What is pityriasis versicolor?

Pityriasis versicolor (sometimes known as  tinea versicolor.) is a skin condition caused by a type of fungus called Malassezia furfur. This fungus normally lives on the skin without causing any problems, but sometimes it can multiply and spread causing symptoms of pityriasis versicolor. It commonly affects the chest, upper arms, upper back, neck, and abdomen. 

Pityriasis versicolor can affect anyone but is more common in teenagers and young adults, and those living in hot, humid climates. The condition affects more men than women. 

What causes pityriasis versicolor? 

Pityriasis versicolor is caused by the overgrowth of the fungus Malassezia. Malassezia is commonly found on the skin of healthy people and does not normally cause any problems. 

Pityriasis versicolor is not contagious, meaning it cannot be passed on to other people. 

It is not known why Malassezia grows out of control in some people and not others, but it may be triggered by: 

• having oily skin
• hot, humid weather 
• hormonal changes
• excessive sweating 
• a weakened immune system 

What are the symptoms of pityriasis versicolor? 

Pityriasis versicolor causes patches on the skin. The patches may be: 

• lighter or darker than the surrounding skin
• pink, red, or pale brown
• dry, itchy, or scaly

Pityriasis versicolor patches don’t go brown in the sun which can make them more obvious. They often improve in cooler, drier weather.

How does pityriasis versicolor treatment work?

Pityriasis versicolor is treated with medications called antifungals. They work by killing the fungal cells or stopping them from reproducing. 

Antifungals can be in the form of: 

• shampoos
• creams
• gels 
• tablets 

How effective is pityriasis versicolor treatment?

Treatments for pityriasis versicolor are usually very effective and clear up the condition within 2-4 weeks.

If left untreated, pityriasis versicolor doesn’t usually clear up on its own, so it’s important to get treatment if you have the condition.

How long does it take for pityriasis versicolor treatment to work?

Symptoms of pityriasis versicolor normally improve after around 2 to 4 weeks of treatment, though severe cases may take longer. It can take several months for your skin to return to its normal colour after treatment. 

Can pityriasis versicolor come back after treatment?

It’s common for pityriasis versicolor to come back after treatment. If this occurs, it is normally treated in the same way as previous outbreaks. 

In some cases, your GP may prescribe preventative measures such as using an antifungal shampoo every 2 to 4 weeks, or for 2 to 3 days before travelling to a warm, humid climate.

What pityriasis versicolor treatments are there?

Treatment for mild pityriasis versicolor normally starts with topical antifungals such as shampoos or creams that are applied to the skin. 

If your pityriasis versicolor is severe, covers a large area of skin or doesn’t respond to topical treatments your GP may prescribe antifungal tablets. 

Topical treatments for pityriasis versicolor include: 

• ketoconazole 2% shampoo (Nizoral) —is applied to affected areas, massaged into a lather, and left for 3 to 5 minutes before rinsing off. It is used once a day for 5 days. 
• selenium sulphide 2.5% shampoo (Selsun blue) —is an over-the-counter medicated shampoo. It is diluted with water before being applied to affected areas, worked into a lather, and left for 10 minutes before being washed off. Selenium sulphide 2.5% shampoo is used once a day for 7 to 10 days. It is not suitable for women who are pregnant or breastfeeding.
• Clotrimazole cream 1% —can be applied over small areas of affected skin. It is applied twice a day for 2 to 3 weeks.  
• Miconazole – Topical miconazole can be used to treat ringworm (a fungal skin infection that causes a red scaly rash), tinea cruris (also known as jock itch, a fungal infection of the skin in the groin or buttocks).

Oral antifungal treatments for pityriasis versicolor include: 

• fluconazole (Diflucan) —The normal dose to treat pityriasis versicolor is 50mg a day for 2 to 4 weeks or 300 to 400m per week for one to three weeks. Swallow your fluconazole tablet or capsule whole with water at the same time each day. 
• Itraconazole (Sporanox) —is given at a dose of 200mg per day for 7 days. 

What’s the best treatment for pityriasis versicolor?

The most effective treatment for your pityriasis versicolor depends on many factors like  the severity of your symptoms, whether you have tried other treatments, your general health, and any other medications you are taking. 

Talk to your GP about which pityriasis versicolor treatment is best for you.

What are the side effects of pityriasis versicolor treatment?

Like all medications, pityriasis versicolor treatment can cause side effects in some people. However, most people don’t experience any side effects, or their side effects are mild and go away within a few days. 

If your side effects are bothering you, getting worse or not going away, speak to your GP. 

Always take your medication exactly as directed by a doctor, read the patient information leaflet carefully before starting your medication, and ask your doctor or pharmacist if you have any questions. 

Common side effects of ketoconazole 2% shampoo and clotrimazole 1% cream include: 

• red or irritated skin 
• a burning sensation on the skin 

Common side effects of fluconazole tablets include: 

• headaches
• nausea (feeling sick) 
• vomiting (being sick)
• diarrhoea 
• abdominal (tummy) pain 

Rare side effects of fluconazole tablets include: 

• yellowing of the skin and the whites of the eyes, clay-coloured stools (poo) and dark urine (pee) —this may indicate liver problems. 
• bruising or frequent infections —may be a sign of a blood disorder.
• Irregular or fast heartbeat 

Common side effects of itraconazole tablets include: 

• constipation
• diarrhoea
• flatulence (passing gas more frequently) 
• nausea 
• swelling of the legs or abdomen 

Rare side effects of itraconazole tablets include: 

• shortness of breath and swollen ankles —may be a sign of congestive cardiac failure. 
• numbness and tingling in the hands and feet —may indicate peripheral neuropathy.
• yellowing of the skin and the whites of the eyes, pale-coloured stools (poo) and dark urine (pee) —this may indicate liver problems. 

Rarely, pityriasis versicolor treatments can cause a serious allergic reaction called anaphylaxis. 

Call an ambulance, or go to A&E immediately if you experience: 

• difficulty breathing
• a red, itchy rash that may include blistered, swollen or peeling skin.
• chest tightness 
• swelling of the face, eyelids, tongue, or throat

Who can take pityriasis versicolor treatment?

Pityriasis versicolor treatment is safe for most people, but it may not be safe for everyone. Always tell your doctor about any medical conditions or allergies you have and any other medications you are taking before starting treatment for pityriasis versicolor. 

Ketoconazole 2% shampoo

You should not use ketoconazole 2% shampoo if you: 

• have ever had an allergic reaction to ketoconazole 2% shampoo or any of its ingredients.

Clotrimazole 1% cream

You should not use clotrimazole 1% cream if you: 

• have ever had an allergic reaction to clotrimazole 1% cream or any of its ingredients.

Fluconazole tablets 

You should not take fluconazole tablets if you: 

• have ever had an allergic reaction to fluconazole or any of its ingredients.
• are taking certain other medications including: 
  • astemizole or terfenadine (for allergies) 
  • cisapride (for stomach upsets) 
  • pimozide (for some types of mental illness) 
  • quinidine (for heart arrhythmias) 
  • erythromycin (an antibiotic for treating infections)

Tell your GP before taking fluconazole if you: 

• have, or have ever had problems with your heart, liver, or kidneys
• have abnormal levels of potassium, magnesium, or calcium in your blood 
• are pregnant 

Itraconazole tablets 

You should not take itraconazole tablets  if you: 

• have ever had an allergic reaction to itraconazole or any of its ingredients.
• have heart failure
• are pregnant 

Tell your GP before taking itraconazole if you: 

• have, or have ever had problems with your heart, liver, or kidneys 
• have cystic fibrosis or other lung problems
• have a weakened immune system
• are breastfeeding 

Drug interactions and itraconazole

Itraconazole reacts with many other medications, meaning it is not safe to take them together. Some drug interactions may be life-threatening. 

Tell your GP about any other medications, including vitamins, supplements and over-the-counter medications, before taking itraconazole.

How do I know if I need pityriasis versicolor treatment?

Pityriasis versicolor can resemble other skin conditions such as vitiligo, psoriasis or pityriasis rosea.

If you have symptoms of pityriasis versicolor, make an appointment with your GP or dermatologist to ensure you get the correct diagnosis and treatment. 

Alternatively, you can get an online diagnosis with Superdrug Online Doctor’s Skin Diagnosis service. 

Simply upload a photo of an affected area of your skin, and one of our expert skin doctors will view it and provide a diagnosis, advice, and treatment within 24 hours.

What other treatment options are there?

Home remedies 

Prevention 

Can pityriasis versicolor be cured?

Sources

NHS: Pityriasis versicolor March 15th 2022 (Accessed January 19th 2023) 

Derm.net: Pityriasis versicolor September 2014 (Accessed January 19th 2023) 

NICE CKS: Pityriasis versicolor July 2022 (Accessed January 19th 2023) 

Medicines.Org.emc: Ketoconazole 2% w/w Shampoo October 5th 2015 (Accessed January 19th 2023) 

Medicines.org.emc: Clotrimazole Cream 1% April 27th 2022 (Accessed January 19th 2023) 

Patient: Pityriasis versicolor March 19th 2021 (Accessed January 19th 2023) 

PubMed: An alternative treatment for pityriasis versicolor, tinea cruris, tinea corporis and tinea faciei with topical application of honey, olive oil and beeswax mixture: an open pilot study March 2004 (Accessed January 19th 2023)