Tinea Faciei Workup

  • Author: Jacek C Szepietowski, MD, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 25, 2012
 

Laboratory Studies

  • Even in the best mycology laboratories, as many as 30% of culture results may be negative, particularly in chronic infections.
  • Mycologic investigation is essential in the diagnosis of tinea faciei. It includes direct microscopic examination for hyphal elements and culturing.
  • The collection of the surface scrapings is important for laboratory studies. The material should be obtained from the border of the lesions where the more severe inflammatory reaction occurs and where more fungal elements are present.
  • Direct microscopic examination is the easiest mycologic procedure.
    • Scrapings are placed in 10-20% potassium hydroxide (KOH) solution, usually with the addition of dimethyl sulfoxide (DMSO). The latter helps to dissolve background keratinocytes to enable visualization of the fungal elements.
    • After warming the slide for a short time, the specimen is examined with a light microscope.
    • Some authors suggest detection is enhanced with special stains, such as chlorazol black E, Parker blue-black ink, or Swartz-Lamkin stain.
  • Culturing allows the identification of the causative pathogen.
    • Culturing is performed routinely with Sabouraud agar and the addition of cycloheximide and chloramphenicol. These substances inhibit the growth of bacteria and other contaminants.
    • After 3-4 weeks of incubation, the final identification is based on morphologic and microscopic findings in the colonies.
  • Dermatophytes may be diagnosed by using special media for rapid detection. This media contains a color indicator that changes from yellow to red with the growth of dermatophytes after a few days of incubation.
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Histologic Findings

Histologic examination may occasionally be useful for establishing the diagnosis, but it is usually unnecessary. Its pattern is variable, ranging from mild focal spongiosis to a chronic spongiotic psoriasiform dermatitis with a mixed dermal inflammatory infiltrate and fungi in the cornified layer.[11] Routine histopathologic evaluation with hematoxylin-eosin staining may reveal cutaneous fungal elements, but periodic acid–Schiff (PAS) staining is recommended to facilitate visualization.

Hyphae may be detected in the stratum corneum of the epidermis. Infections with T rubrum or Trichophyton verrucosum may invade hairs and follicles. A mixed cellular inflammatory infiltrate is usually present in the papillary dermis, and neutrophils may extend into the horny layers above.

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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 GSK Company Salary Employment; Orfagen Consulting fee Consulting; Maruho Consulting fee Consulting; Astellas Consulting fee Consulting; Abbott Consulting fee Consulting; Leo Pharma 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, University of Medicine and Dentistry of New Jersey-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.

Specialty Editor Board

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.

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.

Van Perry, MD  Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

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.

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, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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