Tinea faciei – Ringworm on face

Definition

Tinea facei (also called ringworm of the face) is a fungal infection of the face area (excluded the moustache and beard areas of men – called tinea of the barb). It is a condition which is commonly misdiagnosed (more than any other ringworm infections) and wrongly attributed to other diseases (lupus for example).
Tinea faciei pictures
Face Fungus

Cause

The inflammation is usually caused either by Trichophyton rubrum, Trichophyton mentagrophytes of Microsporum canis – all species of fungi.

Tinea faciei is a fairly common disease, which occurs worldwide. However, fungi that cause it like warmer, moister climates so it is more frequent in tropical areas.

Although all ages can be affected by Tinea faciei, two groups of patients show increased incidence: children who come in contact with animals more often (also possible in neonates) and those aged between twenty to forty years.

Pathogenesis: the infectious agents can spread to the skin by direct contact with an external, infected source (a pet mouse for example) or by spreading from another part of the body which is already affected. Sometimes, Tinea faciei can be seen in people practising wrestling.

Symptoms

Most of the patients show round lesions. The scaling (present in less that two thirds of cases), red, elevated periphery of the skin changes points in the direction of a fungal infection. Commonly, patients complain of itching, burning sensations which get worse after being exposed to the sun. The lesions can affect any area of the facial skin and are usually not symmetric to both sides. The most commonly affected parts of the face are as follows: cheeks, nose, area around the eyes, the chin and the forehead. If the patient has previously been using corticosteroid creams (a type of anti inflammatory drug), involvement of hair follicles can be seen. Sometimes, lesions of the facial skin can appear at the same time as the ones on the body or scalp.

Diagnosis

The doctor may perform some small scrapings from the lesion to microscopically determine the involved pathogen. Sometimes a small piece of skin has to be taken to further clarify the origin of the disease. If corticosteroids have been used, cessation of therapy of a few days can make symptoms more prominent and therefore the diagnosis easier.

Differential diagnosis

The disease can be frequently mistaken for seborrhoeic dermatitis, contact dermatitis, the rash seen in Lyme disease, lupus, photo-toxic eruptions, rosacea and skin infections with Candida.

Tinea faciei treatment

if involvement of hair follicles (called fungal folliculitis) is present, or if the infection is widely spread, oral anti fungal treatment is advised. If there is no observed folliculitis, then topical therapy will usually suffice.

Prognosis

The prognosis with this type of infection is usually good and it should respond to treatment in about four to six weeks.

References

Ali, Asra, 2007, Dermatology. New York : McGraw-Hill Medical Pub. Division.

Arnold, Harry L, Odom, Richard B, James, William D and Andrews, George Clinton, 1990, Andrews’ diseases of the skin. Philadelphia : Saunders.

Burns, Tony and Rook, Graham Arthur, 2010, Rook’s textbook of dermatology. Oxford [u.a.] : Wiley-Blackwell.

Fitzpatrick, Thomas B and Wolff, Klaus, 2008, Fitzpatrick’s dermatology in general medicine. New York [u.a.] : McGraw-Hill.

Wolff, Klaus, Johnson, Richard Allen and Fitzpatrick, Thomas B, 2009, Fitzpatrick’s colour atlas and synopsis of clinical dermatology. New York : McGraw-Hill Medical

Emedicine.medscape.com, 2015, Tinea Faciei. [online]. 2015. [Accessed 13 January 2015]. Available from: http://emedicine.medscape.com/article/1118316-overview

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