Tinea barbae: causes, symptoms, diagnosis, and treatment

Tinea barbae is a superficial fungal infection in the roots of beards and on the lower chin.


Causes

Common pathogens are trichophyton mentagrophytes, trichophyton verrucosum, trichophyton rubrum, trichophyton tonsurans, microsporum gypseum, and microsporum canis.


Signs and Symptoms

Tinea barbae is often localized to the beards and lower chin, and the neck can also be involved. In general, obvious inflammation is present.

Clinically, tinea barbae can be divided into superficial tinea barbae and deep tinea barbae.

Superficial tinea barbae

Initial skin lesions are inflammatory papules on the follicular orifices, gradually developing into inflammatory erythema and extending peripherally. Skin lesions are sharply demarcated, with edges composed of edematous erythema, papules, and vesicles, and the center tends to subside and desquamate, resembling tinea corporis. However, the infected beards are fractured or loose.

Figure 1 tinea barbae

Deep tinea barbae

Skin lesions are dark red, deep, follicular, inflammatory papules or pustules, which can gradually progress into nodules or pus filled masses covered with follicular pustules. Crusts are often on the abscesses, honeycomb granulation are visible after removal of the crusts, and a small amount of pus can be discharged when squeezed. The infected beards are brittle, fragile, and loose. Sometimes, light yellow pus corpuscles can be seen in the roots of the extracted infected beards.


Histopathology

Inflammatory infiltrations around the hair follicles and in the dermis, mainly neutrophils and lymphocytes in the early stage, can be seen. Granulomatous infiltrations composed of lymphocytes, epithelioid cells, histiocytes, and multinucleated giant cells are visible in chronic and regressive lesions. Fungal spores inside and outside the hair shafts or hyphae in the hair follicles and surrounding tissue can be found in periodic acid Schiff (PAS) stain.


Diagnosis

On the basis of clinical presentations, positive fungal examination, and histopathology, a diagnosis can be provided.


Treatment

After removal of the infected beards, antifungals such as 1% econazole solution, 1% bifonazole solution, 2% miconazole cream, and 7% terbinafine cream can be administered.

Superficial infections with protracted duration and deep tinea barbae can be treated with oral griseofulvin, itraconazole, or terbinafine.