Ringworm of the beard, tinea sycosis, "barber's itch"

Tinea barbae is a colonization of the bearded areas of the face and neck, hence being restricted to adult males. The most common causes are T. mentagrophytes and T. verrucosum.

Zoophilic organisms are acquired from contact with cattle, dogs and other animals, therefore classically seen among dairy farmers and cattle ranchers. However, where not antiseptic techniques are used, person-to-person transmission can occur by being shaved in the barbershop [1996]!

Lesions are of three types: a) a mild superficial form, b) inflammatory, deep, pustular, kerion-like, and c) the circinate, spreading form.

The superficial variety causes diffuse erythema and perifollicular papules and pustules, looking exactly like bacterial folliculitis. Hair of the area may be affected with endothrix invasion that causes brittle, lusterless hair.

Cases of the inflammatory type usually cause unilateral involvement of the chin, neck or maxillary area with upper lip sparing. Nodular lesions covered with crusts and seropurulent material end up having an abscess-like appearance. Hairs become loose and brittle. Permanent alopecia and important scarring may be the final consequences.

Finally, the circinate variety has a spreading vesiculopustular border with central scaling, like tinea circinata [1447].

In contrast with other dermatophytoses, tinea barbae should be treated with systemic antifungal agents. Several options are available including: griseofulvin, ketoconazole, fluconazole, itraconazole, and terbinafine. These agents are given as regular doses for 2 to 3 weeks until clinical resolution is achieved. Some patients may need either intralesional or a short course of oral corticosteroid. Because bacterial superinfection is common, systemic antibiotic treatment may be required [616].

Microsporum canis
Microsporum gypseum
Trichophyton megninii
Trichophyton mentagrophytes
Trichophyton rubrum
Trichophyton schoenleinii
Trichophyton verrucosum
Microsporum nanum

Animals, humans, soil

Kerion of Scalp caused by
Microsporum gypseum

References

616. Drake, L. A., S. M. Dinehart, E. R. Farmer, R. W. Goltz, G. F. Graham, M. K. Hordinsky, C. W. Lewis, D. M. Pariser, J. W. Skouge, S. B. Webster, D. C. Whitaker, B. Butler, B. J. Lowery, B. E. Elewski, M. L. Elgart, P. H. Jacobs, J. L. Lesher, Jr., and R. K. Scher. 1996. Guidelines of care for superficial mycotic infections of the skin: tinea capitis and tinea barbae. Guidelines/Outcomes Committee. American Academy of Dermatology. J Am Acad Dermatol. 34:290-4.

1447. Martin, A. G., and G. S. Kobayashi. 1993. Fungal diseases with cutaneous involvement, p. 2421-2451. In T. B. Fitzpatrick (ed.), Dermatology in general medicine, vol. 2. McGraw-Hill, New York.

1996. Sabota, J., R. Brodell, G. W. Rutecki, and W. L. Hoppes. 1996. Severe tinea barbae due to Trichophyton verrucosum infection in dairy farmers. Clin Infect Dis. 23:1308-10.