A 19-year-old man develops hypopigmented patches on the trunk. What is the most appropriate fungal treatment?

• A. Ketoconazole 2% shampoo, apply once daily for up to 5 days, leaving on for 3-5 minutes before rinsing
• B. Terbinafine cream twice daily for 2 weeks
• C. Hydrocortisone cream twice daily
• D. Miconazole oral suspension

Answer: (A)

Tinea versicolor is the likely cause of hypopigmented patches on the trunk in a young adult, caused by Malassezia yeast. The best treatment is an antifungal that specifically targets this yeast and can cover large areas of the trunk. Ketoconazole is an azole antifungal with strong activity against Malassezia. Using a 2% ketoconazole shampoo as a topical treatment—applied to the affected skin, left on for a few minutes, then rinsed, for up to five days—provides effective antifungal exposure over the body surface and is a common, convenient option for tinea versicolor.

Hydrocortisone would not address the fungal infection and could worsen it by suppressing local immunity. Miconazole oral suspension is unnecessary systemic therapy for a localized skin condition. Terbinafine cream targets dermatophytes more than Malassezia, so it’s less reliable for tinea versicolor than ketoconazole.