TINEA VERSICOLOR RESEARCH
Elk Haven Herbals • Research reference • Updated September 2026
About This Research
Tinea versicolor, also called pityriasis versicolor AKA Bermuda rot AKA Hawaiian rot AKA Beach Fungus, is a superficial skin condition associated with Malassezia yeasts. It commonly produces lighter, darker or pinkish patches with fine scaling, especially on the trunk and upper arms. Though it’s recognized more readily in tropical environments it’s presence is worldwide and is a common cause of splotchy skin. Because Malassezia normally lives on healthy skin, treatment is directed at reducing the overgrowth rather than permanently eliminating the organism.
We maintain this page as a running record of the clinical research on tinea versicolor treatment. The literature includes conventional antifungal medicines, keratolytic and other non-specific treatments, newer approaches such as nitric-oxide-releasing preparations, and studies comparing different therapies.
The biggest study so far is the 2023 review of recurrent pityriasis versicolor, which looked at over a decade of studies and organized evidence for topical antifungals, systemic antifungals and non-antifungal approaches.
Read the 2023 recurrent pityriasis versicolor review
What the Research Has Investigated
Clearing the Malassezia overgrowth
Clinical clearing of the visible rash
How quickly different treatments work
Recurrence after treatment
Topical antifungals such as ketoconazole, terbinafine, clotrimazole, luliconazole, econazole and ciclopirox
Non-specific treatments such as selenium sulfide and keratolytic preparations
Oral antifungals such as itraconazole and fluconazole
Nitric oxide / acidified sodium nitrite as a different antifungal mechanism
Safety, irritation and treatment tolerability
Nitric Oxide & Acidified Sodium Nitrite
Featured finding: 87.5% cure with acidified sodium nitrite vs 43.8% with salicylic acid alone after 10 days in a randomized, double-blind tinea-versicolor trial.
2010 — Acidified sodium nitrite in tinea versicolor — A double-blind randomized placebo-controlled trial of 64 patients used a 3% sodium nitrite nitric-oxide-liberating cream with 3% salicylic acid twice daily for 10 days; 87.5% were cured versus 43.8% with 3% salicylic acid alone, a statistically significant difference.
2023 — Recurrent pityriasis versicolor review — The review's treatment table identifies the 2010 sodium-nitrite trial and places its result alongside clinical trials of conventional topical and systemic antifungals.
What the sodium-nitrite result does — and does not — show — The 87.5% versus 43.8% result is a direct comparison against salicylic acid alone, not against ketoconazole, terbinafine, selenium sulfide or another conventional antifungal. It therefore demonstrates a strong result for acidified nitrite in that trial, but does not by itself establish superiority over standard antifungals.
1998 — Acidified nitrite in tinea pedis — An earlier randomized trial found acidified nitrite cream had antifungal activity in athlete's foot, providing clinical evidence for nitric-oxide-based topical antifungal treatment.
Nitric oxide mechanism — Under acidic conditions, nitrite generates nitric oxide and related nitrogen-oxide species that can exert antimicrobial effects, providing a mechanism different from azole and allylamine antifungals.
Ketoconazole & Other Topical Azoles
1998 — Ketoconazole 2% shampoo vs placebo — A large randomized double-blind trial found clinical responses after short ketoconazole shampoo regimens, clearly outperforming placebo.
2016 — Ketoconazole vs luliconazole — A randomized trial reported mycological cure of 72.5% with ketoconazole 2% cream and 92.5% with luliconazole 1% cream after treatment.
2015 — Dapaconazole vs ketoconazole — A randomized double-blind Phase II trial reported clinical and mycological cure rates of 92.6% and 84.6% with dapaconazole 2% cream in the reported analysis, compared with ketoconazole 2% cream.
2018 — Eberconazole vs terbinafine — A randomized comparative study reported complete healing in 80% with eberconazole 1% and 63.33% with terbinafine 1% after two weeks.
Topical azoles as a group — Systematic reviews generally find established topical azoles effective for tinea versicolor, although individual trials can produce different cure rates.
Direct Comparisons Between Common Antifungals
2014 — Terbinafine 1% vs ketoconazole 2% — In a randomized comparative study, cure rates at four weeks were 81.2% with terbinafine and 69% with ketoconazole; at eight weeks they were 70.8% and 61.9%, respectively.
2016 — Ketoconazole 2% vs luliconazole 1% — Mycological cure was reported as 72.5% and 92.5%, respectively.
2018 — Eberconazole 1% vs terbinafine 1% — Complete healing was reported as 80% and 63.33%, respectively.
2019 — Fluconazole + ketoconazole vs itraconazole vs ketoconazole alone — Among 240 patients, clinical cure at four weeks was 62.4% with weekly fluconazole plus ketoconazole foam, 36.3% with itraconazole alone, and 37.5% with ketoconazole foam alone; negative mycological examination rates were 81.3%, 66.3% and 60.0%, respectively.
2010 — Single-dose fluconazole vs clotrimazole — A randomized double-blind study reported complete clinical response in 49.1% with single-dose fluconazole and 30% with topical clotrimazole, with incomplete response more common in the clotrimazole group.
Selenium Sulfide & Keratolytic Treatments
Selenium sulfide vs ketoconazole — Comparative trials generally find both effective, with some studies showing similar mycological cure rates.
Azoles vs keratolytic agents — A pooled analysis of randomized trials did not find a statistically significant difference in clinical cure between topical azoles and keratolytic treatments, although the evidence quality was very low.
Older controlled-treatment evidence — A large systematic review of controlled trials found many topical treatments effective compared with placebo, while also noting limitations in the quality and reporting of older studies.
Oral Antifungals
Fluconazole — Randomized trials support fluconazole for tinea versicolor, particularly when systemic treatment is being considered.
Itraconazole — Clinical studies support itraconazole for extensive or recurrent disease and have also examined intermittent dosing for prevention of recurrence.
Oral ketoconazole — Older studies demonstrated efficacy, but modern practice avoids oral ketoconazole because of potentially serious liver, adrenal and drug-interaction risks.
Oral terbinafine — Reviews generally do not favor oral terbinafine for tinea versicolor because it does not achieve adequate antifungal concentrations in the stratum corneum.
Recurrence & Prevention
Recurrence is common — Because Malassezia is part of normal skin flora, successful treatment does not permanently eliminate the organism.
2020 — Itraconazole prevention study — A randomized study examined monthly preventive itraconazole after an initial treatment course and found lower recurrence measures than placebo during follow-up.
Maintenance treatment — The 2023 review notes that prophylactic treatment may be useful in patients with frequent recurrence and discusses both antifungal and non-antifungal maintenance approaches.
Other / Experimental Approaches
2020 — Adapalene + ketoconazole — A randomized study found the combination improved outcomes compared with either treatment alone in the reported analysis.
2018 — Narrow-band UV-B — A small study of extensive or recurrent disease reported substantial improvement in many participants, although some responders relapsed during follow-up.
2021 — 308-nm excimer laser — A small study of treatment-unresponsive cases reported high improvement, with recurrence observed during follow-up.
2020 — Tea tree oil preparation vs tioconazole — A comparative study reported clinical healing with both approaches, with the tea-tree-oil preparation showing a higher reported healing percentage.
2020 — Methylene-blue photodynamic therapy — A four-patient case series reported complete clinical and mycological cure without relapse during six months of follow-up.
2017 — Tacrolimus vs clotrimazole — A randomized study reported similar complete global cure percentages for tacrolimus and clotrimazole, although these results do not establish tacrolimus as a replacement for antifungal treatment.
2012 — Polyherbal formulation vs sodium thiosulfate — A small randomized single-blind study reported high clinical and mycological cure rates for both treatments.
What the Research Suggests So Far
Topical antifungal treatments have substantial clinical evidence behind them, particularly azoles and other established topical antifungals.
Selenium sulfide and other keratolytic approaches have also been studied extensively.
Different conventional antifungals can produce similar overall outcomes, although individual head-to-head studies sometimes show meaningful numerical differences.
Acidified sodium nitrite is particularly interesting because it represents a different antifungal mechanism.
The 2010 sodium-nitrite trial produced an 87.5% cure rate versus 43.8% with salicylic acid alone after 10 days.
That sodium-nitrite trial did not directly compare nitrite with ketoconazole, terbinafine or selenium sulfide, so superiority over those agents cannot be inferred from that study.
Oral fluconazole and itraconazole have clinical evidence for situations where systemic treatment is appropriate, while oral ketoconazole and oral terbinafine have important limitations.
Visible pigment changes can persist after Malassezia has been cleared, so clinical appearance and mycological cure are not always the same thing.
Recurrence is common because Malassezia normally lives on human skin, which is why prevention and maintenance have been studied separately from treatment of an active episode.
The strongest evidence remains concentrated around established antifungal and keratolytic treatments; nitric oxide, photodynamic therapy and botanical approaches are less extensively studied.
Why We Keep Updating This Page
Tinea versicolor research continues to compare established antifungals, alternative mechanisms and different treatment schedules. We maintain this page as a living reference so readers can see the underlying research rather than relying on a single treatment claim.
New studies can change what we know about effectiveness, recurrence, tolerability and mechanisms of action. When relevant clinical trials or systematic reviews are published, they can be added to this page.
Important Research Note
This page summarizes published research and is not medical advice. Treatment choice can depend on diagnosis, extent of disease, recurrence, age, pregnancy, medications and other health factors. The research also uses different definitions of clinical cure and m