Tinea barbae ringworm affects the facial hair (like the beard area)
Tinea barbae is a condition also known as Tinea sycosis or barber’s itch. Because of the specificity of the involved areas and structures (beard and moustache areas with invasion of hairs) it is a disease of adult males. It is not a very common infection, mostly affecting people working in the agriculture field (more common if working in contact with farm animals – cattle, horses or dogs may be the source). The shift of prevalence towards farmers and ranchers occurred after hygiene in barbers shops improved and the transmission by infected razors decreased. On general, Tinea barbae can be caused by fungi which have adopted to animal or human hosts (in Latin they are called zoophilic and antropophilic species respectively).
Usually two types of clinical presentation are recognised:
- the first type, where deep, nodular, suppurative (suppuration means the formation or discharge of pus) lesions are seen. This type develops slowly, with nodular thickening of the involved skin and swelling that reminds of kerion (a severe ringworm infection of the scalp). The most common causative pathogens are Trichophyton mentagrophytes and Trichophyton verrucosum – both types of fungi. The affected skin is visibly inflamed, the present swellings diffuse. The hairs may be absent or very loose, from the remaining follicular openings pus might be expressed. Usually the lesions are confined to one part of the face or neck skin.
- the second type, where more superficial, crusted and partially bald patches with folliculitis (inflammation of a hair follicle) can be observed. The inflammation usually appears to be milder in nature and the affected hairs can sometimes be extracted with ease. If loss of hairs is present, it usually reverses with therapy. The involved pathogens include Trichophyton violaceum and Trichophyton rubrum, just rarely Epidermophyton floccosum.
In most of the cases the lesion is present on one side of the face or neck and involves the beard area (rarely moustache area and upper lip). The area appears to be itchy, tender and painful.
Diagnosis of Tinea barbae
the diagnosing process starts with the mandatory clinical inspection which in most cases suggests the underlying fungal infection. It is confirmed by microscopically examining the hairs extracted from the affected part of the skin (treated with potassium hydroxide) or by performing a skin biopsy. In some cases the doctor can make an attempt to grow a fungal culture (plant the extracted hair or a piece of skin in the appropriate medium), although this is rarely performed.
Differential diagnosis of Tinea barbae: when barber’s itch is suspected, two conditions with a fairly similar presentation must be kept in mind:
- Inflammation of the hair follicles caused by bacteria called Staphylococci (in Tinea barbae there is usually no involvement of the upper lip and the lesions appear to be confined to one side)
- Herpetic infections (lesions seen with herpes virus appear to be umbilicated – have a central depression)
- Acne vulgaris, rosacea, contact dermatitis, perioral dermatitis or candidal folliculitis
Treatment of Tinea barbae
Although some forms of Tinea can be cured with topical agents this is not one of those cases. The infection show tendencies of spontaneous healing but can, however, persist for months. With barber’s itch systemic, orally taken anti fungals must be prescribed by a doctor and local creams serve merely as part of an adjunctive (joined) therapy.
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