What are the recommended topical treatments for managing pityriasis versicolor in adults?

Recommended topical treatments for managing pityriasis versicolor in adult patients include:

• Ketoconazole 2% shampoo: Apply once daily for up to 5 days. The shampoo should be lathered and left on the affected skin for 3–5 minutes before rinsing off thoroughly. This is the most extensively studied topical treatment and is widely recommended as first-line therapy.
• Selenium sulphide 2.5% shampoo (off-label): For non-pregnant adults, apply once daily for 7 days (one or two applications may be sufficient). The shampoo should be lathered and left on the skin for 10 minutes before rinsing off. It is more likely to cause skin dryness and irritation than ketoconazole shampoo, and dilution with water may reduce irritation.
• Topical imidazole antifungal creams (such as clotrimazole, econazole, or ketoconazole): These can be applied twice daily for up to 2–3 weeks and are an alternative when only small areas are involved or when shampoos are impractical.

Additional important points: Do not prescribe topical or oral corticosteroids as they are not recommended and may worsen the condition. Recurrence is common, and re-treatment is usually appropriate. For prevention of recurrence, ketoconazole shampoo once every 2–4 weeks for up to 6 months can be considered.

In pregnancy, clotrimazole cream is preferred, and ketoconazole shampoo may be used; selenium sulphide shampoo and oral antifungals are not recommended.

Following treatment, skin discoloration may take several weeks or months to resolve fully.

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