Tinea) Versicolor (1 of 4

Pityriasis (Tinea) Versicolor (1 of 4)

1 Patient presents w/ various colored macules (hyper- or hypopigmented, erythematous) w/ ﬁne scales suggestive of pityriasis (tinea) versicolor

2 DIAGNOSIS Do clinical presentation & No ALTERNATIVE microscopy conﬁrm DIAGNOSIS tinea versicolor?

Yes

A Patient education B Pharmacological therapy Topical Antifungals Any one of the following: • Ketoconazole • Imidazole • Butenafi ne • Ciclopirox • Tolnaftate • Naftifi ne • Selenium sulfi de • Terbinafi ne Oral Antifungals (consider for severe or widespread disease) Any one of the following: • Fluconazole • Itraconazole • Ketoconazole © MIMS

Not all products are available or approved for above use in all countries. Speciﬁ c prescribing information may be found in the latest MIMS.

B190 © MIMS Pediatrics 2019 PITYRIASIS (TINEA) VERSICOLOR • • • Antifungals Oral • SulfiSelenium de &Imidazoles • Topical Antifungals • • • • • • • • • Factors that PromoteTinea Versicolor Infection: • • Diagnosis Alternative • Wood’s Exam Light • Culture • Microscopy • • • • • Eff ect: convenientOral therapy be can timeconsuming &less enhancing patient compliance therapytopical skininvolvement, of &failure recurrent orwidespread infections ofsevere Oral therapy incases isindicated agents eff ese are equally w/60-80%recurrence rateective : t c ffe E complete after Skin discoloration treatment wktoresolve may takeseveral patients adequate initialtreatment despite inpredisposed chronically recurs Condition cortisol ofplasma High levels predisposition Immunocompromise malnutrition &hereditary conditions, Excessive sweating Application ofoilstoskin Oily skin Occlusive clothing Prominent regions &subtropical intropical - High temperature &highhumidity - Causative agent isnoteliminated the from skin&recurrence occurs individuals insusceptible - growth Educate patient ofyeast the about basics alba & pityriasis syphilis, secondary versicolorOther conditions tinea w/similarappearance include as dermatitis, seborrheic paleyellow towhitefl spp shows Malassezia uorescence onWood’s light exam spp isdiffi Malassezia Culture because isnotusuallyhelpful ofthefl normal itispart as cult togrow ora “spaghetti as (appears cells visible be &meatballs”) stubby hyphae &yeast Short will - under light microscope ordebris are in10-15%KOH mounted &viewed soln Scales - Potassium hydroxide (KOH) shouldconfi examination ofskinscrapings the rm diagnosis furfur spp &M. Malassezia yeast lipophilic by Caused skin normal donottanalongw/surrounding Lesions may Pruritus present ormay notbe - orpatches macules that may orhyperpigmented have hypo- aslight scale Patient w/erythematous, presents itisgeneralized Although sometimes - of thehand&pubis Facial involvement is common in adolescents, but lesions are also found on the upper trunk, neck, arms, dorsum when the individuals sebaceous glandsare the commonly active Occurs most most inpostpubertal - superfi benign, Common, tothe stratum corneum localized infection cial fungal

are lipophilic; advise patient advise spp are toavoid lipophilic; tothe oilsapplied skinorinthe bathMalassezia Topical eff treatments are typically eradicating intemporarily the disease ective Infection recurrence mayInfection frequently occur less w/oralantifungals iftreated © MIMS Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing B Pityriasis (Tinea) Versicolor (2of4) PHARMACOLOGICAL THERAPY 1 CLINICAL PRESENTATION A PATIENT EDUCATION 2 DIAGNOSIS B191 isthe common most © MIMS Pediatrics 2019 PITYRIASIS (TINEA) VERSICOLOR 1 Various strengths & combinations w/ corticosteroids are available. Specifi information mayfound in the latest MIMS. be c prescribing I ooaoe1 ra Apply 24hrly 2%gel, cream, 1%cream Ketoconazole Isoconazole Econazole Ketoconazole 24hrly x5-7days 100-200mgPO Itraconazole Fluconazole Bfnzl %sl,cemApply 24hrly cream 1%soln, Clotrimazole Bifonazole Imidazoles Drug Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All 1 1 Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products 2% shampoo soln 2% soln,scalp soln 1% scalp Apply 8-12hrly spray 1% cream 2%cream powd spray,cream, lotn, 1% soln, 200 mg PO 24hrly 200mgPO >30 kg: 24hrly 100mgPO 15-30 kg: 12mg/kg/day dose: Max 24hrly 3-6mg/kgPO >4 wk: 48hrly 3-6mg/kgPO 2-4 wk: 72hrly 3-6mg/kgPO <2 wk: placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed Available

© MIMSStrength Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Dosage Pityriasis (Tinea) Versicolor (3of4) ANTIFUNGALS (TOPICAL) 3-5 min24hrly x5days Apply &rinseoff after wkly x2-4wk Apply off &rinse twice x 5days or Apply off &rinse 24hrly Apply 12-24hrly Apply 8-12hrly Dosage Guidelines ANTIFUNGALS (ORAL) Dosage B192 • • Reactions Adverse • Reactions Adverse • Reactions Adverse - Risk of liver damage increases if given for ifgiven ofliver damage Risk increases - oligospermia, fatalliverdamage photophobia, dizziness,alopecia,gynecomastia, Rarely angioedema,paresthesia,thrombocytopenia, headache) itching, urticaria, (rashes, GI eff (N/V,ects pain);Other eff abdominal ects failure) heart pruritus, dizziness, (headache, & jaundice iftreatment >1mth); Other eff ects eff hepatitis transaminases, (elevation ofserum ects GI eff (N/V,ects pain);Hepatic abdominal diarrhea, fever, transaminases) serum sweating, elevated eff pruritus, palpitations, insomnia, (headache, ects GI eff pain,N/V, (abdominal ects Other diarrhea);

>14 days • Instructions Special • Reactions Adverse Treat stated otherwise for2-3wkunless &pruritus erythema burning, mild reactions, hypersensitivity & irritation local Occasional Remarks Remarks © MIMS Pediatrics 2019 PITYRIASIS (TINEA) VERSICOLOR 1 Various strengths acidare &combinations available. Specifi ofsalicylic information foundinthe may latest MIMS. be c prescribing Tolnaftate Terbinafi ne 2.5%lotn, Selenium sulfide acid Salicylic Naftifi ne Ciclopirox olamine) ( Ciclopiroxolamine, Ciclopirox Butenafi ne Apply 12-24hrly Amorolfi ne Antifungals Other 2%cream Tioconazole Sertaconazole Miconazole (Cont’d)Imidazoles Drug All dosage recommendations are for children w/ normal renal & hepatic function unless otherwise stated. otherwise unless function &hepatic renal w/ normal children for are recommendations dosage All 1 Products listed above may not be mentioned in the disease management chart but have been been have but chart management disease the in mentioned be not may above listed Products placed here based on indications listed in regional manufacturers’ product information. product manufacturers’ regional in listed indications on based here placed © MIMS oint cream, 1% soln, gel, spray cream, 1% soln, susp shampoo, Apply 8-12hrly 3% bar, 4%tinct %cemApply 24hrly 1% cream soap 1.5% liqd Apply 24hrly x2-4wk 1% cream Apply 24hrly x2-3wk 0.25% cream lotn 1% soln,cream, cream tinct, 2% soln, Not all products are available or approved for above use in all countries. all in use above for approved or available are products all Not Available Strength Specifi c prescribing information may be found in the latest MIMS. latest the in found be may information Specific prescribing Please see the end of this section for the reference list. reference the for section this of end the see Please ANTIFUNGALS (TOPICAL)(CONT’D) Pityriasis (Tinea) Versicolor (4of4) Dosage Guidelines Apply 8-12hrly x2-3wk Apply 12hrly x1-2wk 5-10 minonce amth Apply off &rinse after To recurrence: prevent 5-10 min24hrly x7days Apply off &rinse after 2-3x/wk 3-5min, Apply after &rinse Apply 12-24hrly Apply 12hrly B193 Dosage • Reactions Adverse • Reactions Adverse • Reactions Adverse • Reactions Adverse • Reactions Adverse • Reactions Adverse • Reactions Adverse • Reactions Adverse • Instructions Special • Reactions Adverse contact dermatitis pruritus, stinging, Irritation, allergic reactions rarely itching, stinging, Redness, pruritus erythema, hypersensitivity, mildburning, irritation, local Occasionally Skin irritation Pruritus, redness, burning, pain burning, redness, Pruritus, erythema, pruritus erythema, sensation, Burning/stinging itching irritation, sensation, erythema, stinging burning/ Contact dermatitis, sensation burning slight pruritus, Erythema, otherwise stated otherwise Treat for2-3wkunless &pruritus erythema burning, mild reactions, hypersensitivity & irritation local Occasional Remarks © MIMS Pediatrics 2019