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.
The zoophilic dermatophyte Trichophyton species of Arthroderma benhamiae, most commonly from pet guinea pigs, is linked with an inflammatory tinea faciei in children and adolescents, particularly in Germany [2] but elsewhere too. [3] It has also been described in China, possibly transmitted from a fox. [4]
Etiology
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. [5, 6] Preexisting factors may include diabetes mellitus. [7]
In Asia, Trichophyton mentagrophytes and Trichophyton rubrum are common. [8, 9] In a survey from Guangdong, China, T mentagrophytes and M canis were most commonly linked with tinea faciei. [10] In contrast, in North America Trichophyton tonsurans is the main pathogen isolated.
Epidemiology
Frequency
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. [5, 11, 12, 13] Tinea faciei was shown to represent approximately 19% of all superficial fungal infections in the pediatric population with dermatomycoses. [14] Consecutive cases diagnosed between 2008 and 2016 were studied retrospectively. In an 8-year period, 72 tinea faciei cases have been diagnosed in a Lisbon hospital, 37 male and 35 female, aged between 8 months and 86 years. [15] Almost 60% were younger than 12 years.
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. [16]
Age
Tinea faciei may appear in persons of any age, with two peaks of disease incidence. Tinea faciei is extremely rare in neonates, with only a few cases described. [17] It has been described in a 14-day-old girl. [18] 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 neonates [19, 20, 21] ; these patients may acquire the infection from siblings or contact with pets. The other peak occurs in those aged 20-40 years. It has been described in a preterm infant due to Trichophyton rubrum, probably from skin-to-skin contact with the mother. [22]
Prognosis
The prognosis for patients with tinea faciei is usually good. The lesions respond to topical and oral antifungal treatment within 4-6 weeks. Scarring may occur in patients with Trichophyton schoenleinii infection; this is extremely rare.
Patient Education
For patient education resources, visit the Skin Conditions and Beauty Center. Also, see the patient education article Ringworm on Body.
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Multiple lesions on the face caused by Microsporum canis infection in a patient who also has tinea capitis.
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Erythematous scaling lesion on the cheek.
