What Is Tinea Barbae

Introduction

Tinea Barbae (TB) is a rare fungal infection that is caused by dermatophytes.¹ Dermatophytes are a group of fungi that are characterized by the ability to digest keratin hence why TB affects hair, skin, and hair follicles.² Due to the lack of awareness about the disease, especially, in the medical field, results are misinterpreted, diagnoses missed and the condition is mismanaged. To avoid this, it is important to review the mechanisms, clinical manifestations, diagnosis, and treatment of TB and that is the intent of this article.

Tinea Barbae was first reported in 1842 by Gruby and was named ‘mentagrophyte’. It was fungal infection from the beard.³  The name of the disease originated from, Tinea meaning ringworm and Barbae the Latin word for beard. Over the years TB has been known as tinea sycosis due to inflammation, barber’s itch, or beard ringworm. All of these names commenced from the idea that TB was caused by the transmission of unsanitary razors commonly done by barbers. As previously noted, Tinea Barbae (TB) is a rare condition, with approximately 150 documented cases. Consequently, making accurate predictions regarding the disease's risk a significant challenge.⁴

Causes and risk factors

TB is caused when dermatophytes are passed to humans via direct contact with humans, soil or animals.^1,5  A type of dermatophyte known as Trichophyton is  the causative agent of TB. There are many different types of Trichophyton originating from domestic animals, such as sheep, pigs, dogs, and dairy cows. Most cases are a result of contact with infected animals (also known as zoophilic), however, there are a few cases that have been reported recently that document human-to-human transmission and are specific to the fungi Trichophyton rubrum.^1,4,5

Who is at risk?

Despite Tinea barbae being uncommon, a few factors may increase the chances of one acquiring the condition. These factors include but are not limited to the following:

• Farmers due to their direct contact with animals
• Teenagers who might be unaware of the use of unsanitary razors, and usually the period  when hair appears on the face during puberty for most boys
• Adult males mainly because of getting barber cuts where razors are not frequently sterilized sanitized or changed
• Autoimmune disease that can destroy hair follicles
• Diabetes since it can  compromise the immune system's defence mechanism
• Any skin trauma from scratches, or cuts 
• Misuses of steroids⁶

It is important to note that, even though  TB affects mostly males, females are still likely to contact TB if personal hygiene is not maintained.

Symptoms

The clinical manifestations of Tinea Barbae are categorised into inflammatory and non-inflammatory. The inflammatory manifestations are usually associated with zoophilic transmissions and develop a lesion (abnormal change in tissue) known as kerion. Kerion is a tender plaque that has draining sinuses. Hair around kerions are normally brittle and can easily be plucked.⁷ There are also some ring-shaped rashes that form on the skin. The list below summarises  the signs and symptoms to look out for in TB:

• Pimple or blisters
• Swelling around the affected area
• Redness
• Lumpy skin
• Crusting of the infected area
• Hair that can easily be plucked
• Pain and itchiness (not always)

The non-inflammatory TB is usually caused by anthropophilic (parasites that prefer humans as hosts) dermatophytes. This type presents with chronic effects compared to the inflammatory ones and resembles more of tinea corporis or bacterial folliculitis.⁸

Diagnosis

Diagnosis is first confirmed by a clinical presentation and physical examination by a healthcare professional. Once Tinea Barbae is suspected a few tests are done. These include microscopic examination where a swab of the affected area is taken and viewed under a microscope in the lab. The sample is used to confirm the presence of the fungus since TB is a fungal infection. Further tests are done to identify the type of fungus, in this case a Trichophyton species. These further tests allow for the appropriate treatments to be administered to patients. Histopathological exams can also be performed. All the tests are essential in identifying TB; however, they are not specific or entirely accurate hence the need for newer methods of diagnosis.

Additionally, TB symptoms are closely associated with other conditions like acne and herpes therefore, the clinical examinations are highly significant. Besides that, specialists should consider other skin conditions for differential diagnosis purposes for instance allergic reactions, contact dermatitis, and folliculitis.

Treatment and management

Antifungal Medications

Antifungal treatments such as griseofulvin are widely used in TB. These can be applied orally or topically (applied to the skin ). Other medications include terbinafine, fluconazole and itraconazole. These have proven to be effective when administered appropriately as advised by health professionals. A few side effects are associated with these drugs. Griseofulvin, for example, patients can cause skin irritation and when used orally, can lead to diarrhoea, vomiting, nausea and rarely anaemia. Doctors must be informed of any underlying health conditions that might compromise the function of the drugs.⁹ Moreover, topical treatments should be used alongside oral antifungal therapy. Inappropriate use of anti-microbial drugs may also lead to antimircrobialresistance hence medical advice should be sought before taking antimicrobial agents.

Home remedies

Topical substances can be applied to the affected area including the use of antifungal shampoos, conditioners, lotions, and creams. Additionally, hair in the affected area can be shaved and the crust  removed by gently damping with a warm towel. Other sources suggest the use of apple cider vinegar, tea tree oil, and garlic as they contain antifungal properties.¹⁰

Prevention

• Washing of hands thoroughly after contact with domestic animals
• Avoid the exchange of hair clipping tools, especially at the barbers
• Sterilising razors and any other tools that come in contact with the skin
• Once a zoophilic transmission is suspected, treatment of the infected animal should transpire, if possible, to avoid further transmission
• Thoroughly cooking meat to destroy the fungus

Consultation with a healthcare professional

According to the NHS (National Health Service), antifungal treatments can be prescribed by a pharmacist and the pharmacist will usually tell you if you should see a GP (General Practitioner). This decision may arise due to no improvement after the use of antifungal medicine or a weakened immune system from underlying health conditions such as diabetes.

Complications

If left untreated TB can advance to serious infections and spread to other parts of the body. TB can cause breaking of skin in affected areas and increases the chances of getting a bacterial infection. A potentially significant complication is hair loss which leads to alopecia. Alopecia is associated with psychological effects such as anxiety, depression, reduced confidence, and embarrassment.¹¹ These effects have a negative impact on individuals’ quality of life.

Summary

• Tinea Barbae, sometimes known as Beard’s ringworm, is a fungal infection that affects the skin, hair, and hair follicles.
• Most cases of TB are a result of contact with affected domestic animals hence why most patients are farmers
• The fungi responsible for TB is that of the Trichophyton species.
• Using apple cider vinegar and antifungal shampoos can help treat Tinea Barbae
• It is important to seek medical advice if symptoms are persistent to avoid infections spreading throughout the body and leading to more serious health complications 

It is important that early diagnosis and proper treatments are administered when TB is suspected. This is why new methods of diagnosis such as the use of genetic sequencing that are more accurate and efficient be researched. The only downside is the cost associated with the use of such methods and the fact that only specialists trained for the field will be able to perform these tests leading to the overworking of health professionals.

Also, scientists can research providing vaccinations for domestic and farm animals as a way of reducing the risk of contracting Tinea Barbae.