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.

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.^[23]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.

Treatment & Management

Lin RL, Szepietowski JC, Schwartz RA. Tinea faciei, an often deceptive facial eruption. Int J Dermatol. 2004. 43:437-440. [QxMD MEDLINE Link].
Nenoff P, Uhrlaß S, Krüger C, Erhard M, Hipler UC, Seyfarth F, et al. Trichophyton species of Arthroderma benhamiae - a new infectious agent in dermatology. J Dtsch Dermatol Ges. 2014 Jul. 12(7):571-81. [QxMD MEDLINE Link].
Ansari S, Ahmadi B, Tabatabaeifar SN, Hedayati MT, Javidnia J, Taghizadeh Armaki M, et al. Familial Cases of Trichophyton benhamiae Infection Transmitted from a Guinea Pig in Iran. Mycopathologia. 2021 Mar. 186 (1):119-125. [QxMD MEDLINE Link].
Tan J, Liu X, Gao Z, Yang H, Yang L, Wen H. A case of Tinea Faciei caused by Trichophyton benhamiae: first report in China. BMC Infect Dis. 2020 Feb 22. 20 (1):171. [QxMD MEDLINE Link].
Atzori L, Aste N, Aste N, Pau M. Tinea Faciei Due to Microsporum canis in Children: A Survey of 46 Cases in the District of Cagliari (Italy). Pediatr Dermatol. 2011 Oct 20. [QxMD MEDLINE Link].
Patel G, Mills C. Tinea faciei due to Microsporum canis abscess formation. Clin Exp Dermatol. 2000 Nov. 25(8):608-10. [QxMD MEDLINE Link].
Singh S, Verma P, Chandra U, Tiwary NK. Risk factors for chronic and chronic-relapsing tinea corporis, tinea cruris and tinea faciei: Results of a case-control study. Indian J Dermatol Venereol Leprol. 2019 Mar-Apr. 85 (2):197-200. [QxMD MEDLINE Link].
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.
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. 2001 Dec. 9(4):283-6. [QxMD MEDLINE Link].
Cai W, Lu C, Li X, Zhang J, Zhan P, Xi L, et al. Epidemiology of Superficial Fungal Infections in Guangdong, Southern China: A Retrospective Study from 2004 to 2014. Mycopathologia. 2016 Jun. 181 (5-6):387-95. [QxMD MEDLINE Link].
Del Boz J, Crespo V, de Troya M. Pediatric Tinea Faciei in Southern Spain: A 30-Year Survey. Pediatr Dermatol. 2011 Oct 13. [QxMD MEDLINE Link].
Ansar A, Farshchian M, Nazeri H, Ghiasian SA. Clinico-epidemiological and mycological aspects of tinea incognito in Iran: A 16-year study. Med Mycol J. 2011. 52(1):25-32. [QxMD MEDLINE Link].
Nicola A, Laura A, Natalia A, Monica P. A 20-year survey of tinea faciei. Mycoses. 2010 Nov. 53(6):504-8. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Borges A, Brasileiro A, Galhardas C, Apetato M. Tinea faciei in a central Portuguese hospital: A 9-year survey. Mycoses. 2018 Apr. 61 (4):283-285. [QxMD MEDLINE Link].
Romano C, Ghilardi A, Massai L. Eighty-four consecutive cases of tinea faciei in Siena, a retrospective study (1989-2003). Mycoses. 2005 Sep. 48(5):343-6. [QxMD MEDLINE Link].
Alkeswani A, Duncan JR, Theos A. Tinea faciei starting at day two of life. Pediatr Dermatol. 2019 Jan. 36 (1):e20-e22. [QxMD MEDLINE Link].
Bassi A, Greco A, Galeone M, Venturini E, Bianchi L, Scarfi F, et al. Tinea Faciei in a 14-Day-Old Girl. J Pediatr. 2016 Jun. 173:259. [QxMD MEDLINE Link].
Bardazzi F, Raone B, Neri I, Patrizi A. Tinea faciei in a newborn: a new case. Pediatr Dermatol. 2000 Nov-Dec. 17(6):494-5. [QxMD MEDLINE Link].
Cohen-Abbo A. Newborn with vesicular rash. Tinea corporis (tinea faciei). Pediatr Infect Dis J. 2000 Jul. 19(7):661, 676-7. [QxMD MEDLINE Link].
Szepietowski J. Dermatomycoses in newborns. Mikol Lek. 1997. 4:41-5.
Stanes EK, Strunk T. Tinea faciei in a very preterm infant. Arch Dis Child Fetal Neonatal Ed. 2018 Jan 23. [QxMD MEDLINE Link].
Meymandi S, Wiseman MC, Crawford RI. Tinea faciei mimicking cutaneous lupus erythematosus: a histopathologic case report. J Am Acad Dermatol. 2003 Feb. 48(2 Suppl):S7-8. [QxMD MEDLINE Link].
Singh R, Bharu K, Ghazali W, Bharu K, Nor M, Kerian K. Tinea faciei mimicking lupus erythematosus. Cutis. 1994 Jun. 53(6):297-8. [QxMD MEDLINE Link].
Agarwal A, Hassanandani T, Das A, Panda M, Chakravorty S. 'Mask tinea': tinea faciei possibly potentiated by prolonged mask usage during the COVID-19 pandemic. Clin Exp Dermatol. 2021 Jan. 46 (1):190-193. [QxMD MEDLINE Link].
Berry A, Abramovici G, Chamlin SL. A 21-day-old boy with an annular eruption. Tinea faciei / Tinea capitis. Pediatr Ann. 2014 Jan 1. 43(1):e16-8. [QxMD MEDLINE Link].
Amigo M, Milani-Nejad N, Mosser-Goldfarb J. Periocular Tinea Faciei. J Pediatr. 2020 Mar 11. [QxMD MEDLINE Link].
Salimbeni L, Delfino C. Tinea faciei incognito. G Ital Dermatol Venereol. 2017 Aug. 152 (4):390-391. [QxMD MEDLINE Link].
Noguchi H, Jinnin M, Miyata K, Hiruma M, Ihn H. Clinical features of 80 cases of tinea faciei treated at a rural clinic in Japan. Drug Discov Ther. 2014 Dec. 8 (6):245-8. [QxMD MEDLINE Link].
Jasterzbski TJ, Schwartz RA. Pseudofolliculitis cutis: a vexing disorder of hair growth. Br J Dermatol. 2015 Apr. 172 (4):878-84. [QxMD MEDLINE Link].
Laureano AC, Schwartz RA, Cohen PJ. Facial bacterial infections: folliculitis. Clin Dermatol. 2014 Nov-Dec. 32 (6):711-4. [QxMD MEDLINE Link].
Kimura U, Yokoyama K, Hiruma M, Kano R, Takamori K, Suga Y. Tinea faciei caused by Trichophyton mentagrophytes (molecular type Arthroderma benhamiae ) mimics impetigo : a case report and literature review of cases in Japan. Med Mycol J. 2015. 56 (1):E1-5. [QxMD MEDLINE Link].
Alteras I, Sandbank M, David M, Segal R. 15-year survey of tinea faciei in the adult. Dermatologica. 1988. 177(2):65-9. [QxMD MEDLINE Link].
Gorani A, Oriani A, Cambiaghi S. Seborrheic dermatitis-like tinea faciei. Pediatr Dermatol. 2005 May-Jun. 22(3):243-4. [QxMD MEDLINE Link].
Nakamura S, Yamada T, Umemoto N, Nakamura T, Wakatabi K, Iida E, et al. Cheek and periorbital peculiar discoid lupus erythematosus: rare clinical presentation mimicking tinea faciei, cutaneous granulomatous disease or blepharitis. Case Rep Dermatol. 2015 Jan-Apr. 7 (1):56-60. [QxMD MEDLINE Link].
Kye H, Kim DH, Seo SH, Ahn HH, Kye YC, Choi JE. Polycyclic Annular Lesion Masquerading as Lupus Erythematosus and Emerging as Tinea Faciei Incognito. Ann Dermatol. 2015 Jun. 27 (3):322-5. [QxMD MEDLINE Link].
Dekio S, Imaoka C, Jidoi J. Corticosteroid-modified tinea faciei simulating rosacea. J Dermatol. 1987 Oct. 14(5):509-11. [QxMD MEDLINE Link].
Czaika VA. Misdiagnosed zoophile tinea faciei and tinea corporis effectively treated with isoconazole nitrate and diflucortolone valerate combination therapy. Mycoses. 2013 May. 56 Suppl 1:26-9. [QxMD MEDLINE Link].
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. 1998 Jul. 78(4):314. [QxMD MEDLINE Link].

Media Gallery

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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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

David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

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

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Tinea Faciei Workup

Laboratory Studies

Histologic Findings

References

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