Tinea Versicolor Treatment

Tinea Versicolor Treatment Overview

Tinea versicolor treatments typically involve topical creams or shampoos available over the counter with several active ingredients and various concentrations as a starting point. Since ringworm and tinea versicolor are caused by dermatophytes and fungi, treatment for both types of infections involve similar active ingredients.

In the case of creams, direct application on the site of infection plus a few centimeters beyond the affected area is usually recommended with a dwell time of a few minutes to several hours before washing off. For shampoos, it is often recommended to be applied daily. Treatment times vary from one or two applications per day for a period of several weeks during infection followed by treatment even after symptoms disappear to ensure complete elimination. Since most of the ingredients are considered to be “broad spectrum”, the same active ingredients may be used to treat a variety of fungal infections.

 

Clotrimazole

Clotrimazole cream

Like most antifungals, clotrimazole works to block the creation of the fungi cell wall (via ergosterol interference) and thus prevents the growth of the fungus. Typical 1% topical creams recommend application twice a day for several weeks for maximal results. Side effects are generally rare but burning, stinging, swelling, irritation, redness, pimple-like bumps, tenderness, or flaking of the treated skin can occur. Consult with your physician if any of these symptoms appear.

 

Griseofulvin

Griseofulvin (brand name: Grifulvin V, Gris-PEG) is an orally available antifungal therapy with known efficacy against a variety of dermatophyte infections. It is produced by the Penicillium patulum fungus and is known to be ineffective when applied topically. The compound works by interfering with a critical component (“microtubule”) within the cellular division process in fungi and thus prevents the dermatophytes from growing and spreading. Treatment times range from 2-8 weeks depending on the site of tinea infection [1]. Treatment doses range between 250-500mg twice daily for adults and a modified amount based on body weight for children [2]. However, caution should be taken when taking the drug as a number of side-effects have been documented [1].

 

Ketoconazole

Nizoral_shampoo

 

 

 

 

 

 

Ketoconazole is available over the counter as an active ingredient in shampoos (“Nizoral”), creams, or lotions. It is commonly used to treat a wide variety of tinea infections including – athlete’s foot, jock itch, ringworm, dandruff, and tinea versicolor. Typical concentrations include 1% as an over-the-counter shampoo and 2% as a cream, and application times vary between 2-4 weeks. Prescription ketoconazole is also available as an oral therapeutic in several countries, however, caution should be taken in monitoring liver side effects. For less toxic alternatives, other azole derivatives may be suggested – including fluconazole and itraconazole.

 

Miconazole

Micronazole cream

Micronazole nitrate typically comes in a 2% topical cream under several brand names including: Lotrimin AF and Monistat. As mentioned above in regards to azole treatments, the compound works to block ergosterol synthesis in fungi cells and prevents further spread of infection. The medication comes in a variety of forms (e.g. pills, tablets, lotions, creams, liquids, powder, gel, etc.), and typical topical applications recommend twice daily use for several weeks.

 

Naftifine

Naftifine hydrochloride is an allylamine antifungal agent available in 1-2% cream or gel (under the brand name Naftin by Merz Pharmaceuticals) and is used to treat a variety of tinea infections. However, the exact science of how it works against dermatophytes is unknown. As a member of the allylamine class of antifungals, a portion of its mechanism of action is attributed to its effects on cellular growth (through interference with squalene epoxidase) [3]. Unlike traditional azole compounds, acquired resistance by tinea infections is not as large as an issue with naftifine (along with additional allylamine compounds) [3]. Consult with your physician to discuss the usage, side effects, and for obtaining a prescription.

 

 

Pyrithione Zinc

Noble_Formula_Bar_Soap

 

 

 

 

 

 

 

Noble Formula antifungal bar soap contains pyrithione zinc which acts on fungi cells by introducing copper into the cells which in turn affects critical proteins [4, 5]. Overall, this process interferes with and disrupts normal cell growth. It is recommended to be used daily and to lather and wait for 10-15 minutes before washing off.

 

Selenium Sulfide

Selenium-sulfide

 

 

 

 

 

 

Sulfide and related compounds have typically been used as an active ingredient in shampoos available over the counter to treat tinea capitis (“ringworm of the scalp”) but have also been shown to be effective against tinea versicolor species. Sulfur and related compounds have been shown to be highly effective as a broad spectrum antifungal that is commonly used in nature as well [6, 7]. Typical shampoos contain a concentration of 1% selenium sulfide and are recommended to be used once daily for several weeks. Selenium shampoos can also be used to treat dandruff which arises from a number of causes apart from fungal infection (e.g. dry skin, irritated and oily skin, etc.).

 

Terbinafine

Terbinafine hydrochloride   Lamisil

Terbinafine is an allylamine antifungal agent that works to block the creation of the fungi cell wall (via ergosterol interference) and thus prevents the growth of the fungus. It’s available over the counter as well as by prescription and comes in various forms including: gels, creams, lotions, and sprays. Topical creams are typically 1% concentrated and require application once daily for several weeks (4-6). There is also evidence supporting the fact that terbinafine may be a more desired alternative to the commonly prescribed griseofulvin due to better efficacy against certain fungal species with reduced treatment times [8].

 

Zinc

Baza moisture barrier anti-fungal cream

Sween Baza is an over the counter cream containing zinc-oxide in combination with 2% miconazole. It can also be used as a broad treatment for candidiasis, jock itch, ringworm, and athlete’s foot. Zinc has been shown to affect the cell structure as well as to introduce reactive oxygen species which are toxic to the fungal infection [9]. Directions for Sween Baza include the application of the cream twice daily for at least two weeks.

 

What’s Right For Me?

An over the counter topical antifungal may be effective for most tinea versicolor treatments. Most infections are usually treated with topical ketoconazole, selenium sulfide shampoos, or zinc creams. Further analysis into the main species of infection, however, may be warranted in an effort to select the most effective treatment. Potential side effects, complications, and drug interactions can also be discussed with a trained physician. As with all possible side effects, the benefits of a particular treatment should be weighed against the potential adverse effects.

 

Keywords

Allylamine – A class of compounds that work by inhibiting a specific component of fungal cell reproduction known as “squalene epoxidase.”

Ergosterol – The cholesterol analog of fungi and protozoa which serves the same or similar functions to that of cholesterol in humans. A main role is in the formation of the cell wall of these organisms and has become a popular target for developing antifungal treatments.

Microtubule – A critical component of the cell cytoskeleton. It is involved in cellular division and is often a pharmaceutical target for drug treatment.

Over the counter – Referring to a medicine that is available without a prescription at your local pharmacy or drug store.

Reactive oxygen species – Chemically active oxygen molecules inside cells. They have a number of roles in normal cellular processes and are generally considered to be damaging to the cells.

Squalene epoxidase – An enzyme that plays an important role in sterol synthesis in cells and overall cell growth.

 

 

References

[1] MedlinePlus: Griseofulvin. Link.

[2] MayoClinic – Drugs and Supplements: Griseofulvin (Oral Route). Link.

[3] Ghannoum M, Isham N, Verma A, Plaum S, Fleischer A, Hardas B. In Vitro Antifungal Activity of Naftifine Hydrochloride against Dermatophytes. Antimicrob Agents Chemother. 2013 Sep; 57(9): 4369–4372. Full text.

[4] Reeder NL, Xu J, Youngquist RS, Schwartz JR, Rust RC, Saunders CW. The antifungal mechanism of action of zinc pyrithione. Br J Dermatol. 2011 Oct;165 Suppl 2:9-12. Link.

[5] Reeder NL, Kaplan J, Xu J, Youngquist RS, Wallace J, Hu P, Juhlin KD, Schwartz JR, Grant RA, Fieno A, Nemeth S, Reichling T, Tiesman JP, Mills T, Steinke M, Wang SL, Saunders CW. Zinc pyrithione inhibits yeast growth through copper influx and inactivation of iron-sulfur proteins. Antimicrob Agents Chemother. 2011 Dec;55(12):5753-60. Link.

[6] Kim S, Kubec R, Musah RA. Antibacterial and antifungal activity of sulfur-containing compounds from Petiveria alliacea L. J Ethnopharmacol. 2006 Mar 8;104(1-2):188-92. Full text.

[7] Cooper RM, Williams JS. Elemental sulphur as an induced antifungal substance in plant defence. J Exp Bot. 2004 Aug;55(404):1947-53. Full text.

[8] Moriarty B, Hay R, Morris-Jones R. The diagnosis and management of tinea. BMJ 2012;345. Full text.

[9] Savi G, Bortoluzzi A, and Scussel V. Antifungal properties of Zinc-compounds against toxigenic fungi and mycotoxin. International Journal of Food Science & Technology 2013; 48(9):1834–1840. Link