Mycoses 2017; 1–5 wileyonlinelibrary.com/journal/myc | 1 © 2017 Blackwell Verlag GmbH Received: 6 September 2016 | Revised: 11 November 2016 | Accepted: 19 December 2016 DOI: 10.1111/myc.12598 ORIGINAL ARTICLE Comparatve efcacy of topical applicaton of tacrolimus and clotrimazole in the treatment of pityriasis versicolor: A single blind, randomised clinical trial Mozhdeh Sepaskhah 1 | Maryam Sadat Sadat 1 | Keyvan Pakshir 2 | Zahra Bagheri 3 1 Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran 2 Basic Sciences in Infectous Diseases Research Center, Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran 3 Department of Biostatstcs, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran Correspondence Mozhdeh Sepaskhah, Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Email: sepaskhah_m@yahoo.com Funding informaton Research deputy of Shiraz University of Medical Sciences, Grant/Award Number: 91-01-01-5510. Summary Background: Pityriasis versicolor (PV) is a common superfcial fungal disease. Possibility of emergence of resistant strains to azoles, and difculty in diferentaton of hypopig- mented PV and early vitligo, encouraged us to evaluate the efcacy of topical tacroli- mus (a calcineurin inhibitor agent with proven in vitro ant-Malassezia efect) for PV treatment generally and its efect on PV-induced hypopigmentaton specifcally. Objectves: To evaluate the efcacy of topical tacrolimus on pityriasis versicolor. Patents/Methods: Fify PV patents were randomly allocated into two equal groups applying either topical clotrimazol or tacrolimus twice daily for 3 weeks. They were evaluated at the beginning of study, in the third and ffh weeks clinically and mycologi- cally (direct smear). Results: Although both treatments resulted in global, clinical, and mycological cure of PV, there was no signifcant diference regarding the mentoned aspects of cure be- tween tacrolimus and clotrimazole treated patents. (P-value: .63, .45, and .26, respec- tvely) Tacrolimus had no signifcant efect on hypopigmentaton in the ffh week follow-up. (P-value: .62). Conclusions: In spite of the lack of efcacy of tacrolimus on PV-induced hypopigmen- taton, the therapeutc efect on PV introduces tacrolimus as a therapeutc opton for PV, especially when early vitligo is among the diferental diagnoses without concern- ing the aggravatng efect of topical cortcosteroids on PV. KEYWORDS antfungal agents, clotrimazole, pityriasis versicolor, skin infecton, tacrolimus, treatment, yeast 1 | INTRODUCTION Malassezia species are involved in the pathogenesis of several skin disorders. 1 In additon to direct fungal infectons like pityriasis versi- color and pityrosporum folliculits, Malassezia species are considered (although controversially in some instances) in the pathogenesis of some infammatory skin diseases; especially, atopic dermatts, sebor- rhoeic dermatts and psoriasis. 2 Besides many topical and systemic medicatons tried with vari- able efcacies to treat Malassezia-associated diseases, including azole agents (ketoconazole, fuconazole, itraconazole, pramiconazole, dapaconazole, clotrimazole, miconazole, futrimazole), ciclopirox olamine, selenium sulphide, adapalene, zinc pyrithione, propylene glycol and terbinafne, 3–14 in vitro ant-Malassezia efect of calcineurin inhibitors (tacrolimus and pimecrolimus) has been evaluated. 15,16 Tacrolimus is a macrolide antbiotc discovered as a metabolite of fungus Streptomyces tsukubaensis. It is a prodrug that afer intracellu- lar actvaton and combining with FK506-binding protein 12 (FKBP12) eventually targets calcineurin phosphatase. Calcineurin phospha- tase dephosphorylates the calcineurin-dependent transcripton fac- tor (Crz1) and enables it to be translocated into the nucleus where it actvates the transcripton of genes involved in the regulaton of