eMedicine Specialties > Dermatology > Fungal Infections

Tinea Barbae: Differential Diagnoses & Workup

Author: Jacek C Szepietowski, MD, PhD, Professor, Vice-Head, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University; Director of the Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Poland
Coauthor(s): Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Contributor Information and Disclosures

Updated: Sep 25, 2009

Differential Diagnoses

Acne Vulgaris
Contact Dermatitis, Irritant
Actinomycosis
Folliculitis
Candidiasis, Cutaneous
Rosacea
Contact Dermatitis, Allergic
Syphilis

Other Problems to Be Considered

Bacterial folliculitis
Candidal folliculitis13,14
Carbuncles
Pustular syphilis
Nodule-cystic acne
Iododerma
Bromoderma
Lupoid sycosis may resemble lupus vulgaris (cutaneous tuberculosis)

Workup

Other Tests

  • Mycologic features form the basis of tinea barbae diagnosis.15 Procedures include direct microscopy, culture, and a Wood lamp examination showing fluorescence when Microsporum canis infection causes tinea barbae.
  • Specimen selection and collection is important. Usually, the material consists of infected hairs (depilated with forceps) and pustular masses. In the superficial variety, which resembles tinea corporis, collect scrapings from the border of the lesion where the inflammatory reaction is more severe. Taking material from the lesion's border increases the possibility of detecting fungi on direct microscopy and culture. Send the specimen for culture, or examine it for fungus.
  • Direct microscopic examination is performed rapidly and easily; however, it requires experience. Place the material on a slide and add a solution of 10-20% potassium hydroxide, with or without dimethyl sulfoxide. This solution provides visualization of fungal elements. Gently warm the slide, especially if no dimethyl sulfoxide is added. Some recommend using special stains, such as chlorazol black E stain or Parker blue-black ink. Direct microscopy usually shows hyphae and/or arthroconidia. Wait for some minutes before evaluating the preparation under microscopy, or reexamine the slide after one-half hour, since fungal elements may be difficult to see just after addition of potassium hydroxide solution.
  • Culture identifies the causative fungus and usually is performed on Sabouraud agar with the addition of cycloheximide and chloramphenicol. These 2 substances inhibit bacterial and other fungal growth to obtain pure dermatophyte colonies. Cultures take approximately 3 weeks to become positive, and final fungal identification is based primarily on morphology and microscopy of the colonies. Occasionally, additional tests are required. Special media for rapid dermatophyte identification that include a color indicator currently are available. In the presence of dermatophytes, the color changes from yellow to bright red.

Histologic Findings

Biopsy specimens occasionally may be required to diagnose tinea barbae. Biopsy shows folliculitis and perifolliculitis with a mixed cellular infiltrate and spongiotic alterations within the follicular epithelium. Lymphocytes or neutrophils also may be evident within follicular epithelium. Neutrophils also may be seen within follicular keratin as microabscesses.

Since fungal elements often are difficult to visualize with hematoxylin and eosin stain, periodic acid-Schiff stain is recommended. Arthroconidia and/or hyphae may be evident within the hair shaft and in the hair follicle. An inflammatory infiltrate is present in the dermis, which in chronic lesions may contain giant cells.

More on Tinea Barbae

Overview: Tinea Barbae
Differential Diagnoses & Workup: Tinea Barbae
Treatment & Medication: Tinea Barbae
Follow-up: Tinea Barbae
Multimedia: Tinea Barbae
References
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References

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  2. Gupta G, Burden AD, Roberts DT. Acute suppurative ringworm (kerion) caused by Trichophyton rubrum. Br J Dermatol. Feb 1999;140(2):369-70. [Medline].

  3. Bonifaz A, Ramirez-Tamayo T, Saul A. Tinea barbae (tinea sycosis): experience with nine cases. J Dermatol. Dec 2003;30(12):898-903. [Medline].

  4. Davis DF, Petri WH, Hood AF. Dairy farmer with a rapidly enlarging lip lesion: tinea barbae. Arch Dermatol. Aug 2006;142(8):1059-64. [Medline].

  5. Kiska DL, Cynamon MH. Photo quiz. Tinea barbae caused by Trichophyton verrucosum. Clin Infect Dis. Oct 1997;25(4):805, 871. [Medline].

  6. Maeda M, Nakashima T, Satho M, Yamada T, Kitajima Y. Tinea barbae due to Trichophyton verrucosum. Eur J Dermatol. May-Jun 2002;12(3):272-4. [Medline].

  7. Kick G, Korting HC. Tinea barbae due to Trichophyton mentagrophytes related to persistent child infection. Mycoses. Nov 1998;41(9-10):439-41. [Medline].

  8. Kawada A, Aragane Y, Maeda A, Yudate T, Tezuka T, Hiruma M. Tinea barbae due to Trichophyton rubrum with possible involvement of autoinoculation. Br J Dermatol. May 2000;142(5):1064-5. [Medline].

  9. Szepietowski JC, Bielicka E, Maj J. Inflammatory tinea barbae due to Trichophyton rubrum infection - autoinnoculation from fingernail onychomycosis?. Case Rep Clin Pract Rev. 2002;3:254-6. [Full Text].

  10. Szepietowski JC, Matusiak L. Trichophyon rubrum autoinoculation from infected nails is not such a rare phenomenon. Mycoses. 2008;51:345-346.

  11. Trotha R, Graser Y, Platt J, et al. Tinea barbae caused by a zoophilic strain of Trichophyton interdigitale. Mycoses. Feb 2003;46(1-2):60-3. [Medline].

  12. Ratka P, Slusarczyk E, Sloboda T, Kusmierski W. [Case of tinea barbae profunda caused by Microsporum nanum]. Przegl Dermatol. Sep-Dec 1983;70(5-6):549-52. [Medline].

  13. Kapdagli H, Ozturk G, Dereli T, et al. Candida folliculitis mimicking tinea barbae. Int J Dermatol. Apr 1997;36(4):295-7. [Medline].

  14. Kurita M, Kishimoto S, Kibe Y, Takenaka H, Yasuno H. Candida folliculitis mimicking tinea barbae. Acta Derm Venereol. Mar-Apr 2000;80(2):153-4. [Medline].

  15. Baran W, Szepietowski JC, Schwartz RA. Tinea barbae. Acta Dermatoven APA. 2004;13:91-4. [Full Text].

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  20. De Lacerda MH, Caldeira JB, Delfino JP, Nunes FP, Goncalves H, Lobo C. [Sycosis of the beard (tinea barbae). Analysis of 42 cases]. Med Cutan Ibero Lat Am. 1981;9(3):161-78. [Medline].

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  24. Macura AB. Resistance to antimycotic drugs. Postepy Dermatol (Poznan). 1997;14:137-40.

  25. Michalowski R, Kuczynska L. [Initial experiences with a natamycin-, neomycin-, and hydrocortisone-containing lotion in tinea barbae]. Mykosen. Mar 1984;27(3):153-6. [Medline].

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  27. Soyer HP, Cerroni L. The significance of histopathology in the diagnosis of dermatomycoses. Acta Derm Venerol (Ljubljana). 1992;1:84-7.

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Further Reading

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Keywords

tinea barbae, ringworm of the beard, barber's itch, trichophytosis barbae, tinea sycosis, sycosis, tinea faciei,

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Contributor Information and Disclosures

Author

Jacek C Szepietowski, MD, PhD, Professor, Vice-Head, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University; Director of the Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Poland
Disclosure: Stiefel Salary Employment; Orfagen Consulting fee Consulting; Maruho Consulting fee Consulting; Astellas Consulting fee Consulting

Coauthor(s)

Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Franklin Flowers, MD, Chief, Division of Dermatology, Professor, Department of Medicine and Otolaryngology, University of Florida College of Medicine
Franklin Flowers, MD is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology
Disclosure: Nothing to disclose.

Pharmacy Editor

Richard P Vinson, MD, Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA
Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Paul Krusinski, MD, Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont
Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

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