The Journal of Dermatology

Vol. 32: 19–21, 2005

Oral Fluconazole in the Treatment of Tinea Versicolor

Mehmet Karakaş, Murat Durdu and Hamdi R. Memişoğlu
Abstract
This study was designed to assess the efficacy, tolerability, and safety of oral fluconazole
given at 300 mg once weekly for two weeks in the treatment of tinea versicolor. Enrolled
into the study were 44 subjects with tinea versicolor, provisionally confirmed by the detec-
tion of fungal hyphae in KOH wet mounts and Wood’s lamp examination. Four subjects
were classified as dropouts because no information was obtained from them after the base-
line visit. Subjects were treated for two weeks orally with fluconazole 300 mg weekly and
followed at the 1st, 2nd, 4th and 12th weeks of treatment. The study included 40 subjects
(26 males and 14 females, mean age 29 years, range 19–48 years). At the week 4 visit, 30
(75%) patients showed a complete cure and 31 (77.5%) patients showed mycologic cure.
Ten (25%) patients had no significant response to therapy. At the final follow-up visit
(week 12), none of the patients showing complete or mycologic cures exhibited a recur-
rence. No adverse effects were observed in any of the patients treated. We believe that, due
to the low incidence of side effects, shorter treatment duration, and increased adaptation
of the patients, fluconazole can be used in the treatment of tinea versicolor with confi-
dence.
Key words: fluconazole; tinea versicolor; weekly therapy

ic problems and, occasionally, some slight

Introduction
Pityriasis versicolor (tinea versicolor) is a
superficial fungal infection of the skin
caused by the genus Malassezia. The
causative fungus is a normal inhabitant of
the skin flora in yeast form (1). However, as
a result of endogenous factors such as mal-
nutrition (2), hyperhidrosis (3, 4), use of
oral contraceptives (5), and systemic corti-
costeroid and exogenous (e.g. humid and
hot climate) factors, it changes from the
yeast form to the mycelial form of the or-
ganism and then causes an infection charac-
terized by hypopigmented or hyperpig-
mented macules which are mildly squamous
(1). The lesions can be scattered over the
neck, shoulders and arms and cause cosmet-
Received March 28, 2004; accepted for publication
July 26, 2004.
Cukurova University, School of Medicine, Depart-
ment of Dermatology, Adana, Turkey.
Reprint requests to: Mehmet Karakaş, M.D.,
Çukurova University, Faculty of Medicine, Depart-
ment of Dermatology, 01330 Adana, Turkey.
itching. This infection has no apparent
dominance of either sex and occurs more
commonly in adolescents and young adults.
Tinea versicolor occurs worldwide with
prevalences reported to be as high as 50%
in tropical countries (5, 6) and as low as 1%
in Scandinavia (7–9). In treatment of local
infections, usage of topical antifungal
agents is found to be quite sufficient. On
the other hand, especially in generalized
cases, due to the fact that application of top-
ical preparations is difficult and time-con-
suming, treatment with systemic antifungals
may be put on the agenda. For this infection
with a high probability of recurrence follow-
ing the treatment, systemic antifungals such
as fluconazole or itraconazole which can
shorten the duration of treatment and ease
the patient’s adaptation to treatment are
being used and studies pertaining to various
durations and dosages have been prepared
(1). The aim of this study was to assess the
efficacy, tolerability, and safety of oral flu-
conazole given at 300 mg once weekly for
20 Karakaş et al
two weeks in the treatment of tinea versicol-
or.
Patients and Methods
Enrolled into the study were 44 subjects with
clinically suspected tinea versicolor, provisional-
ly confirmed by the detection of fungal hyphae
in KOH wet mounts and Wood’s lamp examina-
tion. The major inclusion criteria ensured that
the subjects of either gender were aged 12 years
or higher, had not received systemic and topical
antimycotic therapy in the preceding two
months, were not pregnant or breast-feeding
women, had no liver, renal or gastrointestinal
disease, and had no known intolerance or aller-
gy to azoles. Four subjects were classified as
dropouts because no information was obtained
on these subjects after the baseline visit. The fol-
lowing information was recorderd before the
start of therapy: subject’s initials, age, sex, dura-
tion of infection, localization and area of le-
sions, any previous therapy received, and any
concomitant disease and therapy. Subjects were
treated for 2 weeks orally with fluconazole 300
mg weekly and followed on the 1st, 2nd, 4th,
and 12th weeks of treatment.
Clinical assessment
Clinical signs and symptoms such as pruritus,
hypo or hyperpigmentation, and desquamation
were classified (0=none, 1=mild, 2=moderate,
3=severe) and assessed at the initial clinical ex-
amination and at weeks 1, 2, 4, and 12.
Mycological assessment
Prior to commencement of therapy and dur-
ing weeks 1, 2, 4 and 12 specimens were exam-
ined microscopically for fungal mycelium and
by Wood’s lamp.
Assessment of efficacy
Overall evaluations were performed during
week 4, including the following rating of clinical
signs and mycology of lesions:
1. Complete cure: microscopy and Wood’s light
negative, no residual clinical signs or symptoms.
2. Mycological cure: microscopy and Wood’s
light negative, residual erythema and/or
desquamation and/or pruritus (total score ≤2),
Fig. 1. Efficacy of oral fluconazole in the treat-
ment of tinea versicolor
but no other clinical signs.
3. Failure: no significant response to therapy
as determined by positive mycological tests and
persistent signs and symptoms (total score >2),
or recurrence or a positive mycological test.
Safety assessment
Hematological (hemoglobin, white cell
count, hematocrit), biochemical (creatinine,
bilirubin, SGOT, SGPT), and urine tests were
performed on samples obtained at the initial ex-
amination if previous abnormalities in blood
tests were noted. Any reported side-effects were
recorded at each visit (symptoms or adverse ef-
fects which were not present before treatment
and those which were present but increased dur-
ing the study were accepted as side-effects).
Each adverse event was described in terms of du-
ration (start and end dates), frequency (single
episode, intermittent, continuous), severity
(mild, moderate, severe), and relationship to
study medication.
Results
The study included 40 subjects (26 males
and 14 females, mean age 29 years, range
19–48 years). At the week 4 visit, 30 (75%)
patients were determined complete cure
and 31 (77.5%) patients showed mycologic
cure. Ten (25%) patients showed significant
response to therapy (Fig. 1). At the final fol-
low-up visit (week 12), none of the patients
who showed a complete or mycologic cure
showed a recurrence. No adverse effects
were observed in any of the patients treated.
 Oral Fluconazole in the Treatment of Tinea Versicolor
Discussion
In the treatment of tinea versicolor, appli-
cation of oral antifungals can shorten the
duration of treatment while it eases the pa-
tient’s adaptation to treatment (1). In case
of oral treatment, fluconazole is highly pre-
ferred. There are several studies in which
fluconazole was applied in various durations
and dosages in the treatment of tinea versi-
color (10–13), mostly as a 2 × 300 mg/week
dosage. In one of these studies, the cure rate
(clinical and mycologic cure) ranged
beetwen 78%–98% on the 4th week follow-
up when 300 mg of fluconazole was given
once weekly for 2 weeks (10, 12, 13). In an-
other study, a clinical cure was observed in
79% of the patients with severe recurrent
pityriasis versicolor treated with a single oral
dose of 400 mg of fluconazole (11). No sig-
nificant side effects were reported in these
studies. Our treatment results were close to
those of similar studies, although we ob-
served fewer clinical cures. The adaptation
of the patients was good, and no side effects
were observed. The efficiency of flucona-
zole is believed to be related to the fact that
it reaches high concentrations in plasma,
stratum corneum, and sweat (14). Further-
more, its detection in sweat after 3 hours fol-
lowing a single dose application and on skin
after 10 days is reported as an important ad-
vantage (14).
We believe that, due to the low incidence
of side effects, shorter treatment duration,
and increased adaptation of the patients,
fluconazole can be used in the treatment of
tinea versicolor with confidence.
21
References
1) Gupta AK, Bluhm R, Summerbell R: Pityriasis
versicolor, J Eur Acad Dermatol Venereol, 16: 19–33,
2002.
2) Stein DH: Superficial fungal infections, Pediatr
Clin North Am, 30: 545–561, 1983.
3) Faergemann J, Bernander S: Tinea versicolor
and Pityrosporum orbiculare: A mycological investi-
gation, Sabouraudia, 17: 171–179, 1979.
4) Burke RC: Tinea versicolor: susceptibility factors
and experimental infection in human beings, J
Invest Dermatol, 36: 389–402, 1961.
5) Gupta AK, Batra R, Bluhm RP, Faergemann J:
Pityriasis versicolor, Dermatol Clin, 21: 413–419,
2003.
6) Borelli D, Jacobs PH, Nall L: Tinea versicolor:
Epidemiologic, clinical and therapeutic aspects,
J Am Acad Dermatol, 25: 300–305, 1991.
7) Faergemann J, Fredriksson T: Tinea versicolor
with regard to seborrheic dermatitis: An epi-
demiological investigation, Arch Dermatol, 115:
966–968, 1979.
8) Hellgren L, Vincent J: The incidence of tinea
versicolor in central Sweeden, J Med Microbiol, 16:
501–502, 1983.
9) Svejgaard E: Epidemiology and clinical features
of dermatomycoses and dermatophytoses, Acta
Derm Venereol Suppl, 121: 19–26, 1986.
10) Amer MA and the Egyptian Fluconazole Study
Group: Fluconazole in the treatment of tinea
versicolor, Int J Dermatol, 36: 938–946, 1997.
11) Faergemann J: Treatment of pityriasis versicolor
with a single dose of fluconazole, Acta Derm
Venereol (Stockh) , 72: 74–75, 1992.
12) Shahid J, Ihsan Z, Khan S: Oral fluconazole in
the treatment of pityriasis versicolor, J Dermatol
Treat, 1: 101–103, 2000.
13) Montero-Gei F, Robles ME, Suchil P: Flucona-
zole vs. Itraconazole in the treatment of tinea
versicolor, Int J Dermatol, 38: 601–603, 1999.
14) Haneke E: Fluconazole levels in human epider-
mis and blister fluid (letter), Br J Dermatol, 12:
318–326, 1990.