eMedicine Specialties > Dermatology > Pediatric Diseases

Tinea Faciei

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 24, 2009

Introduction

Background

Tinea faciei is a superficial dermatophyte infection limited to the glabrous skin of the face.1 In pediatric and female patients, the infection may appear on any surface of the face, including the upper lip and chin. In men, the condition is known as tinea barbae when a dermatophyte infection of bearded areas occurs.

Pathophysiology

Keratinophilic fungi, or dermatophytes, are responsible tinea faciei. Dermatophytes release several enzymes, including keratinases, which allow them to invade the stratum corneum of the epidermis. Infection caused by zoophilic dermatophytes is usually associated with inflammatory reactions that are more severe than those due to anthropophilic fungi.

Frequency

International

Tinea faciei is not an uncommon disease. It occurs worldwide. However, as with other cutaneous fungal infections, it is more common in tropical regions with high temperatures and humidity. Tinea faciei was shown to represent approximately 19% of all superficial fungal infections in the pediatric population with dermatomycoses.2

Mortality/Morbidity

Scarring may occur in patients with Trichophyton schoenleinii infection; this is extremely rare.

Sex

Some authors suggest that females may be affected more frequently than males, but the difference is probably semantic. In females, dermatophyte infection of the face is more likely to be diagnosed as tinea faciei, whereas many infections that occur in similar locations in men are diagnosed as tinea barbae. Data indicate a female-to-male ratio of 1.06:1.3

Age

Tinea faciei may appear in persons of any age, with 2 peaks of disease incidence. One peak involves children, who constitute a large group of patients because of their frequent direct contact with pets. Tinea faciei is commonly noted as a dermatosis that occurs after holidays; it is diagnosed more frequently in children after they spend their holidays in rural areas, where they may come into contact with animals when they play. Several cases are also reported in neonates4,5,6 ; these patients may acquire the infection from siblings or contact with pets. The other peak occurs in those aged 20-40 years.

Clinical

History

Physical

  • Because of the complex anatomy of the face, atypical features are more frequently found on the glabrous skin than the typical patches of tinea corporis.
  • Single or multiple erythematous patches without annular structure often resemble other dermatoses; delayed or missed diagnosis may result.
  • Lesions are almost always pruritic.
  • Typical signs of dermatophyte infection of the glabrous skin, similar to those of tinea corporis, may be present. These signs include annular or serpiginous erythematous scaling patches with an active border composed of papules, vesicles, and/or crusts. The most common locations are the cheeks, followed by the nose, periorbital area, chin, and forehead. Some patients may have multiple lesions present in different areas of the face.
Multiple lesions on the face caused by <EM>Micros...

Multiple lesions on the face caused by Microsporum canis infection in a patient who also has tinea capitis.

[ CLOSE WINDOW ]
Multiple lesions on the face caused by <EM>Micros...

Multiple lesions on the face caused by Microsporum canis infection in a patient who also has tinea capitis.


Erythematous scaling lesion on the cheek.

Erythematous scaling lesion on the cheek.

[ CLOSE WINDOW ]
Erythematous scaling lesion on the cheek.

Erythematous scaling lesion on the cheek.

  • In as many as 70% of patients with tinea faciei, various other dermatoses are considered.
    • Tinea faciei is the most frequently misdiagnosed entity among cutaneous fungal infections.
    • The atypical clinical features and incognito presentations support the separation of this disease from tinea corporis.
    • Occasionally, tinea faciei may simultaneously occur with other forms of dermatophyte infections, especially tinea capitis and tinea corporis.

Causes

The causative agents of tinea faciei vary according to geographic regions.

  • Generally, animal reservoirs of zoophilic dermatophytes, especially Microsporum canis, are global among pets and livestock.9
  • In Asia, Trichophyton mentagrophytes and Trichophyton rubrum are common.10,11
  • In contrast, in North America Trichophyton tonsurans is the main pathogen isolated.

More on Tinea Faciei

Overview: Tinea Faciei
Differential Diagnoses & Workup: Tinea Faciei
Treatment & Medication: Tinea Faciei
Follow-up: Tinea Faciei
Multimedia: Tinea Faciei
References
[ CLOSE WINDOW ]

References

  1. Lin RL, Szepietowski JC, Schwartz RA. Tinea faciei, an often deceptive facial eruption. Int J Dermatol. 2004;43:437-440. [Medline].

  2. Lari AR, Akhlaghi L, Falahati M, Alaghehbandan R. Characteristics of dermatophytoses among children in an area south of Tehran, Iran. Mycoses. 2005;48:32-37. [Medline].

  3. Romano C, Ghilardi A, Massai L. Eighty-four consecutive cases of tinea faciei in Siena, a retrospective study (1989-2003). Mycoses. Sep 2005;48(5):343-6. [Medline].

  4. Bardazzi F, Raone B, Neri I, Patrizi A. Tinea faciei in a newborn: a new case. Pediatr Dermatol. Nov-Dec 2000;17(6):494-5. [Medline].

  5. Cohen-Abbo A. Newborn with vesicular rash. Tinea corporis (tinea faciei). Pediatr Infect Dis J. Jul 2000;19(7):661, 676-7. [Medline].

  6. Szepietowski J. Dermatomycoses in newborns. Mikol Lek. 1997;4:41-5.

  7. Meymandi S, Wiseman MC, Crawford RI. Tinea faciei mimicking cutaneous lupus erythematosus: a histopathologic case report. J Am Acad Dermatol. Feb 2003;48(2 Suppl):S7-8. [Medline].

  8. Singh R, Bharu K, Ghazali W, Bharu K, Nor M, Kerian K. Tinea faciei mimicking lupus erythematosus. Cutis. Jun 1994;53(6):297-8. [Medline].

  9. Patel G, Mills C. Tinea faciei due to Microsporum canis abscess formation. Clin Exp Dermatol. Nov 2000;25(8):608-10. [Medline].

  10. Nenoff P, Mugge C, Hermann J, Keller U. Tinea faciei incognito due to Trichophyton rubrum as a result of autoinoculation from onychomycosis. Mycoses. 50, suppl.2;2007:20-25.

  11. Pustisek N, Skerlev M, Basta-Juzbasic A, Lipozencic J, Marinovic B, Bukvic-Mokos Z. Tinea incognito caused by trichophyton mentagrophytes -- a case report. Acta Dermatovenerol Croat. Dec 2001;9(4):283-6. [Medline].

  12. Dekio S, Imaoka C, Jidoi J. Corticosteroid-modified tinea faciei simulating rosacea. J Dermatol. Oct 1987;14(5):509-11. [Medline].

  13. Wilmer A, Wollina U. Oral terbinafine in the treatment of griseofulvin-resistant Tinea capitis et faciei et corporis in a 10-month-old girl. Acta Derm Venereol. Jul 1998;78(4):314. [Medline].

  14. Alteras I, Sandbank M, David M, Segal R. 15-year survey of tinea faciei in the adult. Dermatologica. 1988;177(2):65-9. [Medline].

  15. Gorani A, Oriani A, Cambiaghi S. Seborrheic dermatitis-like tinea faciei. Pediatr Dermatol. May-Jun 2005;22(3):243-4. [Medline].

  16. Cirillo-Hyland V, Humphreys T, Elenitsas R. Tinea faciei. J Am Acad Dermatol. Jul 1993;29(1):119-20. [Medline].

  17. Daniels J, Pahari A. Tinea faciei. Indian Pediatr. Oct 2004;41(10):1061-2. [Medline].

  18. [Guideline] Drake LA, Dinehart SM, Farmer ER, et al. Guidelines of care for superficial mycotic infections of the skin: tinea corporis, tinea cruris, tinea faciei, tinea manuum, and tinea pedis. Guidelines/Outcomes Committee. American Academy of Dermatology. J Am Acad Dermatol. Feb 1996;34(2 Pt 1):282-6. [Medline].

  19. Filice C, Chamlin SL. A 7-year-old girl with a pruritic facial eruption. Tinea faciei. Pediatr Ann. 2008;37:726-728.

  20. Jorquera E, Moreno JC, Camacho F. [Tinea faciei: epidemiology]. Ann Dermatol Venereol. 1992;119(2):101-4. [Medline].

  21. Khaled A, Chtourou O, Zeglaoui F, Fazaa B, Jones M, Kamoun MR. Tinea faciei: a report on four cases. Acta Dermatovenereol Alp Panonoca Adriat. 2007;16:170-173.

  22. Lee SJ, Choi HJ, Hann SK. Rosacea-like tinea faciei. Int J Dermatol. Jun 1999;38(6):479-80. [Medline].

  23. Ohta Y, Saitoh N, Tanuma H, Fujimura T, Katsuoka K. Local cytokine expression in steroid-modified tinea faciei. J Dermatol. Jun 1998;25(6):362-6. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

tinea faciei, ringworm, ringworm of the face, facial ringworm, superficial dermatophyte infection, glabrous skin, tinea barbae, keratinophilic fungus, dermatophyte, Microsporum canis, M canis, Trichophyton mentagrophytes, T mentagrophytes, Trichophyton rubrum, T rubrum, Trichophyton tonsurans, T tonsurans

[ CLOSE WINDOW ]

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

Bernice R Krafchik, MBChB, FRCPC, Professor Emeritus, Department of Pediatrics, Section of Dermatology, University of Toronto
Bernice R Krafchik, MBChB, FRCPC is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Royal College of Physicians and Surgeons of Canada, and Society for Pediatric Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Van Perry, MD, Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas Health Science Center
Van Perry, MD is a member of the following medical societies: American Academy of Dermatology and American Society for Laser Medicine and Surgery
Disclosure: Nothing to disclose.

CME Editor

Glen H Crawford, MD, Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital
Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons
Disclosure: Nothing to disclose.

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.

RELATED MEDSCAPE ARTICLES
Articles
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.