Tinea faciei (facial ringworm, ringworm of the face) is a fungal infection caused by human or animal fungi. The infectious disease manifests on the face in the form of superficial red spots. Because the benign infection is rare and the symptoms are also reminiscent of other diseases, the doctor often makes an incorrect diagnosis. Antifungal medications applied to the skin and sometimes taken by mouth resolve the condition, relieving the patient of facial skin lesions within a few weeks.

• Terminology of tinea faciei
• Epidemiology of fungal infection
• Causes: Due to animal and human fungi
• Symptoms: Red spots on facial area

• More severe symptoms
• Also other fungal infections

• Diagnosis and examinations
• Therapy
• Prognosis

Terminology of tinea faciei

Tinea faciei does not include the infection of the beard and mustache area in men, because doctors use the medical term ‘tinea barbae’ (fungal infection of the beard area of men). In children and female patients, the infection may present on any part of the face, including the upper lip and chin.

Epidemiology of fungal infection

Tinea faciei occurs worldwide, but mainly in tropical areas with a humid climate and high temperatures. The disease is therefore less well known in Western countries. Women may be more likely to suffer from the infection, but women are generally more likely to seek medical attention when facial symptoms develop. In addition, men are often diagnosed with tinea barbae when the symptoms occur in the beard area. The condition occurs at any age, but especially in children (through contact with pets) and people between the ages of twenty and forty. However, children and the elderly are also affected by tinea faciei.

Causes: Due to animal and human fungi

Keratinophilic (growing on keratin-rich tissue) fungi or dermatophytes (fungal parasites of the skin) are responsible for tinea faciei. Dermatophytes release various enzymes, including keratinases, that allow them to penetrate the stratum corneum of the epidermis.Contact with infected dogs may lead to the fungal infection / Source: Kim BolsTypes of fungi Both zoophilic ( animal ) and anthropophilic ( human ) fungi may cause tinea faciei. Examples of animal fungi include Microsporum canis (M. canis) from cats and dogs, T. verrucosum from agricultural livestock, and Trichophyton (species Arthroderma benhamiae ) from guinea pigs. An example of an anthropophilic fungus is Trichophyton rubrum (T. rubrum) . Infection caused by zoophilic dermatophytes is usually associated with more severe inflammatory responses than those caused by anthropophilic fungi.Spread The spread of the infection occurs through direct contact with infected people, infected animals, contaminated objects (such as towels) or the ground.

Symptoms: Red spots on facial area

Tinea faciei is a superficial infection limited to the bald skin of the face. Every possible part of the face is affected such as the cheeks, nose, eye area, chin (in women) and forehead. The symptoms of tinea faciei are reminiscent of those of tinea corporis (body fungus: ring-shaped rash). The disease has an acute course (sudden onset and rapid spread) or a chronic course (slow development of a mild, barely inflamed skin rash).The patient presents with single or multiple round or oval pink to red scaly spots. The skin lesions vary in size from one to five centimeters. Itching almost always occurs. The edge of the affected skin is sometimes raised and contains bumps, blisters or scabs. Often the center of the lesion has normal-appearing skin with a ring-shaped border, leading to the nickname ringworm, although the infection is not caused by a worm. The fungal infection sometimes also manifests itself in the form of a kerion (fungal abscess).

More severe symptoms

The symptoms worsen with exposure to sunlight. Also, patients with weak immune systems (such as patients with diabetes, leukemia, or HIV/AIDS) are more likely to develop facial ringworm or have more severe forms of the disease.

Also other fungal infections

Occasionally, tinea faciei co-occurs with other forms of dermatophytes, especially tinea capitis (head fungus) and tinea corporis.

Diagnosis and examinations

Diagnostic examination The doctor confirms the diagnosis of tinea faciei by microscopy and culture of skin scrapings.Differential Diagnosis Tinea faciei is often misdiagnosed by the doctor as a non-fungal condition such as:

• actinic keratoses (skin lesions caused by prolonged exposure to the harmful UV rays of sunlight)
• acute complications of sarcoidosis (disorder with symptoms of the skin, eyes, lungs and nervous system)
• acute cutaneous lupus erythematosus
• allergic contact dermatitis (rash with redness and itching)
• atopic dermatitis (atopic eczema: skin disease with itching)
• bullous systemic lupus erythematosus
• cutaneous candidiasis (fungal infection of the skin caused by the fungus Candida)
• cutaneous lupus erythematosus
• discoid lupus erythematosus (skin disorder)
• drug-induced lupus erythematosus
• granuloma annulare (skin condition with ring-shaped nodules)
• irritant contact dermatitis (skin inflammation due to exposure to substances)
• neonatal and pediatric lupus erythematosus (autoimmune disorder)
• pediatric syphilis (bacterial infection through sexual contact)
• perioral dermatitis (skin condition with a rash around the mouth)
• pityriasis alba (skin disease with red and then white spots)
• pityriasis rosea (birthmark and fiery rash on torso)
• polymorphic light eruption (skin disease due to sun exposure)
• psoriasis (chronic skin disease with dry skin and flakes)
• rosacea (skin condition with redness and swelling of the face)
• seborrheic dermatitis (skin disease with dandruff and red skin)

The misdiagnosis is especially common in patients receiving treatment with local ( applied to the skin) steroids or oral (taken by mouth) steroids (tinea incognita).

Therapy

The doctor usually treats Tinea faciei with topical (applied to the skin) antifungal agents (antimycotics). Sometimes the treatment is unsuccessful, or many lesions are present. The doctor then decides to prescribe oral antifungal medications such as terbinafine and itraconazole. It is also important to have pets checked by the vet for the presence of a fungal infection, and then also have the animal treated for the infection.

Prognosis

The prognosis for patients with tinea faciei is usually good. The skin lesions respond to the antifungal treatment within four to six weeks. Scars may occur in patients with a Trichophytonschoenleinii fungal infection, but this fungus is extremely rare.

read more

• Tinea (ringworm): Skin infections caused by fungi
• Fungal skin infections: Skin infection due to fungi