# Tinea Versicolor (Pityriasis versicolor) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: BAD Guidelines for Tinea Versicolor 2014 · Nizoral 2% Shampoo SmPC section 4.2 (eMC product 1510) · Egyptian National Drug Formulary, antimicrobial 2023, selenium sulfide monograph, tinea versicolor - Verified date: 2026-08 ## Verified against - Nizoral 2% Shampoo SmPC section 4.2 (eMC product 1510) - Egyptian National Drug Formulary, antimicrobial 2023, selenium sulfide monograph, tinea versicolor ## Treatment metadata - Ketoconazole — topical - Selenium sulfide — topical ## Complete treatment card ```text TINEA VERSICOLOR (PITYRIASIS VERSICOLOR) Sources: BAD Guidelines for Tinea Versicolor 2014 · Nizoral 2% Shampoo SmPC section 4.2 (eMC product 1510) · Egyptian National Drug Formulary, antimicrobial 2023, selenium sulfide monograph, tinea versicolor Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (1) - Lesions are usually painless or mildly itchy, though itching can become severe in hot, humid weather [itching] SIGNS - what you find (7) - Lesions appear as multiple sharply bordered, oval, finely scaly patches that may be lighter, darker, or reddish, sometimes merging together [scaling] - Scale is often not obvious until the skin is stretched or scraped, which brings it out, known as the evoked scale sign - Lesions favor the upper trunk and upper arms, with facial involvement more common in children - An inverse form favors skin folds, the face, or isolated limb areas and is most common in immunocompromised patients - A follicular form on the back, torso, and limbs affects hair follicles, causing lighter or darker skin around them - A papular form shows uniform reddish-brown bumps about 2 to 3 mm across, usually painless and on the torso [papules] - A rare atrophying variant produces oval, reddish or ivory lesions with a wrinkled surface, often linked to prolonged topical steroid use TESTS (5) - Diagnosis can often be made from the characteristic appearance alone, without further testing - Dermoscopy typically shows fine scale and a contrast halo ring around the lesion - KOH microscopy gives a definitive diagnosis, showing grape-like clusters of yeast plus long hyphae - A stain such as methylene blue or ink blue can be added to the KOH prep to improve visibility since KOH alone lacks color contrast - Culturing the causative Malassezia yeast is difficult because it needs fastidious growth conditions IF NOT THIS - what else fits (11) - Seborrheic dermatitis tends to be more red with thicker scale and also involves the scalp, eyebrows, and nasolabial folds - Pityriasis rosea shows a collarette of scale in a fir-tree pattern on the trunk, usually preceded by a larger herald patch - Erythrasma affects the armpits or groin and glows coral-red under Wood's lamp, unlike tinea versicolor - Pityriasis alba does not fluoresce under Wood's lamp and mainly affects children with a history of atopic dermatitis - Secondary syphilis frequently involves the palms and soles, unlike tinea versicolor - Tinea corporis by definition spares the feet, groin, face, scalp hair, and beard hair - Vitiligo causes complete depigmentation, whereas tinea versicolor only causes partial lightening - Confluent and reticulated papillomatosis shows scaly hyperpigmented macules merging into a net-like pattern on the neck, between the breasts, or upper back - Guttate psoriasis produces small, inflamed, drop-shaped scaling plaques on the trunk and upper arms, often after a strep infection - Mycosis fungoides can present as hypopigmented patches on the trunk and limbs, most often in people with darker skin - Terra firma-forme dermatosis affects the neck or ankle and, unlike tinea versicolor, wipes off with an alcohol swab Source StatPearls "Tinea Versicolor" - disease-level clinical article Status traced to the source above 1. KETOCONAZOLE [1st line] Adult Apply 2% shampoo once daily for 5 days (leave on 5 min before rinsing), or 2% cream 1-2 times daily for 2-3 weeks x 5 days (shampoo); 2-3 weeks (cream) Peds Children >=12 years: apply shampoo once daily for 5 days Source Nizoral 2% Shampoo SmPC section 4.2 (eMC product 1510) Why Topical azole antifungal active against the lipophilic yeast Malassezia furfur that causes pityriasis versicolor; clears the causative organism, though the resulting skin discolouration takes months to normalise afterward. Caution Caused by lipophilic yeast Malassezia furfur. Inform patient that hypopigmented spots take months to normalize after yeast eradication. Lather shampoo over entire chest/back and leave on for 5 minutes before washing off. Egypt KONAZOLE 2% CREAM 15 GM ALFACURE PHAR... 6.00 EGP CURAZOLE 2% TOPICAL CREAM 15 GM EVA PHARMA 7.00 EGP KETODERM 2% TOP. CREAM 20 GM SEDICO 7.00 EGP KONAZOLE 2% SHAMPOO 60 ML ALFACURE PHAR... 12.00 EGP KETODERM 2% GEL SHAMPOO 60 GM SEDICO 18.00 EGP WELLOFUNG 2% TOPICAL CREAM 40 GM EGPI > HEALTH... 48.00 EGP ZAKAN 2GM/100ML SHAMPOO 60 ML SIGMA 18.30 EGP NIZAPEX 20MG/GM SHAMPOO 80 ML APEX PHARMA 68.00 EGP 2. SELENIUM SULFIDE [2nd line] Adult Apply 2.5% lotion to the affected skin with a little water, leave 10 minutes, then rinse thoroughly; once daily x 7 days Peds Not recommended in infants Source Egyptian National Drug Formulary, antimicrobial 2023, selenium sulfide monograph, tinea versicolor Why Antifungal and antiseborrhoeic lotion, an alternative to azole therapy for tinea versicolor that is particularly useful for widespread trunk involvement. Caution Avoid contact with eyes, genital mucosa, and inflamed or broken skin. Rinse off thoroughly after designated exposure to prevent skin irritation. Selenium sulfide is an alternative topical antifungal and antiseborrheic agent for widespread trunk involvement. Ten minutes, then wash it off. Leaving selenium sulfide on overnight is not a stronger course, it is a chemical burn waiting to happen. Egypt TINASEL 2.5 GM CREAM 20 GM ALFACURE PHAR... 5.00 EGP VENEER HAIR SHAMPOO 120 ML EGYPTIAN COMP... 32.95 EGP SELENO CARE HAIR SHAMPOO 150 ML SIGMA > INTER... 98.00 EGP SELENGENA ANTI-DANDRUFF SHAMPOO 120 ML EGYPTIAN CO. FOR COSMETICS (E.C.C... 105.00 EGP SELENGENA ANTI-DANDRUFF SHAMPOO 220 ML EGYPTIAN CO. FOR COSMETICS (E.C.C... 165.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)