Tinea faciei

Guinea pig mushroom.

Dermatophyte infection of the face.

Pathogen: T. mentagrophytes, M. canis (zoophilic), T. rubrum (anthropophilic).

Especially children and young people.

• Erythematous, sharply demarcated, marginally accentuated, pruriginous, scaly plaques and follicularly bound pustules.
• A manifestation is not infrequently visible in other localisations.

• If zoophilic dermatophytes are detected, all animals with which there has been contact should be examined. 
• Investigate other people in the household.
• Therapy should be carried out with both topical and systemic antifungals!

• Topical therapy
• Clotrimazole- Crème (Canesten®-Crème)
• Terbinafine-Crème (Terbinafine®-Crème 1%)
• Ketoconazole-Crème (Nizoral®-Crème 2%)
• Amorolfin-Crème (Loceryl® 0.25%-Crème)
• Griseofulvin-Crème: not on sale in Switzerland
• Bifonazole cream: not on sale in Switzerland
• Econazole-Crème (Pevaryl® cream 1%)
• Ciclopirox cream (Ciclocutane® Crème or Lsg.)

• Ketoconazole-containing shampoo  (Ketozol®-shampoo, Keto-med®-shampoo, Lur®-shampoo, Nizoral®-shampoo): leave on for 5- 10 minutes.
• Ciclopirox-containing shampoo (Sebiprox®-shampoo): leave on for 5- 10 minutes. 
• Pregnancy: Only nystatin is permitted.

• Systemic therapy
• Terbinafine (Lamisil®, Myconormin®) p.o. 250 mg 1x daily for 6 weeks
• Alternatively: itraconazole (e. g.e.g. Sporanox®) p.o. 200 mg 1x tgl. for 7 days
• Alternative: Griseofulvin p.o. 500 mg 2x tgl. (not commercially available in Switzerland)

• Children: Although only griseofulvin is approved in children, we rather recommend the use of itraconazole with regard to the data situation.

• Generally, bed linen and cuddly toys should also be washed at a minimum of 60°C. In case of additional onychomycosis, appropriate diagnostics and therapy should be initiated.

1. Czaika VA. Misdiagnosed zoophile tinea faciei and tinea corporis effectively treated with isoconazole nitrate and diflucortolone valerate combination therapy. Mycoses 2013;56:26-9.
2. Ishizaki S, Sawada M, Suzaki R, et al. Tinea Faciei by Microsporum gypseum Mimicking Allergic Reaction following Cosmetic Tattooing of the Eyebrows. Medical Mycology Journal 2012;53:263-6.
3. Kang D, Ran Y, Li C, Dai Y, Lama J. Impetigo-Like Tinea Faciei Around the Nostrils Caused by Arthroderma vanbreuseghemii Identified Using Polymerase Chain Reaction-Based Sequencing of Crusts. Pediatric Dermatology 2012;30:e136-e7.
4. Kieliger S, Glatz M, Cozzio A, Bosshard PP. Tinea capitis and tinea faciei in the Zurich area - an 8-year survey of trends in the epidemiology and treatment patterns. Journal of the European Academy of Dermatology and Venereology 2014;29:1524-9.
5. Nenoff P, Schetschorke C. Tinea Faciei. New England Journal of Medicine 2014;370:e31.
6. Viera MH, Costales SM, Regalado J, Alonso-Llamazares J. Inflammatory Tinea Faciei Mimicking Sweet's Syndrome. Actas Dermo-Sifiliográficas 2013;104:75-6.