What are the other Names for this Condition? (Also known as/Synonyms)

• Barbers' Itch
• Folliculitis Barbae
• Tinea Barbae Infection

What is Ringworm Infection of the Beard? (Definition/Background Information)

• Ringworm Infection of the Beard, also termed as Tinea Barbae Infection, is a fungal infection that affects the beard on the face and neck region
• The group of fungus causing the infection are called dermatophytes (most typically caused by the genus Trichophyton)
• This infection causes red blister-like lesions with crusty formations, on the bearded areas of the face. Itching sensations, pain, and oozing are commonly noted
• Ringworm Infection of the Beard is a contagious fungal infection that develops due to poor hygiene and prolonged warm moist conditions. This condition mainly affects male individuals (after puberty), and is often acquired from farm animals
• The species of fungus that infects non-humans are likely to elicit a more vigorous inflammatory response than the species that are routinely found on human beings 
• Ringworm Infection of the Beard is easily treated using antifungal medications and by maintaining a proper hygiene

Who gets Ringworm Infection of the Beard? (Age and Sex Distribution)

Ringworm Infection of the Beard is often confined to older adolescent boys and adult men.

What are the Risk Factors for Ringworm Infection of the Beard? (Predisposing Factors)

The potential risk factors for Ringworm Infection of the Beard are:

• Coming into close contact with infected farm animals and playing with infected pets may cause a severe infection - agriculture workers generally form the single highest risk group
• Wrestling and other activities that include extensive skin-skin contact
• Sharing items, such as shaving razors (at hair salons), combs, rugs, bed linens, bath towel, hair brushes, with individuals having fungal infections
• Individuals residing in overcrowded neighborhoods (that are warm and humid) with poor living conditions
• Neglecting fungal infection at other locations of the body
• If the individual has a weak immune system or diabetes, there is a greater susceptibility to fungal infections such as Ringworm Infection of the Beard
• Those who were infected with fungal infections in the past have an elevated risk

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Ringworm Infection of the Beard? (Etiology)

Ringworm Infection of the Beard is caused by a fungus.

• Mold-like fungi, belonging to genus Trichophyton, transmitted in warm-wet areas from animals are the prime cause of this infection. The fungus release enzymes called keratinase that invades the skin and hair follicles, causing severe inflammatory pustules
• A dry and clean skin does not facilitate the growth of the fungus. However, damp and warm conditions, as well as friction and microtraumas increase their invasion, growth and proliferation, which results in an infection
• Ringworm Infection of the Beard spreads through:
  • Direct contact with infected farm animals such as horses and cattle
  • Infected pets such as cats and dogs
  • From another infected individual
  • By using shared items

What are the Signs and Symptoms of Ringworm Infection of the Beard?

Ringworm Infection of the Beard signs and symptoms may include:

• The fungus typically affect the hair follicles and shaft, causing hair breakage and temporary hair loss at various locations
• Expanded red papules (bumps) and fluid-filled lesions form on the skin surface. Generally, burning,  itchy, or stinging sensations are less intense
• With time, the skin crack and peel, exposing the raw tender skin and tissue inside that get inflamed and swollen
• Once these blisters break, crusty formations are observed, the hair get matted, and dead cell debris are seen
• When the causative fungal species are the usual human types, the presentations are less severe. Often, in such cases, non-inflammatory and superficial patches with lesions around the follicles are observed
• An infection caused through the animal route is severely inflammatory and presents a higher degree of signs and symptoms

How is Ringworm Infection of the Beard Diagnosed?

A Ringworm Infection of the Beard or Tinea Barbae Infection is visually recognizable, and the physician may conclude the diagnosis based on a simple physical examination. However, the infection is normally confirmed by the following diagnostic tests:

• Performing a biopsy of the affected skin
• Skin culture, to identify the exact type of fungus causing the condition - this method may take about 2-3weeks’ time
• A sample of the hair or skin is examined microscopically, to detect the presence of the fungus. This is the most cost effective and least invasive, quickest test used
• Wood’s lamp test - the use of ultraviolet rays to check the fluorescent properties of the infection
• A differential diagnosis may need to be considered in order to eliminate other skin infections/conditions presenting similar signs and symptoms

Bacterial culture and sensitivity are also done. The amount of inflammation elicited can help make the differentiation from primary bacterial infection and possible secondary impetiginization

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Ringworm Infection of the Beard?

Complication due to Ringworm Infection of the Beard may include:

• The infection may spread to other regions of the body, such as the scalp, groin, torso, limbs, etc.
• Permanent scarring, hair loss, bald patches on the chin and cheek may occur due to a worsening of the skin condition. This may lead to intensely painful inflammations and blister-oozing pus (kerions), followed by crusty formations
• There is a risk of other bacterial infections affecting the body
• Recurrence of the infection
• Young teenagers and young adults with the disease may have mental and emotional agony, including low self-esteem

How is Ringworm Infection of the Beard Treated?

The treatment measures for Ringworm Infection of the Beard may include:

• Most skin-related fungal infections respond extremely well to treatment with over-the-counter antifungal medications and dry powder applications. The condition can be cured within 4-6 weeks in most cases
• Antifungal creams cannot always penetrate deep enough to eliminate the fungus in the hair shafts that are involved. In such a (common) situation, oral antifungal medications will be giving along with the topicals. Usually terbinafine will be prescribed or griseofulvin
• Secondary bacterial infections are treated with oral and/or topical antibiotics
• Self-care is essential, which also helps shorten the recovery period. Certain basic steps to be followed include:
  • Careful, non-traumatic shaving of uninvolved areas
  • Applying hot-moist compresses, to remove crusts and debris from the infected follicles
  • Regular washing and cleaning of the face to prevent spread of the infection to other regions
  • Using clean and disinfected razors, towels, combs, and hairbrushes
  • Disinfecting common shared spaces, such as toilets and shower areas, bathtubs, kitchens, bedrooms, etc.
  • Taking the oral medications as prescribed
• In order to avoid recurrence of the infection, the antifungal treatment measures have to be continued for an extended period of time (per advice of the physician), even after the condition seems clear

How can Ringworm Infection of the Beard be Prevented?

Some basic steps to ensure the prevention of Ringworm Infection of the Beard, especially if the risk factors are high, include:

• Keep your beard (including hair and scalp) clean and dry regularly
• Change shaving razors frequently, use newer ones; avoid wearing any clothing that causes too much friction with the area
• Fungal infections transmit through contact and hence, avoid sharing common personal items, like combs, towels, razors, beddings, etc.
• The infection can spread from infected animals and pets. Such animals may show signs of bald skin patches on their body, or sometimes they may be asymptomatic
• Treat any fungal infection immediately, and prevent them from spreading to other regions of the body
• Be aware of fungal infections and learn to recognize the early signs; take prompt treatment measures

What is the Prognosis of Ringworm Infection of the Beard? (Outcomes/Resolutions)

The prognosis of Ringworm Infection of the Beard with appropriate treatment is excellent.

• Irrespective of the severity of the infection, an effective treatment course can control the condition within 1-2 months
• It responds very well to antifungal treatment and good self-care
• In order to prevent its recurrence, the treatment has to be continued even after all the signs of infection have ceased
• If the infection spreads to other parts of the body, or other secondary bacterial infections arise, then an extended course of treatment with antibiotics may be required
• Individuals with diabetes or other immunodeficiency-related diseases should seek immediate medical advice, if they develop any skin fungal infection

Additional and Relevant Useful Information for Ringworm Infection of the Beard:

Many decades ago, barbers at hair salons used to employ the same razor for many customers on a regular basis. Thus, the fungal infection was more frequent back then. Hence, it used to be known as Barber’s Itch or Barber’s Rash.