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Recurrent tinea versicolor: treatment with itraconazole or fluconazole?

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Report by

Anastasia Pantazidou, Senior House Officer, Department of Paediatrics, North Middlesex Hospital, London, UK;

Checked by

Marc Tebruegge, Specialist Registrar, Department of Paediatric Infectious Diseases, St Mary’s Hospital, London, UK

A 14-year-old girl is seen in the paediatric outpatient department. She was referred by her general practitioner (GP) with persistent tinea versicolor. The GP had previously treated her with topical clotrimazole over the last few years with varying degree of success. The girl has recently returned from a trip to South America during which she experienced an exacerbation of her symptoms.

On examination you find multiple oval to round shaped lesions which are hypopigmented with superficial scaling, that appear particularly prominent in the axillary region and around the neck. The girl tells you that these areas had previously been darker than the surrounding skin, which was more obvious during the winter months. Under Wood’s light examination the lesions appear fluorescent yellow. You obtain samples for microbiological confirmation but concur with the GP that this is tinea versicolor.

The girl expresses her distress about her external appearance and is very keen to finally get rid of this problem. You wonder whether oral antifungal agents may provide a more effective alternative to topical treatment and consult the British National Formulary for Children (BNFC 2006). The formulary states that oral itraconazole should be considered if …

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