Tinea versicolor

The differential diagnosis for PIH includes the following fixed drug eruption, systemic drug-induced hyperpigmentation, macular amyloid, ashy dermatosis, melasma, and tinea versicolor. Medications such as tetracyclines, antimalarial drugs, arsenic, bleomycin, and doxorubicin can result in hyperpigmentation of the skin. 

Despite negligible cerebrospinal fluid concentrations, itraconazole shows promise in the treatment of cryptococcal and coccidioidal meningitis. Additional uses for itraconazole include treatment of vaginal candidiasis, tinea versicolor, dermatophyte infections, and onychomycosis. Fungal naU infections account for most use of this drug in the outpatient setting. 

Ciclopirox olamine (Loprox) is a pyridone derivative available for the treatment of cutaneous dermatophyte infections, cutaneous C. albicans infections, and tinea versicolor caused by Malassezia furfur. It interferes with fungal growth by inhibiting macromolecule synthesis. 

Tinea pedis, tinea corporis, tinea cruris, tinea versicolor Topical Apply to affected area and immediate surrounding skin daily for 4 wk. 

Tinea versicolor Topical Solution Apply to the affected area twice a day for 7 days. Systemic mycosis PO 250-500 mg/day for up to 16 mo. 

It is indicated in dermatophytoses, tinea versicolor, onychomycoses, oropharyngeal candidiasis, cutaneous candidiasis, chronic mucocutaneous candidiasis, oculomycoses systemic mycoses like cryptococcosis, candidiasis and aspergillosis subcutaneous mycoses like sporotrichosis and chromomycosis. 

Pharmacokinetic studies indicate that 1-2% of the dose is absorbed when applied as a solution on the back under an occlusive dressing. Ciclopirox olamine is available as a 1% cream and lotion (Loprox) for the topical treatment of dermatomycosis, candidiasis, and tinea versicolor. The incidence of adverse reactions has been low. Pruritus and worsening of clinical disease have been reported. The potential for delayed allergic contact hypersensitivity appears small. 

Ketoconazole is effective in the therapy of cutaneous infections caused by epidermophyton, microsporum, and trichophyton species. Infections of the glabrous skin often respond within 2-3 weeks to a once-daily oral dose of 200 mg. Palmar-plantar skin is slower to respond, often taking 4-6 weeks at a dosage of 200 mg twice daily. Infections of the hair and nails may take even longer before resolving, with low cure rates noted for tinea capitis. Tinea versicolor is responsive to short courses of a once-daily dose of 200 mg. 

Miconazole Vaginal Cream 2% Tinea Pedis, Tinea Cruris, Tinea Corporis, and Cutaneous Candidiasis Enough to cover affected areas twice daily (morning and evening) Tinea Versicolor Enough to cover affected areas once daily... 

Tinea pedis, tinea cruris, tinea corporis, cutaneous candidiasis, tinea versicolor, tinea rubrum Action Antifungal antibiotic cellular depletion of essential substrates /or ions Dose Adults Peds >10 y. Massage into affected area bid Onychomycosis Apply to nails daily, w/ removal q7d Caution [B, ] Contra Component sensitivity Disp Cream, gel, topical susp, shampoo, nail lacquer SE Pruritus, local irritation, burning Interactions None noted EMS None OD Not likely, no info available if large amt ingested... 

The imidazoles, which currently include clotrimazole, econazole, ketoconazole, miconazole, oxiconazole, and sulconazole, have a wide range of activity against dermatophytes (epidermophyton, microsporum, and trichophyton) and yeasts, including Candida albicans and Pityrosporum orbiculare, the cause of tinea versicolor. 

Martin AG, Kobayashi GS Yeast infections Candidiasis, pityriasis (tinea) versicolor in Fitzpatrick TB, Eisen AZ, Wolff K, Freedberg IM, Austen KF (eds) Dermatology in General Medicine, ed 4. New York, McGraw-Hill, 1993, pp 2421-2451. 

Selenium sulfide is used as an antiseborrheic agent and as a shampoo in the treatment of Tinea versicolor. Selenite is also found in mineral supplements and is used in parenteral nutrition. However, selenium has gained undeserved popularity as a constituent of health foods and alternative tonics, perhaps because selenium deficiency has been implicated in the pathogenesis of some forms of malnutrition in children. However, even in children with selenium deficiency the benefit to harm balance has not been estabhshed. Indeed, in protein deficiency it seems to be particularly toxic. Nor is there any serious basis for its reputation as a remedy for cystic fibrosis, to prevent aging, or as a sexual stimulant. 

The fungus Pityrospornm orhiciilare cau.ses an additional type, tinea versicolor. This organism, called Malassezia furfur in older literature, cau.ses yellow to brown patches or continuous scaling over the trunk and occasionally the legs, face, and neck. The affected areas may be identified by the inability to tan in the sun. 

Superficial int ecUons Tinea versicolor Picriftt Pityrosporum orhiailare Trichosporon cuttmemi (while) Pirdraia hortae (black)... 

Ciclopirox is considered an agent of choice in the tn ment of cutaneous candidiasis, tinea corporis, tinea cniiir. tinea pedis, and tinea versicolor. It is a second-line agent for the treatment of onychomycosis (ringworm of the naih> Loprox is formulated as a cream and a lotion, each contain-... 

CTolhniazole is availabie as a solution in polyethylene ilunl 400. a lotion, and a cream in a concentration of These arc ail indicated for the treatment of tinea pedi.s. tr.i cruris, tinea capitis, tinea versicolor, or cutaneous 3diiiiasis. A 1% vaginal cream and tablets of 100 mg d II0 mg arc available for vulvovaginal candidiasis, ilttimizulc is extremely stable, with a shelf life of mote iin 5 years,... 

Indications Anticancer (stomach, colorectal, lung, prostate), arthritis, asthma, heart disease, HIV inhibitor. Treatment of dandruff, fungal infections (tinea versicolor), and seborrhea Category Antioxidant Trace element... 

Pityrosporum Tinea versicolor Superficial, asymp- Ciclopirox... 

Topical use Treatment of tinea pedis (athlete s foot), tinea cruris (jock itch), tinea corporis (ringworm), candidiasis, and tinea versicolor... 

In the treatment of tinea pedis, tinea cruris, and tinea versicolor the cure rate may be over 90%. In the treatment of vulvovaginal candidiasis, the mycologic cure rate at the end of 1 month is about 80 to 95%. Pruritus sometimes is relieved after a single application. Some vaginal infections caused by Candida glabrata also respond. 

The azoles miconazole (Micatin, others) and econazole (Spectrazole, others) and the allylamines naftifine (Naftin) and terbinafine (Lamisil, others) are effective topical agents for the treatment of localized tinea corporis and uncomplicated tinea pedis. Topical therapy with the azoles is preferred for localized cutaneous candidiasis and tinea versicolor. 

It is used principally in the treatment of tinea pedis, tinea cruris, tinea corporis, tinea manuum, and tinea versicolor. Haloprogin s mechanisms of action in yeast cells are thought to be inhibition of respiration and disruption of yeast cell membranes. Its mechanism of action in dermatophytes is unknown. 

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