A 41-year-old man comes to the physician with a faint skin rash over his upper body. He first noticed it in the spring season, but it worsened during the summer. The patient has mild itching, but otherwise the rash is asymptomatic. He takes omeprazole for acid reflux but his medical history is otherwise unremarkable. He does not use tobacco, alcohol, or illicit drugs. The patient has been sexually active with 2 partners during the last year, and uses condoms on most occasions. The physical examination findings are shown below. Which of the following is the best treatment for this patient?

Question

A 41-year-old man comes to the physician with a faint skin rash over his upper body.  He first noticed it in the spring season, but it worsened during the summer.  The patient has mild itching, but otherwise the rash is asymptomatic.  He takes omeprazole for acid reflux but his medical history is otherwise unremarkable.  He does not use tobacco, alcohol, or illicit drugs.  The patient has been sexually active with 2 partners during the last year, and uses condoms on most occasions.  The physical examination findings are shown below.  Which of the following is the best treatment for this patient?

Quizplus · Accepted Answer

Explanation: The treatment of choice for patients with tinea versicolor is topical anti-fungal therapy. Any anti-yeast topical agent (eg, selenium sulfide, terbinafine, clotrimazole, ketoconazole) can be used. The success rate with topical anti-fungal agents exceeds 80%. With extensive disease or recalcitrant infection, oral antifungals (ketoconazole, itraconazole, or fluconazole) are preferred. Topical terbinafine is effective, but oral terbinafine and oral griseofulvin are ineffective (Choice C). (Choice A) Intramuscular benzathine penicillin G is used for the treatment of primary, secondary, and early latent syphilis. (Choice B) Oral erythromycin has been advocated for use in patients with pityriasis rosea. However, evidence for this practice is mixed and it is not currently recommended. (Choice D) Topical corticosteroids are commonly used in patients with eczema and other non-infectious inflammatory dermatoses. Educational objective: The treatment of choice for tinea versicolor is topical anti-fungal therapy. References: Pityriasis versicolor: a systematic review of interventions. (http://www.ncbi.nlm.nih.gov/pubmed/20956647)

A 41-Year-Old Man Comes to the Physician with a Faint