Tinea faciei is the name used for infection of the face with a dermatophyte fungus. It 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) is acquired from cats and dogs, and T verrucosum, from farm cattle, are also common.
Tinea faciei resembles tinea corporis (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. Lesions are usually asymmetric and it is often unilateral. It is frequently aggravated by sun exposure. It may also present as a kerion (fungal abscess).
It is essential to look for and treat tinea infection elsewhere (look at the feet, groins, and nails) and in a suspected zoophilic infection, identify, isolate and treat the source animal.
Tinea faciei is often misdiagnosed as a non-fungal condition such as:
Misdiagnosis is particularly common in those treated with topical steroids or oral steroids (tinea incognita).
The diagnosis of tinea faciei is confirmed by microscopy and culture or PCR of skin scrapings.
Tinea faciei is usually treated with topical antifungal agents, but if the treatment is unsuccessful, oral antifungal medicines may be considered, including terbinafine and itraconazole.
In recent years, antifungal drug resistance has made treatment more challenging.
