin spotted white. This is because TV produces azelaic acid, a natural skin bleaching agent."

Tinea versicolor treatment options

It can be unsettling to see discoloration spreading, but the good news is that there are numerous treatments that can halt its progression. The best option depends on your infection’s severity and location. According to the American Academy of Dermatology (AAD), when determining an appropriate treatment, dermatologists will consider "where the tinea versicolor appears on your body, how much skin has tinea versicolor, how thick the spots have grown, and the climate."

Quite often, all it takes to treat a case of pityriasis versicolor is an over-the-counter lotion, antifungal cream, or shampoo. In more severe cases or ones that cover a large area, prescription topical or oral antifungals might be necessary. Because Malassezia occurs naturally, these treatments primarily work to manage its levels, and there's always a chance that they could go out of balance again. It's not uncommon to see tinea versicolor disappear only to return down the road. Fortunately, it will not cause permanent scarring, pigment changes, or other damage.

Tinea versicolor medications

If you're looking to eradicate a bout of tinea versicolor, which medications will do the job? Because it's a superficial fungal infection, your best bets are antifungal medications.

Antifungal creams

Creams are the most common treatment option because they're accessible, affordable, and effective. You're likely familiar with Lotrimin (clotrimazole) and Lamisil (terbinafine), which are widely available over-the-counter and by prescription. There are several other topical antifungal options, commonly referenced as "azoles," like ketoconazole, econazole, and miconazole. When applied regularly to the affected area, these creams can weaken fungal cell membranes and prevent their growth. Sometimes, they can further irritate your skin, causing itching, burning, and redness, although these cases are rare.

Oral antifungals

Many dermatologists will recommend topical medications as the first option for the treatment of tinea versicolor. But when creams and lotions fail, what's next? Oral antifungals can be another, more intensive approach. Lotrimin and Lamisil offer oral options, but your healthcare provider might also prescribe Diflucan (fluconazole) or Sporanox (itraconazole). While taking one of these, you may experience nausea, vomiting, upset stomach, or headache.

Medicated shampoo

Believe it or not, dandruff is from the same fungal family as tinea versicolor, so washing the affected areas with dandruff shampoos can help control the Malassezia accumulation. Selenium sulfide shampoos like Selsun Blue or ones containing zinc pyrithione like Head & Shoulders are great options. While it may control your condition, using these shampoos can also dry out and irritate your skin as a side effect.

What is the best medication for tinea versicolor?

Every person has different skin, so it's less about finding the "best" overall medication and more about finding the best medication for a specific individual. This is based entirely on the condition severity, medical history, current health, and other medications. Consult a healthcare provider and/or dermatologist to find out which treatment is best.

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What is the best medication for tinea versicolor?