Managing Dermatophytes Infection on the Face

Dermatology, SKIN by Caroline Astrid, MD

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What are dermatophytes and dermatophytosis?

Dermatophytes are fungi that invade keratinized tissues such as skin, hair, and nails. Dermatophytosis is an infection caused by dermatophytes; these infections are commonly referred to as “tinea” infections.

Dermatophytes need keratin as their source of nutrition (keratinophilic) for their growth. Their ability to invade keratinized tissues underlines the pathogenesis of superficial fungal infection of skin, hair, and nails. Dermatophytes don’t infect mucosal surfaces.

Dermatophytosis are generally named according to the site of infection. Here is the name formula in dermatophytosis:

[ Tinea + a Latin term denoting location or other descriptive factor ]

For example, dermatophytosis that is limited to the glabrous skin of the face is called tinea faciei. In female and pediatric patients, this infection may appear on any surface of the face, including the upper lip and chin. Dermatophytosis that occurs in the beard area of males is called tinea barbae.

Superficial fungi that cause dermatophytosis can be classified according to their natural habitat:

  • Zoophilic species (are transmitted to humans from animals).
  • Geophilic species (cause sporadic human infection from direct contact with the soil).
  • Anthrophilic species (restricted to human hosts and are transmitted via direct contact).

Some of the most commonly encountered dermatophyte pathogens in tinea barbae:

  • Trichophyton verrucosum
  • Trichophyton mentagrophytes
  • Trichophyton rubrum
  • Trichophyton violaceum
  • Trichophyton megninii
  • Trichophyton schoenleinii
  • Trichophyton tonsurans
  • Trichophyton interdigitale
  • Trichophyton ernacei
  • Microsporum canis
  • Microsporum nanum
  • Microsporum gypseum
  • Epidermophyton floccosum

HOW CAN WE MANAGE DERMATOPHYTES INFECTION ON THE FACE?

FIRST, use antifungal medication.

In tinea barbae, oral antifungal agents are usually necessary. Here are some of the antifungal agents that can be used to treat tinea barbae:

  • Griseofulvin 1g/day for 6 weeks.
  • Terbinafine 250mg/day for 2-4 weeks.
  • Itraconazole 200mg/day for 2-4 weeks.
  • Fluconazole 200mg/day for 4-6 weeks.

Some topical agents can also be used as adjuvant therapy:

  • Zinc pyrithione 1% or 2%.
  • Povidone-iodine 2.5%.

IMPORTANT NOTE: Antifungal medications have been implicated in numerous cases of hepatotoxicity and other adverse effects, so DO NOT SELF DIAGNOSE AND DO NOT CONSUME ORAL ANTIFUNGAL AGENTS WITHOUT CONSULTING WITH YOUR DERMATOLOGIST FIRST. See your dermatologist when topical antifungal agents don’t work!

IT IS ALSO IMPORTANT TO APPLY A THIN LAYER OF TOPICAL ANTIFUNGAL AGENT, COVER THE LESION AND AT LEAST 2 CM BEYOND THE LESION. RUB GENTLY IN A CIRCULAR MOTION UNTIL THE MEDICATION DISAPPEARS. APPLY ONCE OR TWICE DAILY FOR 2-4 WEEKS OR AS ADVISED BY YOUR DERMATOLOGIST.

SECOND, prevent the infection from spreading to other areas. Here are some tips on how to do it:

  • Treat the area for as long as recommended by your dermatologist. Anti-fungal medicine may work quickly. You may see clearing or no longer feel symptoms in a few days.
  • Wash your hands after touching or scratching the infected area, before touching another area of your body.
  • Keep the infected area clean and dry. The fungus that causes dermatophytosis thrives in warm, moist areas, so you should keep the area clean and dry.

THIRD, avoid wearing hijab, shawl or clothes that are made from non-absorbent fabrics.

FOURTH, avoid shaving hairs in the infected area or maybe you can shave using disposable razor, if you must.

FIFTH, avoid sharing towels and other personal items.

SIXTH, if you suspect your pet has been infected, bring it to the vet as soon as possible and avoid direct contact with it.

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