Tinea versicolor (pityriasis versicolor) is a chronic superficial fungal disease caused by Malassezia furfur, a yeast normally found on the skin. It is in yeast form in the unaffected skin areas and in the mycelial phase on affected skin. The disease usually is located on the upper trunk, neck, or upper arms. Symptoms may include scaling, erythema, and pruritis. It may appear as slightly scaly brown macules or whitish macules. Treatment options include oral or topical terbinafine (1% cream or gel), oral or topical ketoconazole, oral fluconazole, or topical treatments, such as ciclopiroxolamine, piroc-toneolamine, zinc pyrithione, or sulfur-containing substances, such as selenium sulfide; the most common treatment is selenium. Patients are asked to wet themselves in the shower, turn off the water, apply the selenium and let it sit for 10 minutes, and then rinse. Also, oral fluconazole, 200 mg, once or repeated once a week later is a simple and effective treatment. Of note, oral terbinafine, 250 mg, daily for 12 weeks is associated with slightly decreased cyclosporine levels. Terbinafine is an allylamine that binds to a small subfraction of hepatic cytochrome P450 in a type I fashion. Side effects seen during terbinafine use include gastrointestinal distress in up to 5% of patients and skin rashes in 2% of patients.
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