Tinea faciei (face) and barbae (beard)

This chapter discusses tinea faciei and tinea barbae and is set out as follows:

• Refer to the related chapter on Tinea - an overview

• Refer to clinical findings

Tinea faciei

• Fungal infections of the face are not common, but may be overlooked as a possible diagnosis

• Red annular patches with a leading edge, which is often scaly. Occasionally small pustules may be present. The presence of an asymmetrical rash should raise the index of suspicion for tinea

Tinea barbae

Fungal infections occasionally affect the beard / moustache areas. The clinical features are as follows:

• Often presents with marked inflammation and aggregated pustules, exudation and crusting. Affected hairs tend to come away quite easily. It is frequently misdiagnosed as a bacterial infection although it may be distinguished from boils secondary to bacteria by the relative lack of pain and the ease with which the hairs come away

• Milder cases need to be differentiated from bacterial folliculitis, pseudofolliculitis, acne or rosacea

• Tinea faciei - adequate scrapings should be taken with the back of a scalpel blade from the advancing edge of the lesion. The scrapings should be sent to microbiology either in a commercial sample pack or in folded black paper held by a paper clip. Adhesive tape (eg sellotape) stripping may be useful if scale is limited

• Tinea barbae - scrapings and affected hairs should be sent for mycology, false negative results are not uncommon. The presence of Staph. aureus on a swab does not exclude tinea as bacterial colonisation or infection may occur as a secondary event

Tinea faciei

• Treatment is normally with a topical antifungal agent eg terbinafine (Lamisil ®) cream BD for 2 weeks, or one of the imidazole creams such as miconazole (Daktarin ®) cream BD for 2-4 weeks. If the rash is very extensive or inflammatory (pustules present) treat systemically with eg terbinafine for 2 weeks

Tinea barbae

• Treatment with a systemic agent eg terbinafine is needed, usually for 2-4 weeks