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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.
| Drug name | Drug class | Administration route | Standard dosage | Common side effects |
| Lotrimin (clotrimazole) | Antifungals–Imidazoles | Topical, oral | Applied to the affected area 2 times per day for 4-8 weeks | Redness, stinging, itching, peeling |
| Lamisil (terbinafine) | Antifungal | Topical, oral | Applied to the affected area 2 times per day for 4-8 weeks | Burning, redness, itching, irritation |
| Zeasorb (miconazole) | Antifungals–Imidazoles | Topical | Applied to the affected area 2 times per day for 2-4 weeks | Skin irritation, burning, rash |
| Loprox (ciclopirox) | Antifungal | Topical | Applied to the affected area 2 times per day for 1 week | Burning, itching, stinging, redness |
| Ecoza (econazole) | Antifungals–Imidazoles | Topical | Applied to the affected area once per day for 2-6 weeks | Burning, itching, stinging, redness |
| Nizoral (ketoconazole) | Antifungals–Imidazoles | Topical, oral, shampoo | Topical: Applied to the affected area once per day for 2-6 weeks Oral: Once per day as advised by your healthcare provider | Topical: Itching, skin irritation; Oral: Nausea, vomiting, headache, dizziness |
| Diflucan (fluconazole) | Antifungal | Oral | One 50 mg tablet per day | Nausea, vomiting, upset stomach, headache |
| Sporanox (itraconazole) | Antifungals–Triazoles | Oral | 200 mg per day | Dizziness, nausea, headache, upset stomach |
| Selsun Blue (selenium sulfide) | Antifungal | Shampoo | Use to wash affected area once per day for 7 days | Skin irritation, dry skin, oily hair and scalp, or dry hair and scalp |
| Head & Shoulders (zinc pyrithione) | Antifungal | Shampoo | Use to wash affected area once per day for 7 days | Stinging sensation of scalp, peeling skin |
Dosage is determined by your healthcare provider based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of tinea versicolor medication?
It's always a good idea to take a look at potential side effects when researching medications. They might be rare, but you should at least be aware. Here are some more common side effects you might encounter:
- Topical antifungals: Itching, burning, blistering, redness, peeling, hives, or skin cracks
- Oral antifungals: Nausea, vomiting, diarrhea, rash or interactions with other medications
- Medicated shampoos: Skin irritation, dry hair or scalp
Keep in mind that this is not a complete list of side effects, just the most common ones. Speak with your healthcare provider for more information and a comprehensive list of potential reactions before beginning treatment.
What is the best home remedy for tinea versicolor?
Maybe you've just noticed the first inklings of potential pityriasis versicolor and you don't want to use the heavy stuff yet. Or maybe you'd rather try a natural route before lathering on antifungal cream. Either way, there are some home remedies and lifestyle changes that can help prevent and treat this fungal imbalance.
To avoid tinea versicolor in the first place, you'll want to—as best as you can—keep your skin cool and dry, according to Dr. Kormeili. "TV loves heat and moisture! If you provide an environment of dry, cool skin it won't want to grow there," she says. "Your body oils and sweat are like an open buffet for TV to eat and prosper. Make sure to shower after any activity that makes you sweaty. Wear cotton or natural fabrics that wick away moisture from the skin. Wash your skin with dandruff shampoos after any activity that makes you sweaty to prevent infection."
On top of that, dietary alterations can help boost your immune system and control your body's yeast levels. Dr. Hayag's advice? "Eat fruits and vegetables–great sources of immune-boosting vitamins A, C, and E, minerals, and antioxidants–and foods with probiotics like yogurt. Probiotics have beneficial bacteria, which is great for immune function." And if you're getting recurring tinea versicolor infections, she says, "stay away from yeast-promoting foods like sugars, highly refined carbohydrates, alcohol, vinegar, and peanuts."
Other natural remedies can include:
- Apple cider vinegar: Mix with equal parts water and apply it to the affected area.
- Turmeric: Mix with water to make a paste, apply, and leave for 30 minutes.
- Onions: Crush into a paste and apply it to the affected area.
- Aloe vera: Extract the gel from an aloe leaf and apply.
- Lemongrass: Apply oil or shampoo to the affected area.
While some people find these remedies effective, keep in mind that they haven't been proven in clinical studies, while other treatments have.
Frequently asked questions about tinea versicolor
What triggers tinea versicolor?
An accumulation of Malassezia, a yeast that is a part of your skin's natural flora triggers tinea versicolor.
How long does it take for tinea versicolor to go away?
You might be able to correct your skin's fungal imbalance quickly with topical or oral medications, but it can take six to 12 months for normal skin color to return. It's common for tinea versicolor to recur even after it has fully healed.
How do you get rid of tinea versicolor fast?
Visit your healthcare provider to discuss the best medication for your tinea versicolor case. Whether it's a topical or oral antifungal, use it diligently for two weeks (or the amount of time your healthcare provider advises).
Can tinea versicolor go away on its own?
No. Cool, dry climates can help reduce its severity, but it's very rare to see tinea versicolor disappear on its own.
How can I treat tinea versicolor at home?
Keep your skin as cool and dry as possible, which will make it a non-conducive environment for fungus. Consistently apply OTC antifungal creams or wash the affected area with a dandruff shampoo twice per day for a period of two weeks.
What is the best over-the-counter treatment for tinea versicolor?
Many cases of tinea versicolor respond well to over-the-counter versions of Lotrimin or Lamisil. Topical antifungals are the first line of treatment and typically show long-term efficacy.
Which drug is prescribed for a patient with tinea versicolor?
Dermatologists will often prescribe itraconazole or fluconazole for patients with more severe or persistent tinea versicolor.
What antifungal cream is best for tinea versicolor?
Different people respond well to different treatments, so it's hard to name a singular "best" cream. However, in one recent study, terbinafine and ketoconazole creams showed impressive effectiveness.
Is there a cure for tinea versicolor?
Since Malassezia is a natural part of your skin flora, there's not a cure that will make you permanently immune to pityriasis versicolor. Rather, most treatments focus on keeping this yeast's growth under control. You can cure it temporarily, but there's no guarantee that it's gone forever.