SKIN - Tinea Versicolor - Topical Treatment (Malassezia furfur, Pityrosporum orbiculare) General statement: Creams may be practical for small areas but are expensive and difficult to apply to extensive infection. Shampoo and lotion are easy to apply. Oral therapy for extensive infection, frequent recurrence, or infection resistant to topical therapy. Recurrences are common. Once-a-month shampoo or lotion may reduce recurrences.
Clotrimazole (OTC) (Lotrimin^®, Mycelex^®) Generics available Pregnancy: B; Lactation: Unk Cream 1%	Children and Adult: Apply twice daily for 2-4 weeks.	Avoid contact with eye(s).
Ketoconazole Shampoo (Nizoral^®) Pregnancy: C; Lactation: Unsafe Shampoo 2% Cream 2%	Children and Adult: Apply to dampened skin. Leave on 5 minutes, then rinse. Repeat daily for 1-3 days. Cream: Apply once daily for 2 weeks.	Caution: Avoid contact with eye(s) and mucous membranes. May remove curl from permanently waved hair.
Econazole (Spectazole^®) Pregnancy: C; Lactation: Unk Cream	Children and Adult: Apply once daily for 2-4 weeks.	Avoid contact with eye(s). Wash Hands after application.
Miconazole (Monistat-Derm^®) Pregnancy: C; Lactation: Unk Cream 2%	Children and Adult: Apply twice daily for 2-4 weeks.	Avoid contact with eye(s).
Selenium sulfide 2.5% (Selsun^®, Excel^®) Generics available Pregnancy: C; Lactation: Unk Shampoo 1%: Selsun Blue^® 1% (OTC) Shampoo and Lotion 2.5%	Children and Adult: Apply 2.5% lotion or shampoo to affected areas and lather with a small amount of water. Keep on skin for 10 minutes, then rinse thoroughly. Repeat once daily for 7-14 days or alternatively apply overnight once per week for 2 weeks.	Wash hands after treatment, avoid contact with eye(s). Important side effects: May irritate skin and discolor hair or jewelry. Rinse thoroughly after use.
SKIN - Tinea Versicolor - Oral Treatment (Malassezia furfur, Pityrosporum orbiculare)
Fluconazole (Diflucan^®) Pregnancy: C; Lactation: Likely Safe Tabs: 50 mg, 100 mg, 150 mg, 200 mg	Children: Not approved. Adult: 400 mg PO once. Repeat once a month if needed.	Food: May take with or without meals. Important side effects: Nausea, vomiting, diarrhea, dizziness. Potentially significant drug interactions. Consult a pharmacist.
Itraconazole (Sporanox^®) Pregnancy: C; Lactation: Unsafe Caps:  65 mg, 100 mg    Tablet: 200 mg	Children: Not approved. Adult: 200 mg once daily for 5-7 days.	Food: Avoid grapefruit products while taking. Take capsules with food. Take oral solution on an empty stomach. Not well absorbed with acid-suppressing drugs.
		Caution: May cause hepatitis. Use with caution in persons with history of liver disease. Consider periodic liver function tests. May cause or contribute to congestive heart failure or cardiac dysrhythmias. Use with caution in persons with history of cardiac disease. Use for onychomycosis is contraindicated in patients with history of ventricular dysfunction or CHF. Use is contraindicated in any patient taking cisapride, dofetilide, quinidine, midazolam, triazolam, pimozide, lovastatin, or simvastatin. Not well absorbed with acid-suppressing drug.
		Has caused bone defects and changes in tooth appearance in rats; implications for humans are not established.
Ketoconazole (Nizoral^®) Pregnancy: C; Lactation: Unsafe	Children ≥2 years: 3.3-6.6 mg/kg once daily (max 400 mg/day) once per week for 3 weeks.	Food: Food may increase absorption. Do not take with acid-suppressing agents.
Tabs: 200 mg	200 mg @ 4-5 mg/kg daily 25 lb (11 kg) = ¼ tab Q24H 50 lb (22 kg) = ½ tab Q24H 75 lb (33 kg) = ¾ tab Q24H 100 lb (45 kg) = 1 tab Q24H Adult: 400 mg as a single dose once per week for 3 weeks or 200 mg daily for 5-7 days.	Important side effects: Liver toxicity, nausea, dizziness, headache.