If a patient’s KOH is negative and/ or the patient does not respond to treatment for tinea versicolor (which includes topical or oral antifungals), a trial of oral antibiotics for CRP may be reasonable. Response to an oral antibiotic, such as minocycline, will help to confirm the diagnosis. Although most patients with CRP do not have an endocrine disorder, it’s a good idea to keep this reported association in mind, and perform further testing, as needed.
Oral minocycline is the treatment of choice
The preferred treatment for CRP is oral minocycline (100 mg orally twice a day for 6 weeks).1,2 Oral azithromycin, erythromycin, clarithromycin, tetracycline, cefdinir,3 roxithromycin,5 doxycycline,2 and amoxicillin6 have also been used. Isotretinoin is an effective alternative to oral antibiotics, but clinicians often avoid it because of the adverse side effect profile.
With oral antibiotic therapy, the patient may completely clear and stay clear, or go on to have multiple recurrences or exacerbations. Topical retinoids have also been used with some success,4 but most reported cases have been successfully treated with oral antibiotics.1
Our patient required Tx for several months
We initially treated our patient with doxycycline (100 mg orally twice a day) for 1 month. The lesions cleared after 2 weeks and then recurred during week 4 of treatment. We discontinued the doxycycline, and started the patient on minocycline. The primary lesions resolved after 5 weeks of minocycline, though we noted residual post-inflammatory hyper-pigmentation (FIGURE 2). Our patient continued the medication for an additional 8 weeks. He was lost to follow-up.
FIGURE 2
Weeks later, hyperpigmentation remains
Correspondence
Kendall Lane, MD, LCDR, MC, United States Navy, Navy Medical Center San Diego, 34520 Bob Wilson Drive, Suite 300, San Diego, CA 92134