Tinea barbae B35.0

Mostly zoophilic dermatophytes, especially Triphophyton verrucosum (main host: cattle, pathogens of bovine lichen) and Trichophyton mentagrophytes var. interdigitale (main host: rodents), more rarely also other Trichophyton and Mikrosporum species (see Trichophyton, Mikrosporum). Regionally different also anthrophilic dermatophytes like Trichophyton rubrum may be the predominant pathogen of a Tinea barbae (Duarte B et al. 2019).

Simultaneous detection of a Tinea manuum and/or a Tinea unguium gfls. in the presence of immunosuppression (pathogen is transferred from the hands to the facial area) is indicative.

Herd-shaped, initially inflammatory, scaly redness. In the further course of the disease, circumscribed non-purulent and purulent folliculitis (follicular pustules), furunculoid nodules and confluent abscesses may occur. Diseased hair can be epilated painlessly. Painful regional swelling of the lymph nodes, possible disturbance of the general condition with fever. Tinea barbae is often preceded by several months of therapy with external corticoids. Wet shaving promotes the spread of the pathogens.

A smear test is usually not effective; in this case, Staphylococcus aureus can be detected mainly in the context of a secondary infection.

Important is the detection of fungi in or on the depilated hair, in the native preparation and in culture. Tr. verrucosum and Tr. interdigitale cause an ectothrix infestation with large arthrospores.

• Folliculitis simplex barbae: Succulent erythema with numerous, partly confluent, follicularly bound pustules; later honey yellow crusts. Painful and burning, especially when shaving. Mostly distributed over a large area, clearly follicularly accentuated with pointed conical follicular papulo-pustules. Negative fungal culture.
• Gram-negative folliculitis: Chronic persistent, pale red follicular papules and pustules on an inflammatory reddened ground. Often severe seborrhea. More itchy than painful. No lump formation, no confluence of lesions.
• Eosinophilic, sterile pustulosis (eosinophilic, pustular folliculitis): Only the infantile form is of importance for differential diagnosis because of the distribution pattern. Mainly boys (5 times more frequently than girls) at the age of 5-10 months are affected. Disseminated, very itchy and reddened papules and plaques with development of sterile pustules. Confluence to larger foci is possible, also anular and polycyclic foci with central regression and peripheral progression may occur. Histology is diagnostic!
• Folliculitis barbae candidamycetica (Candida folliculitis): Visible are small follicular papules and papulo-pustules, also confluent, more itching than painful, hair may be missing in the lesional area. Culture from smear material and inoculation culture from depilated hairs. On rice agar typical cultures develop within 24 h at 22 degrees C.
• Tuberculosis cutis colliquativa: Rare; eminently chronic disease; usually several globular, subcutaneous nodules covered by livid red skin. Later softening, perforation and fistulation or ulceration. Healing with the formation of funnel-shaped scars as well as bead, tip and bridge scars. Recurrent nodule eruptions.
• Actinomycosis: Very rare; the infection spreads from the depth of the lower jaw to the skin. Fever and local pain may be accompanying symptoms. Very coarse, blue-red, infiltrated indurations and nodules with a tendency to ulceration or melting with a tendency to fistula and pronounced scarring. Often adhesions in the surrounding tissue. In the exiting pus macroscopically recognizable, 0.2-0.5 cm large, irregularly shaped, yellowish, solid grains ( drusen) can already be seen. No spontaneous healing.
• Folliculitis decalvans (see also Folliculitis sycosiformis atrophicans) Rather rare differential diagnosis of follicular inflammation in the beard area. Eminently chronic clinical picture characterised by gradually spreading scarred hair loss. Initially disseminated, small follicular papules, later pustular transformation, crust formation. Peripheral progression of the foci, central scarred healing. Irregularly shaped scar foci with small spots of irreversible hair loss result. Formation of tuft hairs (typical for this disease).

Removal of the beard. Always internal antifungal therapy, see Tinea. Recommended is the therapy with Terbinafine 250mg/day p.o. over a period of 4-6 weeks.

Broad-spectrum antimycotics from the group of triazoles (see antimycotics below) are effective against dermatophytes and yeasts and also detect Gram-positive pathogens (superinfection).

In farmers, tinea barbae may be occupational in nature due to contact with infected large animals. In this case it is notifiable via the dermatological procedure according to No. 3102 of the Ordinance on Occupational Diseases (diseases transmissible from animals to humans).

1. Duarte B et al (2019) Adult tinea capitis and tinea barbae in a tertiary Portuguese hospital: A 11-year audit
   . Mycoses 62:1079-1083.
2. Seebacher C et al (2006) Tinea capitis. J Dtsch Dermatol Ges 4: 1085-1091
3. Seebacher C et al (2007) Tinea of the free skin. J Dtsch Dermatol Ges 11: 921-926