Dermatology A to Z
What causes tinea versicolor?
Tinea versicolor is a harmless skin disorder caused by a yeast living on normal skin. Usually this yeast, which is present on everyone’s skin, grows sparsely and is not visible. In some individuals, it grows more actively. This causes slightly scaling patches on the trunk, neck, or arms known as tinea versicolor. On untanned skin, tinea versicolor rash is a pink to coppery tan. On tanned skin, the tinea versicolor patches are lighter, since tanning doesn’t occur in the rash areas. The failure to tan is temporary; the skin tans normally after the rash has cleared up.
Tinea versicolor is not contagious. Tinea versicolor is more common in hot, humid climates and often comes back in the summertime. A person who has tinea versicolor will commonly get recurrent outbreaks each summer.
Selsun Lotion: Treatment with one overnight application of selenium sulfide (Selsun) suspension is usually effective. Individuals with sensitive skin should only leave the medication on 15-20 minutes instead of overnight. At bedtime, massage the medicine thoroughly into the affected areas. Spread the medicine over large areas: if you have spots on your chest, apply medicine to your entire trunk. (chest, back and abdomen)from the knees to the neck. The next morning, wash off all the medicine in the shower. Usually a single treatment will make tinea versicolor gradually disappear over the next few weeks. I favor two treatments one week apart. If you still have the rash (new areas appearing) after one month, repeat the treatment once. If the rash hasn’t gone away one month after this second treatment, please come to the clinic for re-evaluation.
Selsun Blue Shampoo: Selenium sulfide is the active ingredient in this shampoo. Develop a good lather over the trunk and affected areas in the shower and leave on the skin for 5 minutes before washing off. Do this daily for one week if an active infection is evident. To prevent further outbreaks, use in the shower weekly during spring and summer and monthly in the fall and winter.
Nizoral Shampoo: The active ingredient is ketoconazole, which is used in pill form for extensive tinea versicolor. This shampoo is used in a similar manner as Selsun Blue.
Other Topical Agents: Other antifungal creams and ointments can be used but are difficult to apply over large areas and more expensive. Lamisil is available over-the-counter and is quite successful in treating tinea versicolor.
Oral Agents: For widespread or resistant cases, oral ketoconazole is given. One dose is taken on day one and the same dose is repeated seven days later. The pill is taken in the morning before activity. Activity which induces sweating (the drug is excreted in the sweat onto the skin) should then be performed. The sweat should remain on the skin throughout the day (do not shower, swim or bath until the evening).
Prophylactic Treatment: Individuals who have tinea versicolor are subject to recurrences. Some people find it simpler to use Selsun or Nizoral once or twice a month than to wait for the lesions to appear. If this is your first episode of tinea versicolor, you might just wait and see what happens after initial treatment. If you have already had several outbreaks, try using Selsun or Nizoral once or twice a month whether you notice lesions or not. Most physicians say it is not a matter of if tinea versicolor will recur, but when and how often.