What is tinea faciei
Tinea faciei also known as facial ringworm, tinea faciale or ringworm of the face, is the name used for uncommon infection of the surface (superficial) skin of the face with a dermatophyte fungus. Tinea faciei may be passed to humans by direct contact with infected people, infected animals, contaminated objects (such as towels) or the soil. Tinea faciei does not include infection of the beard and moustache area, which is called tinea barbae. Tinea faciei is uncommon and often misdiagnosed at first.
Tinea faciei can be due to an anthropophilic (human) fungus such as Trichophyton rubrum (T. rubrum). Infection often comes from the feet (tinea pedis) or nails (tinea unguium) originally. Zoophilic (animal) fungi such as Microsporum canis (M. canis), from cats and dogs, and Trichophyton verrucosum, from farm cattle, are also common.
In children and most women, tinea faciei can appear on any part of the face. In all men and in women who have dark, course hair on their face, it is known as beard ringworm (tinea barbae) when the infection occurs on the bearded part of the face.
Tinea faciei is often misdiagnosed as a non-fungal condition such as:
- Atopic dermatitis
- Seborrheic dermatitis
- Psoriasis
- Rosacea
- Actinic keratoses
- Contact allergic dermatitis
- Perioral dermatitis
- Cutaneous lupus erythematosus
- Polymorphous light eruption
Misdiagnosis is particularly common in those treated with topical steroids or oral steroids (tinea incognita).
Tinea faciei (facial ringworm) may occur in people of all ages, of all races, and of both sexes. However, it is more common in warmer, more humid climates. In addition, it is most frequently seen in adults aged 20–40.
People with suppressed immune systems (eg, with diabetes, leukemia, or HIV/AIDS) are more likely to develop facial ringworm or to have more severe forms of the disease.
If you suspect that you have tinea faciei (facial ringworm), you can try one of the following over-the-counter antifungal creams or lotions:
- Terbinafine
- Clotrimazole
- Miconazole
Apply the cream to each lesion and to the normal-appearing skin 2 cm beyond the border of the affected skin for at least 2 weeks until the lesions are completely gone. Because ringworm is very contagious, avoid contact sports until lesions have been treated for at least 48 hours.
Since people often have tinea infections on more than one body part, examine yourself for other ringworm infections, such as in the groin (tinea cruris), on the feet (tinea pedis, athlete’s foot), and anywhere else on the body (tinea corporis).
Have any household pets evaluated by a veterinarian to make sure that they do not have a fungal (ie, dermatophyte) infection. If the veterinarian discovers an infection, be sure to have the animal treated.
If the lesions do not improve after 1–2 weeks of applying an over-the-counter antifungal cream, see your doctor for an evaluation.
The diagnosis of tinea faciei is confirmed by microscopy and culture of skin scrapings.
Is tinea faciei contagious?
Yes. The fungi that cause tinea faciei can live on skin, surfaces, and on household items such as clothing, towels, and bedding.
Tinea (commonly called “ringworm”) spreads easily between humans and animals 1. Tinea can also spread from one part of the body to another (for example, a patient with tinea pedis can go on to develop tinea cruris). Humans and animals can also be non-symptomatic carriers and can spread tinea to others. Transmission also occurs via fomites; infection can spread through shared towels, clothing, bedding, etc., as well as hard surfaces (particularly in moist areas) such as shower stalls, locker room floors, pool areas, etc.
You can take the following steps to protect yourself and your pet:
DO
- Wash your hands with soap and running water after playing with or petting your pet.
- Wear gloves and long sleeves if you must handle animals with ringworm, and always wash your hands after handling the animal.
- Vacuum the areas of the home that the infected pet commonly visits. This will help to remove infected fur or flakes of skin.
- Disinfect areas the pet has spent time in, including surfaces and bedding.
- The spores of this fungus can be killed with common disinfectants like diluted chlorine bleach (1/4 c per gallon water), benzalkonium chloride, or strong detergents.
- Never mix cleaning products. This may cause harmful gases.
Do not handle animals with ringworm if your immune system is weak in any way (if you have HIV/AIDS, are undergoing cancer treatment, or are taking medications that suppress the immune system, for example).
For pets
Protect your pet’s health
- If you suspect that your pet has ringworm, make sure it is seen by a veterinarian so treatment can be started.
- If one of your pets has ringworm, make sure you have every pet in the household checked for ringworm infection.
Tinea faciei prevention
- Keep your skin clean and dry.
- Wear shoes that allow air to circulate freely around your feet.
- Don’t walk barefoot in areas like locker rooms or public showers.
- Clip your fingernails and toenails short and keep them clean.
- Change your socks and underwear at least once a day.
- Don’t share clothing, towels, sheets, or other personal items with someone who has ringworm.
- Wash your hands with soap and running water after playing with pets. If you suspect that your pet has ringworm, take it to see a veterinarian. If your pet has ringworm, follow the steps below to prevent spreading the infection.
- If you’re an athlete involved in close contact sports, shower immediately after your practice session or match, and keep all of your sports gear and uniform clean. Don’t share sports gear (helmet, etc.) with other players.
Tinea faciei signs and symptoms
Tinea faciei resembles tinea corporis (body ringworm). It may be acute (sudden onset and rapid spread) or chronic (slow extension of a mild, barely inflamed, rash). There are round or oval red scaly patches, often less red and scaly in the middle or healed in the middle. It is frequently aggravated by sun exposure. It may also present as a kerion (fungal abscess).
The most common locations for tinea faciei (facial ringworm) include the following:
- Cheeks
- Nose
- Around the eye
- Chin
- Forehead
Tinea faciei (facial ringworm) appears as one or more pink-to-red scaly patches ranging in size from 1 to 5 cm. The border of the affected skin may be raised and may contain bumps, blisters, or scabs. Often, the center of the lesion has normal-appearing skin with a ring-shaped edge, leading to the nickname “ringworm,” even though it is not caused by a worm.
Tinea faciei (facial ringworm) can be itchy, and it may get worse or feel sunburned after exposure to the sun.
Tinea faciei diagnosis
Your healthcare provider can usually diagnose tinea faciei (facial ringworm) by looking at the affected skin and asking questions about your symptoms. He or she may also take a small skin scraping (scales) to be examined under a microscope or sent to a laboratory for a fungal culture. This procedure, called a KOH (potassium hydroxide) preparation, allows the doctor to look for tell-tale signs of fungal infection.
Tinea faciei treatment
Once the diagnosis of tinea faciei (facial ringworm) is confirmed, your physician will probably start treatment with a topical antifungal medication. Most infections can be treated with prescription-strength topical creams and lotions, including:
- Terbinafine
- Clotrimazole
- Miconazole
- Econazole
- Oxiconazole
- Ciclopirox
- Ketoconazole
- Sulconazole
- Naftifine
Rarely, more extensive or long-standing infections may require treatment with oral antifungal pills, including:
- Terbinafine
- Itraconazole
- Griseofulvin
- Fluconazole
The ringworm should go away within 4–6 weeks after using effective treatment.
Tinea faciei prognosis
The prognosis for patients with tinea faciei is usually good. The lesions respond to topical and oral antifungal treatment within 4-6 weeks. Scarring may occur in patients with Trichophyton schoenleinii infection; this is extremely rare.
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