Definition And Description

This is an affection due to the lodgment and development of the trichophylon tonsurans on the hairy parts of the face in adult males. It appears upon the cheeks, chin, and upper lip, and at first as a very slightly elevated, circular, reddish patch, upon which a few scales may be perceived. This patch extends centrifugally, and if the hairs are sparse exhibits a tendency to assume a normal aspect at its centre, thus forming a ring, whose advancing periphery is a little raised above the surface. If, however, the hairs are plentiful, it mows them down as in trichophytosis capitis, and leaves nothing but a bushy stubble. Later, other and similar patches appear which, by mutual extension, may unite with each other, modifying the typical circular form of the lesion.

If the disease last for any length of time, additional phenomena may be presented. These are due to secondary inflammation excited by the presence of the parasite, and may consist in papules, tubercles, pustules, small abscesses, and even ulceration, and may be present to such an extent as to render the affection exceedingly disfiguring. The extent and severity of these lesions will vary with the individual peculiarities of the patient; some cases presenting little more than the special trichophytic appearances, while others exhibit the secondary lesions to a marked degree.

Trichophytosis barbae, like the other varieties, is exceedingly contagious, and is frequently transferred from one to another by the indiscriminate use of unclean shaving appliances. It may also be contracted from persons suffering from other forms of trichophytosis.

Diagnosis

The only real difficulty presented in diagnosis is the differential diagnosis between it and an eczematous inflammation of the hair-follicles. The history of the case, that is, the information that the affection, at its commencement, exhibited itself in the form of well-defined circular lesions, is strong presumptive evidence that it is the parasitic one, and not an eczema barbae, which is usually more diffuse. In extracting the hairs in trichophytosis they will frequently break, leaving a portion of root in the follicle, in strong contrast to the hairs in eczema barbae, which, as a rule, can be pulled out without fracture, and frequently accompanied with their root-sheaths. In addition, the microscope affords a very ready means of diagnosis.

Prognosis

The prognosis is good. Advanced cases may, and usually are tedious, but are perfectly curable under appropriate and persistent treatment.

Treatment

This consists in epilation and the application of an antiparasitic lotion or ointment. The tincture of iodine, the bichloride lotion, or a mercurial ointment, will usually prove sufficient. Treatment should not be abandoned until all chance of relapse is past.