Inflammatory and non-inflammatory TB have to be distinguished clinically.

The former is caused by zoophilic dermatophytes and is associated with hardened efflorescences such as plaques and nodules. These efflorescences may be scattered throughout the affected area or concentrate in certain spots. In most cases, symptoms are first noted in the bearded areas of chin and neck and subsequently spread to the cheeks. Only severe TB comprises the entire bearded area of face and neck from the start. The lips are rarely affected.

Efflorescences are further characterized by their reddish color and the presence of pustules and sinuses on their surface. All over the affected area, hair becomes loose and can easily be removed. Upon closer inspection of such hair, it can be observed that hair roots are involved in a pus-like mass. The hair shaft is often broken.

In advanced stages of the disease, exudate starts to cover plaques and nodules and forms crusts. Also, systemic symptoms such as disturbed general condition, fever and lymphadenopathy may be developed.

Non-inflammatory TB is caused by anthropophilic dermatophytes. It occurs less frequently than inflammatory TB. Here, papules and crusts delimit erythematous spots. As is the case in inflammatory TB, infected hair tends to break. Patients suffering from chronic forms of non-inflammatory TB may present with small pustules affecting the hair follicles.

Of note, TB may run an asymptomatic course, but pruritus is usually present. In rare cases, tinea blepharociliaris may be observed in TB patients [8].

• Inflammation

  Corticosteroids are sometimes used in addition to antifungal creams to help relieve itching and inflammation. [merckmanuals.com]

  Generally, the infection occurs as a follicular inflammation, or as a cutaneous granulomatous lesion, i.e. a chronic inflammatory reaction. [commons.wikimedia.org]

  Tinea barbae causes inflammation on the skin because fungi not only infest the hair but even the follicles of hair. Similarly, there are several types of dermatophytes that cause tinea barbae such as zoophilic. [natural-homeremedies.org]

  The patient developed a severe phlegmoneous inflammation of the bearded part of the face. Later, the patient was successfully treated by a combination of itraconazole and fluconazole. [read.qxmd.com]

  […] dermatophytes; in children, usually due to Trichophyton, Microsporum and Epidermophyton ( Am Fam Physician 2008;77:1415 ) Kerion celsi: superimposed bacterial folliculitis on tinea of scalp Majocchi granuloma: nodular granulomatous perifolliculitis; inflammation [pathologyoutlines.com]

• Asymptomatic

  The annular lesions have scales at their periphery. tinea incognita Tinea corporis that grows rapidly and in unusual patterns after the use of topical steroids. tinea kerion Kerion. tinea nigra An asymptomatic superficial fungal infection that affects [medical-dictionary.thefreedictionary.com]

  Most often, there is little or no inflammation; asymptomatic or mildly itching lesions with a scaling, slightly raised border remit and recur intermittently. [merckmanuals.com]

  A laboratory abnormality with elevated liver function tests was observed in one (5.9%) of 17 patients; this was asymptomatic, and reversible. No patient discontinued therapy. [researchgate.net]

• Swelling

  Tinea barbae: A fungal infection (known as ringworm) of the bearded area of the face and neck, with swelling and marked crusting, often with itching. In the days when men went to the barber daily for a shave, tinea barbae was called barber's itch. [medicinenet.com]

  * Condition results in fungal spores on the outside of the coarse facial hair, and with swelling, red lumpy areas, pus-filled blisters, and crusting around the hair, but is not excessively itchy or painful. [ozarkderm.com]

  […] follows: Trichophyton mentagrophytes Trichophyton verrucosum Trichophyton rubrum Trichophyton violaceum Microsporum canis T. tonsurans T. megninii Symptoms and Treatment Typical symptoms of tinea barbae are a pimple or blister amongst affected area, swelling [creative-biolabs.com]

• Fever

  Associated symptoms including enlargement of neck lymph nodes, body pains, and fever often occur with kerion. The incidence of tinea barbae has dropped because of sanitation and hygiene. It is, however, still common in warm and humid countries. [wisegeek.com]

  Painful regional swelling of the lymph nodes, possible disturbance of the general condition with fever. Tinea barbae is often preceded by several months of therapy with external corticoids. Wet shaving promotes the spread of the pathogens. [altmeyers.org]

  Besides, loose or broken hair, depilation, and some constitutional symptoms as fever, malaise, and regional lymphadenopathy can also be present. [creative-biolabs.com]

  […] include: Severe pustular eruptions on chin, cheeks and bearded parts of the neck Deep inflammatory or non inflammatory plaques Hair appears loose or broken, and can be pulled out easily Patches exudates pus and appear crusty or scaly and may be itchy Fever [ringworm-treatment.net]

• Lymphadenopathy

  Regional lymphadenopathy can occur if the infection has been long standing or is superinfected. [visualdx.com]

  Besides, loose or broken hair, depilation, and some constitutional symptoms as fever, malaise, and regional lymphadenopathy can also be present. [creative-biolabs.com]

  The child with tinea capitis will generally have cervical and suboccipital lymphadenopathy, and the physician may need to broaden the differential diagnosis if lymphadenopathy is absent.7 However, lymphadenopathy can also occur in nonfungal scalp disease [aafp.org]

  Clinical presentation Round, pruritic scaly plaques with broken hair shafts or alopecia in affected areas May mimic seborrheic dermatitis Kerion: severe form of tinea capitis characterized by a deep, boggy plaque with pustule formation Postauricular lymphadenopathy [amboss.com]

• Diarrhea

  They also may cause side effects such as headache, diarrhea, nausea and abdominal pain. Gram-negative folliculitis. [knowyourdisease.com]

• Papule

  FIGURE 1: (a) Erythematous papules on the right malar and erythematous nodular-cystic lesions in the beard area. (b) Erythematous papules and erythematous nodular-cystic lesions in the beard area. [scielo.br]

  Folliculitis Presentation is with multiple small papules and pustules with an erythematous base that are pierced by a hair in the center. [explainmedicine.com]

  It begins with red, slightly elevated scaly patches that on examination reveal minute vesicles or papules. New patches spring from the periphery while the central portion clears. There is often considerable itching. [medical-dictionary.thefreedictionary.com]

• Alopecia

  […] by scaling lesions with a vesiculopustular border on the bearded areas of the face and neck. true or false: The deep pustular type has deep, follicular pustules on the bearded areas of the face and neck that result in nodular keloids and kerions with alopecia [quizlet.com]

  Differential diagnosis of dermatophytoses includes Folliculitis decalvans (a rare, scarring alopecia in which a patch of alopecia with pustules enlarges) Bacterial pyodermas Dissecting cellulitis Topical or oral antifungals Sometimes corticosteroids Topical [merckmanuals.com]

  Permanent scarring and alopecia are possible sequelae. Involved hairs are often loose and easily removed with tweezers. Regional lymphadenopathy can occur if the infection has been long standing or is superinfected. [visualdx.com]

  Clinical appearance is variable, including scaly, crusting, pustules and/or black dot alopecia. Tinea unguium (onychomycosis)[6]: Onycholysis or separation of the nail from the nail bed commonly occurs. [patient.info]

• Skin Disease

  CONTINUE SCROLLING OR CLICK HERE SLIDESHOW Rosacea, Acne, Shingles, Covid-19 Rashes: Common Adult Skin Diseases See Slideshow [medicinenet.com]

  See: illustration TINEA CRURIS tinea cruris A fungus skin disease of surfaces of contact in the scrotal, crural, anal, and genital areas. [medical-dictionary.thefreedictionary.com]

  A wealth of new features makes it easier, than any other resource, to identify, treat, and manage the full range of skin diseases. Presents outstanding photographs for virtually every common skin disorder. [books.google.ro]

• Blister

  * Condition results in fungal spores on the outside of the coarse facial hair, and with swelling, red lumpy areas, pus-filled blisters, and crusting around the hair, but is not excessively itchy or painful. [ozarkderm.com]

  […] are anthropophilic organisms as follows: Trichophyton mentagrophytes Trichophyton verrucosum Trichophyton rubrum Trichophyton violaceum Microsporum canis T. tonsurans T. megninii Symptoms and Treatment Typical symptoms of tinea barbae are a pimple or blister [creative-biolabs.com]

  Within eight hours to five days of exposure to the bacteria, a rash of red, round, itchy bumps will appear that later may develop into small pus-filled blisters (pustules). [pharmacypedia.org]

• Skin Rash

  MORE RELATED WORDS FOR TINEA BARBAE barber's itch noun facial skin rash sycosis sycosis barbae tinea barbae Roget's 21st Century Thesaurus, Third Edition Copyright © 2013 by the Philip Lief Group. [thesaurus.com]

  Athlete's foot causes itching, burning and cracked skin between your toes. Jock itch causes an itchy, burning rash in your groin area. [icdlist.com]

  Tinea Barbae is mainly transmitted by using shaving razors that have been used by someone else probably by someone who has had an infection resulting in an itchy skin rash around the cheek and the jaw area where maximum amount of beard grows. [epainassist.com]

  Causes of Tinea Barbae Tinea barbae is also known as barber’s itch because it was mainly transmitted during shaving with shared razors by barbers and the resulting skin rash is itchy. [healthhype.com]

• Scalp Mass

  Tinea barbae may also occur as an inflammatory kerion (a large, boggy scalp mass caused by a severe inflammatory reaction to the dermatophyte) that can result in scarring hair loss. [msdmanuals.com]

• Irritability

  Commonly affects neck and beard area due to jewelry. [1],[2],[4] Irritant contact dermatitis Strong irritants elicit an acute reaction after brief contact and diagnosis is usually obvious. [explainmedicine.com]

  When the fungal infection sets in, the result is a ring-shaped red or white mark on the scalp or skin, causing itchiness, irritation, and even hair loss if the damage to the follicle is significant enough. [drnikko.com]

  The moisturizer can alleviate skin irritation and prevent excessive dryness of the skin. Dryness can exacerbate skin irritation. Use a fresh razor when shaving or switch to an electric razor, suggests Mayo Clinic. [livestrong.com]

  It is a skin condition that can also cause redness and irritation of the skin. Most of the time, using a dandruff shampoo can help control your dandruff. If that does not work, contact your health care provider. [icdlist.com]

• Confusion

  Differential diagnosis[7] Other annular rashes are often confused with tinea infections. Eczema and psoriasis are commonly confused with tinea. [patient.info]

  For example, tinea corporis can be confused with eczema, tinea capitis can be confused with alopecia areata, and onychomycosis can be confused with dystrophic toe-nails from repeated low-level trauma. [aafp.org]

  Tinea barbae should not be confused with folliculitis – an infection of the hair follicles usually due to bacteria. While folliculitis can superimpose and existing beard fungus, these two infectious conditions are separate conditions. [healthhype.com]

• Trichotillomania

  View/Print Table TABLE 1 Tinea Infections Type Common causative species Differential diagnosis Tinea capitis Trichophyton tonsurans Alopecia areata Microsporum andouinii* Impetigo Microsporum canis *† Pediculosis Psoriasis Seborrhea Trichotillomania Tinea [aafp.org]

In order to diagnose TB, a fungal infection has to be detected [9]. Clinical examination may reveal indicative findings, but is usually not sufficient to confirm the diagnosis. Wood lamp examination is recommended since Microsporum canis is one of the most common causative agents of TB.

Microscopic analysis and fungal cultures are frequently necessary to confirm TB. Samples may consist in infected and recently depilated hair as well as material collected from pustules. In patients presenting with symptoms suspicious of chronic TB, scrapings from lesion borders should be examined. It is more likely to isolate fungi from lesion borders than from lesion centers. Microscopic analysis may provide rapid results and is easily available. However, it requires lots of experience to be able to identify hyphae and arthroconidia and to diagnose dermatophytoses. In order to prepare a microscopic examination, samples should be placed on a slide and be treated with 10-20% potassium hydroxide that may or may not contain dimethyl sulfoxide. It is recommendable to delay the examination for some minutes after adding potassium hydroxid. Analysis of warmed samples is somewhat easier. Special dyes such as chlorazol black E or Parker ink may help to recognize fungal pathogens.

Sabouraud agar supplemented with cycloheximide and chloramphenicol to avoid bacterial overgrowth is used to establish fungal cultures. Samples may need to be cultivated up to three weeks, which is the main disadvantage of this technique. However, detailed examination of potentially growing fungal colonies allows for the determination of the causative agent. Some microbiological laboratories may dispose of special media that may provide earlier results.

If TB cannot be confirmed nor ruled out after taking the aforementioned measures, a biopsy may be indicated. Folliculits and perifolliculits are the most common findings. Microabscesses may be observed. Affected areas are infiltrated by a variety of inflammatory cells. Lymphocytes may be present in the spongiotic follicular epithelium. Giant cells may be observed in biopsy samples obtained from chronic TB patients. In order to visualize fungal elements, Periodic Acid Schiff stain is recommended. Hyphae and arthroconidia may be encountered in hair follicles and within the hair shaft.

• Trichophyton Mentagrophytes

  In most cases, the zoophilic ectothrix Trichophyton mentagrophytes and Trichophyton verrucosum are responsible for this type of infection. [ncbi.nlm.nih.gov]

  Currently, in most cases, the causative organisms are zoophilic ectothrix, namely, Trichophyton mentagrophytes and Trichophyton verrucosum, acquired from animals. [link.springer.com]

• Trichophyton Rubrum

  Tinea faciei incognito due to Trichophyton rubrum as a result of autoinoculation from onychomycosis. Mycoses. 2007;50:20–25. [ncbi.nlm.nih.gov]

  American Academy of Dermatology. ( 8642096 ) Drake L.A....Scher R.K. 1996 27 Severe tinea barbae due to Trichophyton verrucosum infection in dairy farmers. ( 8953077 ) Sabota J....Hoppes W.L. 1996 28 Trichophyton rubrum invasion of human hair apparatus [malacards.org]

  Tinea faciei incognito due to Trichophyton rubrum as a result of autoinoculation from onychomycosis. [scielo.br]

Similar to other dermatophytoses, treatment relies on oral antimycotics [10]. The treatment of choice consists in a daily dosis of 250 mg terbenafine and should be administered over the course of four weeks. This therapy has been recommended for different species of dermatophytes that may cause TB [11]. A therapy based on a daily dosis of 20 mg per kg gresiofulvin may serve as an alternative but should be continued at least eight weeks. Other therapeutic options include the administration of itraconazole at a dosis of 100 mg per day for approximately six weeks. In general, treatment periods should rather be based on the clinical evolution of the patient than on universal recommendations.

Topical use of antimycotic formulations is not sufficient to control TB but usually supplements systemic therapy. Azoles and allylamines may be used [12].

As for supportive measures, the affected areas should be shaved or depilated. Crusts should be softened with damp compresses in order to facilitate skin cleaning.

If at all possible, the source of the infection should be determined and eliminated. Tinea pedis, onychomycoses and other fungal infections should be treated. Also, antimycotic treatments are available for pets and livestock.

Prognosis is good. TB usually responds well to treatment. Even if left untreated, spontaneous remission of inflammatory TB is likely to occur within a few months. Tissue damage mediated by dermatophytes and aggravated by the patient's immune response may, however, leave scars and areas of alopecia.

Spontaneous remission may not occur in patients showing non-inflammatory TB. Here, the disease may become chronic. For further description of inflammatory and non-inflammatory TB, please see chapter presentation.

The old term "barber's itch" refers to the fact that TB was mainly transmitted by barbers who attended several men with the same instruments, an observation typical for infectious diseases.

Indeed, TB is caused by dermatophytes, very common fungal pathogens that also trigger tinea pedis (athlete's foot) and tinea cruris (jock itch). There are several species of dermatophytes that may cause TB and the majority of them corresponds to zoophilic dermatophytes that originate from pets or livestock [3], e.g. Trichophyton mentagrophytes var granulosum, Trichophyton mentagrophytes var erinacei, Trichophyton verrucosum and Microsporum canis. The most common triggers for TB are Trichophyton mentagrophytes var granulosum and Trichophyton verrucosum [4]. Trichophyton mentagrophytes var erinacei is transmitted by hedgehogs and thus less frequently detected [5]. Among anthropophilic dermatophytes, Trichophyton rubrum and Trichophyton violaceum are the most common causative agents. However, Trichophyton megninii and Trichophyton schoenleinii may also be detected in samples obtain from TB patients [6]. Elsewhere, Trichophyton interdigitale and Microsporum nanum and even Arthroderma benhamiae have been registered as causative agents of TB [7].

It has been reported that TB may be triggered by pathogens transmitted from the feet or other parts of the body by the patient themselves.

Dermatophytes release keratinolytic enzymes and thereby cause damage to the superficial layers of the skin. This results in rash and pruritus that, in turn, are aggravated by the patient's immune response. Efflorescences are frequently triggered by secondary bacterial infection.

The vast majority of TB cases corresponds to older adolescent and adult males because the disease affects the bearded areas of face and neck. If similar infections and symptoms occur in children or females of any age, the resulting disease is termed tinea faciei.

Although dermatophytes are distributed throughout the world, the current incidence of TB is rather low.This may be attributed to the disappearance of barbers and to the common use of single-use razors. Nowadays, rural populations show higher prevalence of TB and this may be due to the fact that they are more commonly exposed to zoophilic dermatophytes that colonize the skin of their animals. Furthermore, warm, humid climates seems to promote infections with dermatophytes and thus increase the incidence of diseases like TB.

Dermatophytes causing TB are keratinophilic fungi that may infect such tissues that contain keratin, e.g. the stratum corneum of the skin but also nails and hair. Deeper tissue layers are usually not affected. Dermatophytes release keratinolytic enzymes that facilitate tissue colonization that, in turn, most easily occurs through hair and hair follicles. This explains why the bearded area of face and neck is more susceptible to dermatophytoses. Mycotic infection provokes an immune response whose magnitude highly depends on the causative agent. In this context, zoophilic dermatophytes do usually account for more severe immune responses than anthropophilic dermatophytes. Kerions are often attributed to the intense immune response triggered by the former, but may also be caused by anthropophilic dermatophytes such as Trichophyton rubrum [6]. An alternative hypothesis regarding the formation of kerions states that certain species of dermatophytes may release toxins or metabolites that diffuse into the affected tissue. This hypothesis, however, is less accepted.

TB can largely be prevented by adopting certain hygiene routines.

In this context, razors and similar instruments should not be shared with other people and should be replaced regularly. This also applies for towels and further objects that may come into contact with other people's faces. Antimicrobial treatments should be applied to the face after shaving. Skin care is another important factor in TB prevention, since fungi may enter the skin via tiny lesions.

Additionally, the possibility to transmit pre-existing fungal infections from the feet or other parts of the body to the face should be considered. Adequate treatment of the former is the best option to eliminate this source of TB.

Because most causative agents originate from animals, hands should be washed after touching them. Dermatologic problems should be seen by a veterinarian and be treated accordingly.

Tinea barbae (TB) refers to a facial dermatophytosis affecting the bearded areas of face and neck [1]. The disease is almost exclusively detected in older adolescents and adult men. Its overall incidence has been decreasing for a long time because general hygiene measures have been adopted in large parts of the world.

TB is caused by distinct species of dermatophytes, the majority of which originate from pets and livestock [2]. However, anthropophilic dermatophytes may also be isolated from TB lesions. The inflammatory form of the disease is associated with hardened plaques and nodules that carry pustules, draining sinuses and crusts. In contrast, erythematous patches delimited by pustules and crusts characterize the non-inflammatory form of the disease.

TB patients respond well to treatments. Spontaneous remission is likely in cases of inflammatory TB, but may leave scars and areas of alopecia. Systemic antimycotic treatment is usually combined with topic administration of antimycotic drugs.

The term tinea barbae (TB) describes a skin disease affecting the bearded areas of face and neck in older adolescents and adult men. Therefore, it has often been referred to as "barber's itch".

Causes

The disease is caused by dermatophytes, i.e. fungal pathogens that may originate from animals, from other people or even from another part of the patient's own body. Most frequently, dermatophytes are contracted when touching an infected animal. Insufficient measures regarding face hygiene may also promote TB. In this context, razors or towels shared with other people suffering from TB may be the source of the causative fungi. Warm, humid climates facilitate pathogen development.

Trichophyton and Microsporum are the most common fungi triggering TB. These fungi release keratinolytic enzymes and thereby damage the outer layers of the skin and cause an immune response.

Symptoms

Physicians distinguish between inflammatory and non-inflammatory forms of TB. Both forms cause hair loss in the affected areas.

Inflammatory TB is usually caused by dermatophytes contracted from animals. It is typically characterized by itching, hardened plaques and nodules that generally develop in the bearded areas of chin and neck but may then spread to the cheeks. Crusts may form on the surface of these plaques and nodules.

Non-inflammatory TB may be associated with reddish patches that are delimited by pustules and crusts.

In some cases, no symptoms or only mild pruritus may be noted by TB patients.

Diagnosis

Clinical examination is usually not sufficient to diagnose TB. However, the appearance of skin lesions may indicate possible TB. This also applies to the results of an examination with a special lamp emitting UV-light. Certain parts of fungi become visible when illuminated with this lamp.

Hair and tissue samples may be taken and analyzed microscopically to detect the presence of dermatophytes. If such an examination does not yield concluding results, similar samples may be used to prepare a fungal culture.

Treatment

Hair remaining in the affected areas should be shaved or depilated. Crusts should be softened with damp compresses and need to be removed.

Drug therapy is based on systemic treatment and topic supplementation. In order to cure the disease, medication needs to be taken for up to eight weeks. Terbinafine, griseofulvin and itraconazole are compounds that mediate antimycotic effects. Prognosis is good.

If possible, the source of the disease should be identified and eliminated. Adequate hygiene measures should be implemented. If there are animals suffering from dermatophytoses, they should be treated.

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