Tinea Versicolor Treatment: Medication, Therapy, and More

Tinea versicolor is a common skin infection caused by a fungus called Malassezia.

Many people have this fungus naturally growing on their skin, but an overgrowth may cause small, scaly patches of discoloration on your skin.

You can treat tinea versicolor with antifungal treatments, with options available over the counter at pharmacies and as prescriptions.

Antifungal medications can eliminate the fungal growth from tinea versicolor.

Depending on the amount of tinea versicolor on your skin, you may be able to treat it with over-the-counter (OTC) products. Other times, you may need to see a healthcare provider, such as a dermatologist, for prescription treatment. 

Over-The-Counter (OTC)

Two types of OTC products can treat mild tinea versicolor—medicated cleansers sold as anti-dandruff shampoos and antifungal creams. 

• Medicated cleansers: Research has found tinea versicolor can be treated with anti-dandruff shampoos containing selenium sulfide, zinc pyrithione, and ketoconazole. Lather and apply the shampoo like a body wash, leaving them on for several minutes before rinsing off. Do this once daily for seven days, then follow up with your healthcare provider if you still have symptoms.
• Antifungal creams: Some OTC antifungal creams, meant to treat other fungal infections like vaginal yeast infections, athlete’s foot, and jock itch, can also treat tinea versicolor. Apply medicated creams with clotrimazole or miconazole to the affected areas at night, rinsing off the next day in the shower. You may need to do this daily for at least two weeks to see results.

These treatments are safe to use when you follow the specific product instructions.

Medicated cleansers for dandruff can cause mild side effects like dryness and skin irritation with repeated use, and you should avoid contact with your eyes. The most common side effect of antifungal creams is skin irritation. Stop using it if you experience blistering, burning, itching, or redness.

Prescription

If OTC treatments don’t help, ask your healthcare provider about prescription medications. These fall into two categories: prescription-strength topicals and oral antifungals.

Prescription-strength topical treatments: Creams and cleansers are very effective against tinea versicolor. If you need a stronger dosage than available OTC options, your provider may prescribe a shampoo containing selenium sulfide, zinc pyrithione, or ketoconazole. They may also opt for a cream with a stronger clotrimazole or miconazole dose.

Other effective topical treatments, like Lamisil (terbinafine) and ciclopirox, are only available by prescription. They should be used the same way as OTC treatments and generally have the same side effects.

Oral antifungal tablets: For people who don’t respond to topical cleansers or creams, oral antifungal medications may be an option. They may also be used when tinea versicolor is too widespread for topical treatment alone. The most common oral antifungals prescribed are itraconazole and fluconazole, taken once daily for 1-2 weeks.

While generally safe, some people shouldn’t take oral antifungals, including people with heart disease, chronic kidney disease, or liver disease. Side effects like upset stomach, headache, skin rash, or itching can also occur.

The only therapy that may help treat tinea versicolor is phototherapy or ultraviolet light. Phototherapy isn’t commonly used as a treatment because it hasn’t been widely studied and is less accessible. 

One study found ultraviolet-B (UVB) phototherapy to be a safe and effective treatment. However, the number of people in the study was small. 

Consider phototherapy if your tinea versicolor hasn’t improved with medications. It’s generally safe, though common side effects of UVB phototherapy include short-term skin inflammation, burning, and swelling, long-term effects such as wrinkling and premature signs of aging, and basal and squamous cell skin cancers.

Tinea versicolor doesn’t cause permanent injury or damage to your skin, though it can become a chronic problem if left untreated. Some people even experience hair loss where the patches develop. It isn’t contagious and doesn’t affect your life expectancy.

Tinea versicolor is easy to treat, but it can be stubborn. The discoloration may linger after the fungus has been removed. Many people find their symptoms return year after year whenever the weather gets warm (or after returning to activities that trigger symptoms, like sunbathing or working out in tight-fitting clothing).

Some people have tinea versicolor once and never again after treatment, but many experience it regularly. If tinea versicolor returns every time you’re exposed to triggering conditions, there are ways to try to prevent it. Here are some things to consider:

Avoid Your Triggers

People generally notice that their symptoms worsen in the summer months (or in tropical climates) because warm environments can lead to fungal growth. Sweating while exercising or using oil-based skincare products also can trigger it.

You can’t control the weather or climate, but you can keep the areas of your skin typically affected by tinea versicolor cool and dry. Likewise, if heavy or oily skincare products cause tinea versicolor for you, switch to lighter ones.

Cover Your Skin

Sun exposure can make tinea versicolor more noticeable. Keeping your skin covered with light clothing can minimize its appearance. Wearing loose-fitting clothing also reduces the amount of heat and moisture on your skin and prevents fungi from growing.

Ask a Healthcare Provider About Preventive Treatments

Some people prevent tinea versicolor by pretreating their skin with medication when they know the fungus may grow. Your healthcare provider may recommend using a medicated treatment of choice each time the weather gets warmer or even year-round if you live in a hot, humid climate.

Others avoid recurring overgrowth by treating their tinea versicolor once a month for six months. Your provider can recommend the best way to prevent recurrent tinea versicolor based on your symptoms, triggers, and climate.