Follow-Up on Tinea Versicolor: A Case Study by Dr. Caroline Vaughn
By. Dr. Caroline Vaughn
Introduction
in November 2023, I evaluated a 29-year-old female patient presenting with tinea versicolor. This common fungal infection, caused by an overgrowth of yeast on the skin, was localized to the left inferior anterior neck, middle sternum, and superior thoracic spine. During her initial visit, I prescribed a comprehensive treatment plan aimed at tackling the infection from both systemic and topical angles. Today, we will review her progress, reinforce key aspects of her treatment, and provide further counseling on managing this condition.
Initial Treatment Plan Recap
To address the widespread nature of her tinea versicolor, the following regimen was prescribed:
Fluconazole 200 mg tablets:
Two tablets taken weekly with an acidic drink (e.g., orange juice), followed by an hour of sweating to enhance medication absorption.
Duration: 4 weeks.
Ketoconazole 2% Topical Cream:
Applied once daily to affected areas for 2 weeks.
Ketoconazole 2% Shampoo:
Used once weekly, applied to the rash and left on for 3-5 minutes before rinsing.
This multi-faceted approach was designed to combat the infection locally and systemically, ensuring maximum effectiveness.
Follow-Up Findings and Continued Management
During today’s follow-up, the patient reported some improvement but noted that mild discoloration and itching persist. We reviewed her adherence to the treatment plan, and she confirmed compliance. To ensure complete resolution and prevent recurrence, I advised the patient to continue with the following:
Fluconazole 200 mg tablets: Continue the weekly regimen as outlined, ensuring proper hydration and following each dose with an acidic beverage for optimal absorption.
Ketoconazole 2% Shampoo: Maintain weekly application to manage the yeast on the skin's surface.
Ketoconazole 2% Topical Cream: Resume for another 2-week course if any residual rash persists.
Patient Counseling and Education
Understanding Tinea Versicolor
I explained to the patient that tinea versicolor is a common condition, especially in young adults, often triggered by heat, humidity, and excessive sweating. While easily treatable, it can recur, particularly in individuals prone to sweating or those living in warm climates.
Preventative Skin Care
Patients are encouraged to incorporate medicated shampoos containing zinc pyrithione, selenium sulfide, or ketoconazole into their skincare routine, even after the rash clears. These can be used weekly to help prevent recurrence.
When to Contact the Office
The patient was advised to reach out if:
The infection spreads despite adherence to the treatment plan.
New symptoms, such as severe itching or discomfort, develop.
Signs of an allergic reaction or adverse medication effects arise.
Medication Counseling
Ketoconazole
I discussed the importance of pairing oral antifungals with acidic drinks to improve absorption and highlighted potential side effects, such as:
Mild: Headache, nausea, upset stomach.
Rare but severe: Liver function abnormalities, including possible liver failure.
The patient understands the need for periodic liver function tests (LFTs) if prolonged treatment is required.
Fluconazole
Similarly, we reviewed the possible side effects of fluconazole, including gastrointestinal discomfort and headache. Rare but severe risks like liver or kidney issues were emphasized, with the patient agreeing to contact the office if any unusual symptoms occur.
Next Steps
The patient received refills to complete the prescribed course of treatment:
Fluconazole 200 mg tablets: 8 tablets for the 4-week course.
Ketoconazole 2% Topical Cream: 60 g with 1 refill for extended use if needed.
Ketoconazole 2% Shampoo: 120 mL with 11 refills for maintenance therapy.
The patient left today’s visit well-informed and confident in her treatment plan. We will continue to monitor her progress and provide additional support as needed.
Conclusion
Tinea versicolor is a manageable condition with the right combination of medications and preventative care. By adhering to treatment and maintaining healthy skin practices, patients can effectively control this condition and reduce the likelihood of recurrence. For any concerns or questions, I’m always here to guide my patients toward healthier skin.
Dr. Caroline Vaughn