History

Infection often begins on the chin or neck, but in severely affected patients, tinea barbae may cover the entire bearded area of the face and neck, occasionally resulting in indurated verrucous plaques or nodules.

Tinea barbae may be asymptomatic; however, mild pruritus is characteristic. Spontaneous resolution of tinea barbae may occur, especially in inflammatory tinea barbae.

Lupoid sycosis, a deep form of tinea barbae, is so named because it may resemble lupus vulgaris.^[21]

Physical Examination

Clinical manifestations of tinea barbae relate to the causative pathogen. Two clinical varieties of the disease are identified: inflammatory and noninflammatory.

Inflammatory deeper tinea barbae is caused primarily by zoophilic dermatophytes. This variety, termed a kerion, is the most common clinical presentation. Most patients show solitary plaques or nodules; however, multiple plaques are relatively common. Usually localized on the chin, cheeks, or neck, involvement of the upper lip is rare. The characteristic lesion is an inflammatory reddish nodule with pustules and draining sinuses on the surface. Hairs are loose or broken, and depilation is easy and painless. Pus-filled whitish masses involve the hair root and follicle. Over time, the surface of the indurated nodule is covered by exudate and crust. This variety of tinea barbae usually is associated with generalized symptoms, such as regional lymphadenopathy, malaise, and fever. Tinea barbae profunda may be due to a variety of fungi, including T mentagrophytes, A benhamiae, and M nanum.^{[8, 18, 22]}

Noninflammatory superficial tinea barbae is caused by anthropophilic dermatophytes. This variety of barbae is less common and resembles common tinea corporis or bacterial folliculitis (sycosiform variety).^[23]Typically, erythematous patches show an active border composed of papules, vesicles, and/or crusts. Hairs are broken next to the skin, or they plug the hair follicle. In the sycosiform variety, small follicular pustules are observed. Hairs are broken or loose. This variety represents a chronic variant of tinea barbae. Rarely, one may see tinea blepharociliaris associated with tinea barbae.^[24]

See the images below.

Inflammatory tinea barbae resulting from Trichophyton mentagrophytesvar granulosuminfection.

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Wax model of kerionlike tinea barbae. Courtesy of the Museum of the Department of Dermatology, University of Medicine, Wroclaw, Poland.

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Differential Diagnoses

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Beswick SJ, Das S, Lawrence CM, Tan BB. Kerion formation due to Trichophyton rubrum. Br J Dermatol. 1999 Nov. 141(5):953-4. [Medline].
Gupta G, Burden AD, Roberts DT. Acute suppurative ringworm (kerion) caused by Trichophyton rubrum. Br J Dermatol. 1999 Feb. 140(2):369-70. [Medline].
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Davis DF, Petri WH, Hood AF. Dairy farmer with a rapidly enlarging lip lesion: tinea barbae. Arch Dermatol. 2006 Aug. 142(8):1059-64. [Medline].
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Media Gallery

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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Author

Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Professor of Pediatrics, Professor of Medicine, Rutgers New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, New York Academy of Medicine, Royal College of Physicians of Edinburgh, Sigma Xi, The Scientific Research Honor Society

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: Received income in an amount equal to or greater than $250 from: Elsevier; WebMD<br/>Served as a speaker for various universities, dermatology societies, and dermatology departments.

Additional Contributors

Franklin Flowers, MD Professor Emeritus, Department of Dermatology, 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.

Tinea Barbae Clinical Presentation

History

Physical Examination

References

Tables

Contributor Information and Disclosures

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