Tinea Barbae
EPIDEMIOLOGY
Tinea barbae is by definition seen only in males. Largely transmitted by contaminated barbers' razors in the past, improved sanitation has reduced its incidence. Tinea barbae is now more often contracted by direct exposure to cattle, horses, or dogs, and is thus most commonly seen in rural settings among farmers or ranchers.
ETIOLOGY
Tinea barbae is most commonly caused by the zoophilic organisms T. mentagrophytes and T. verrucosum, and, uncommonly, M. canis. Among the anthropophilic organisms, T. megninii, T. schoenleinii, and T. violaceum may cause tinea barbae in endemic areas, while T. rubrum is an infrequent cause.
CLINICAL FINDINGS
Tinea barbae is typically unilateral and more often involves the beard area than the moustache or upper lip. Three forms exist.
Inflammatory Type.
Usually caused by T. mentagrophytes and T. verrucosum, inflammatory tinea barbae is analogous to kerion formation in tinea capitis. The lesions are nodular and boggy with a crusting seropurulent discharge. Hairs in this area are lusterless, brittle, and easily epilated to demonstrate a purulent mass about the root. Perifollicular pustulation may coalesce to form sinus tracts and abscess-like collections of pus, eventuating in a scarring alopecia.
Superficial Type.
Caused by the less inflammatory anthropophiles, this form of tinea barbae closely resembles bacterial folliculitis, with mild diffuse erythema and perifollicular papules and pustules (see Fig. 188-8B). Hairs that are dull and brittle make endothrix infection with T. violaceum a more likely etiology than T. rubrum.
Circinate Type.
Much like tinea circinata of glabrous skin, circinate tinea barbae exhibits an active, spreading vesiculopustular border with central scaling and relative sparing of the hair
Differential Diagnosis of Tinea Barbae
Most Likely
· Bacterial folliculitis (sycosis vulgaris), perioral dermatitis, candidal folliculitis, pseudofolliculitis barbae, acne vulgaris/rosacea, contact dermatitis
Rule Out
· Halogenoderma, herpes simplex
