A dark-skinned 14-year-old adolescent presents with a nonpruritic rash with loss of pigment; The PNP diagnoses tinea versicolor and treats with:

A dark-skinned 14-year-old adolescent presents with a nonpruritic rash with loss of pigment; The PNP diagnoses tinea versicolor and treats with:

• A. Systemic ketoconazole and steroid cream
• B. Selenium sulfide shampoo and systemic ketoconazole
• C. Steroid cream and erythromycin
• D. Silver sulfadiazine cream and an antihistamine

Answer: (B)

Tinea versicolor is a superficial fungal infection of the skin (Malassezia species) that causes nonpruritic hypo- or hyperpigmented macules, which is common in darker-skinned adolescents. Treating it requires antifungal therapy that clears the yeast on the skin. Selenium sulfide shampoo is a topical antifungal that reduces the yeast on the skin and helps resolve pigment changes when applied to the affected areas. For more extensive disease or if topical therapy alone isn’t enough, adding an oral antifungal like ketoconazole provides systemic coverage. Using both approaches addresses both surface colonization and deeper skin involvement, which is why this combination is the best choice. Steroid creams are avoided in fungal infections because they can suppress the local immune response and worsen or mask the infection. Erythromycin (an antibiotic) won’t treat a fungus. Silver sulfadiazine is used for burns, not tinea versicolor, and antihistamines don’t address the fungal cause.

Tinea versicolor is a superficial fungal infection of the skin (Malassezia species) that causes nonpruritic hypo- or hyperpigmented macules, which is common in darker-skinned adolescents. Treating it requires antifungal therapy that clears the yeast on the skin.

Selenium sulfide shampoo is a topical antifungal that reduces the yeast on the skin and helps resolve pigment changes when applied to the affected areas. For more extensive disease or if topical therapy alone isn’t enough, adding an oral antifungal like ketoconazole provides systemic coverage. Using both approaches addresses both surface colonization and deeper skin involvement, which is why this combination is the best choice.

Steroid creams are avoided in fungal infections because they can suppress the local immune response and worsen or mask the infection. Erythromycin (an antibiotic) won’t treat a fungus. Silver sulfadiazine is used for burns, not tinea versicolor, and antihistamines don’t address the fungal cause.