Tinea barbae is a fungal infection occurring on the bearded areas of the neck and face, specifically affecting the hair follicles. This infection, which is also called ringworm of the beard, mostly affects male adults and adolescents. It is also known as barber’s itch because in the past, the unsanitary razors used by barbers frequently served as the mode of transmission of the infection. Tinea barbae appears as inflammatory plaques or noninflammatory patches that resemble skin conditions such as tinea corporis or folliculitis. Treatment involves the topical application or oral intake of antifungal drugs.
This fungal infection is caused by dermatophytes, which are keratinophilic or keratin-loving fungi. Examples of keratinophilic dermatophytes include Trichophyton rubrum, Trichophyton violaceum, Trichophyton mentagrophytes, and Trichophyton verrucosum. Members of the genus Trichophyton are the most common organisms isolated, thus tinea barbae is also called trichophytosis barbae. In order to invade the skin and hair, these dermatophytes release enzymes such as keratinases, which break down keratin. Once these organisms have invaded the hair and hair follicles, the body reacts by inducing the inflammatory cascade.
Anthropophilic dermatophytes, which undergo human-to-human transmission, cause the noninflammatory superficial form of tinea barbae. This form resembles tinea corporis, or ringworm of the body, and may appear as reddish patches with vesicles and crusts. The inflammatory deeper form of this skin condition, caused by zoophilic dermatophytes, is called kerion. Characteristically, it looks like a reddish nodule with pustules which eventually lead to pus-filled masses that drain and become crusted. Associated symptoms including enlargement of neck lymph nodes, body pains, and fever often occur with kerion.
The incidence of tinea barbae has dropped because of sanitation and hygiene. It is, however, still common in warm and humid countries. In addition, rural inhabitants and agricultural workers are prone to this infection because dermatophytes are commonly acquired through animal-to-human transmission. The bearded areas of the neck and face are involved, thus this disease is almost exclusive to men. When similar areas are affected in women and children, the disease is called tinea faciei.
Shaving or depilation is recommended because hairs are affected in tinea barbae. Application of a warm compress helps remove the crusts and debris. Although antifungals can be applied topically, the better mode of medical treatment is oral intake of these drugs. Examples of antifungals used for tinea barbae are griseofulvin, terbinafine, itraconazole, and fluconazole. If tinea barbae is left untreated, scarring and permanent balding may occur.