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Tinea Barbae Workup

  • Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD  more...
 
Updated: Jun 21, 2016
 

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Mycologic features form the basis of tinea barbae diagnosis.[23] 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.

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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.

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Contributor Information and Disclosures
Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Coauthor(s)

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: Received consulting fee from Orfagen for consulting; Received consulting fee from Maruho for consulting; Received consulting fee from Astellas for consulting; Received consulting fee from Abbott for consulting; Received consulting fee from Leo Pharma for consulting; Received consulting fee from Biogenoma for consulting; Received honoraria from Janssen for speaking and teaching; Received honoraria from Medac for speaking and teaching; Received consulting fee from Dignity Sciences for consulting; .

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster 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, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Paul Krusinski, MD Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Franklin Flowers, MD Department of Dermatology, Professor Emeritus Affiliate Associate Professor of Pathology, University of Florida College of Medicine

Franklin Flowers, MD is a member of the following medical societies: American College of Mohs Surgery

Disclosure: Nothing to disclose.

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Inflammatory tinea barbae resulting from Trichophyton mentagrophytesvar granulosuminfection.
Wax model of kerionlike tinea barbae. Courtesy of the Museum of the Department of Dermatology, University of Medicine, Wroclaw, Poland.
 
 
 
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