Definition

Tinea is an infection caused by fungi of the dermatophyte group. Tinea fasciitis is a fungal infection of the facial skin, whereas tinea barbae refers to fungal infections in the mustache and beard. Tinea fasciitis is a fairly common infection that affects people all over the world. Meanwhile, tinea barbae is one of the world's rarest dermatophyte fungal infections.

Causes

Tinea fasciitis and tinea barbae are caused by dermatophyte fungal infections. These fungi release several enzymes that allow them to invade the top layer of your skin. When infection occurs, an inflammatory reaction occurs in the skin.

Dermatophyte fungi are categorized into three types based on where they are transmitted from, namely:

• Anthropophilic fungi, or fungi that transmit between humans. An example is Trichophyton rubrum. Infection from this fungus often occurs due to exposure to the fungus on the feet (tinea pedis) and nails (tinea unguium)
• Zoophilic fungi, or fungi transmit from animals to humans. Microsporum canis is a fungus transmitted from dogs and cats, Trichophyton verrucosum from livestock such as cattle, and Trichophyton erinacei from sheep and pigs
• Geophilic fungi, or fungi that transmit from soil to humans. Tinea fasciitis can occur due to this type of fungal infection, for example, Nannizzia gypsea. Meanwhile, to date, no cases of tinea barbae have been found to originate from geophilic fungi

Risk Factor

Fungal infections can occur in all people. Some studies have found that tinea fasciitis is more common in women than men, but this could be due to differences in diagnosis. In women, fungal infections of the face are categorized as tinea fasciitis, while in men, infections can occur on the face and beard, so it may be categorized as tinea barbae.

Tinea fasciitis has two peak risk ages: pediatric age and between 20 and 40 years old. Tinea fasciitis is commonly associated with childhood because children frequently play with pets or animals found during school vacations. Infants may also contract the infection from their parents or siblings.

Meanwhile, because tinea barbae is a fungal infection that affects mustaches and beards, it is far more common in adolescent and adult men than in women. In very rare cases, tinea barbae can occur in women who have hirsutism or excessive facial hair growth.

Fungal infections, both tinea fasciitis and tinea barbae, are more common in people with compromised immune systems. This can be due to:

• Diabetes mellitus
• Injury near the site of infection
• Long-term use of steroid medication
• Therapy that lowers the body's immune system such as organ transplant patients

Symptoms

Tinea fasciitis

The symptoms of tinea fasciitis may include scaly reddish plaques, and these plaques are usually not very red and scaly in the center. These reddish plaques may be round or oval in shape. In addition, if the fungal infection is severe, there may be a buildup of pus due to the fungal infection (kerion). These plaques are most commonly found on the cheeks, nose, around the eyes, chin, and forehead.

This infection can occur suddenly and spread quickly (acute) or more slowly and less severely (chronic). Symptoms may also be aggravated by sun exposure. Tinea fasciitis may occur along with fungal infections of the head and body.

Tinea Barbe

Meanwhile, tinea barbae has two different forms, namely:

• Kerion (pus buildup):

Kerion is a form of barbe tinea accompanied by an inflammatory reaction. The kerion can be a plaque or lump with a pusted linting (or pus flowing out). Usually, this plaque or bump is reddish, warm, and thick. Hair in areas experiencing kerons is very easy to break and does not pain when lifted. Usually, the kerion is accompanied by enlargement of the lymph nodes, fever, and symptoms are not feeling well. The kerion is usually only caused by fungal infection, but can also be followed by bacterial infection. The kerion is mostly caused by zoophilic mushrooms, which are transmitted from animal to human.

• Superficial dermatophytosis:

This form of tinea barbae infection is not accompanied by severe inflammatory reactions.  It usually takes the form of scaly reddish plaques surrounded by dense or purulent clusters. Hair near this area may break, or the infection occurs in the hair follicle (where hair grows). This form is also usually a symptom of a chronic or slow-onset fungal infection and is commonly caused by anthropophilic fungi

Diagnosis

Tinea fasciitis and tinea barbae can be diagnosed based on the chief complaint, symptoms, and physical examination. Because their symptoms can be similar to those of other skin diseases, laboratory tests are required to make a definitive diagnosis. The examination is usually done with a skin scraping. The scraped skin is then treated with potassium hydroxide (KOH) to kill the skin or hair cells. Afterward, the results will be observed under a microscope to look for fungi.

Culture of the fungus from skin scrapings can also be done to find the cause. However, culture is more time-consuming, and is usually only done when treatment is unsuccessful or for a research purpose.

Management

Tinea fasciitis is typically treated by applying antifungal medication to the sores' edges. If the treatment is unsuccessful, the doctor may prescribe oral antifungal medications. Meanwhile, tinea barbae is treated with antifungal medications taken by mouth. Tinea fasciitis is typically treated for 4-6 weeks, whereas tinea barbae takes at least 6 weeks and can be extended for an additional 2-3 weeks based on the doctor's recommendation and treatment success rate.

Complications

Complications are rare in tinea fasciitis. In infections caused by the fungus Trichophyton schoenleinii, the infection may leave scars, but this is very rare.

Well-treated tinea barbae may heal without scarring. However, if left untreated, scarring alopecia or baldness may occur due to scarring. Chronic or long-standing forms of tinea barbae are usually more difficult to heal on their own.

Prevention

Tinea fasciitis and tinea barbae are primarily prevented by avoiding infected people and animals. If you suspect your pet has the fungus, you can take the animal to the vet for immediate treatment. During treatment, the animal will need to be isolated. This is necessary so that the animal does not come into contact with your skin or that of your child.

In addition, fungal testing can also be done on farm animals that have the potential to transmit fungi. If the test shows an infection, you can consult a veterinarian to treat the infection.

You can also avoid human-to-human transmission by not sharing combs, brushes, or hats with others. When working with farm animals, you should also wear personal protective equipment like gloves, boots, and long sleeves. You should also wash your hands regularly, especially after touching pets.

When to see a doctor?

If you have itching and reddish plaques on your face and/or beard, you should see a doctor. The symptoms of fascial tinea and tinea barbae can be similar to those of other skin diseases, so further examination may be required. Your risk of developing fascial tinea and tinea barbe is higher if you have pets, farm animals, or frequently come into contact with wild animals.

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