Top Tips for Identifying and Treating Barber's Itch

Medically reviewed by Susan Bard, MDMedically reviewed by Susan Bard, MD

Barber's itch is a rare infection also known as tinea barbae or beard ringworm. It typically affects the skin, hair, and hair follicles in the beard and mustache areas in men who grow facial hair.

Barber's itch most often occurs in dairy farmers and cattle ranchers who have contact with infected animals. Person-to-person transmission can occur after getting a shave in a barbershop that does not follow antiseptic procedures.

How Barber's Itch Looks and Feels

Barber's itch usually affects the beard and mustache areas, including the cheeks, chin, and upper neck. Symptoms can range from mild to intense and appear between four and 14 days after the skin comes in contact with the fungi.

Symptoms of barber's itch can include:

• Intense inflammation (swelling) and redness

• Superficial, circular patches with pink or red borders in lighter skin, dark red, purple, brown, or gray borders in darker skin

• No skin color change in the center of circular patches

• Itching at the affected site

• Pus-filled bumps that may become crusted over

• Temporary alopecia (hair loss)

• Swollen lymph nodes

• Raw, open skin

• Raised, soft, spongy skin that leaks fluid

• Occasionally, feelings of fatigue

In severe cases, lesions can develop into a kerion. This is an inflamed, boggy, thickened, pus-filled area with scaly spots or patches of broken hair.

In the later stages of barber's itch, the area can have a pus-filled appearance, with deeper infection in the hair follicle. Without treatment, permanent hair loss and scarring may result.

What Isn't Barber's Itch

Barber's itch is a fungal infection frequently misdiagnosed as a bacterial infection. The differential diagnosis includes bacterial folliculitis, an infection of the hair follicles caused by Staphylococcus aureus.

Milder cases of tinea barbae appear similar to the following diseases that cause comparable symptoms. In making a diagnosis of barber's itch, it should be differentiated from the following conditions:

• Pseudofolliculitis (also called razor bumps, a chronic inflammatory skin condition caused by shaved hairs that grow into and under the skin)

• Acne (a skin condition in which hair follicles become clogged with dead skin cells and oil)

• Rosacea (a chronic inflammatory skin condition that causes a facial rash and reddened skin)
  

The relative lack of pain and ease with which hairs come away from the skin distinguishes barber's itch from boils caused by bacteria.

Starting Barber's Itch Treatment

Trying to treat beard ringworm on your own can be difficult. However, suppose you begin treatment in the earliest stages of the disease when your symptoms are mild. In that case, you may have success with one of the following over-the-counter antifungal topical treatments:

• Terbinafine

• Clotrimazole

• Miconazole

If you do not see improvement, you may need prescribed treatments. In addition, prolonged self-medication with inappropriate treatments such as topical creams that contain steroids can increase the prevalence of unresponsive symptoms.

Don't be discouraged if you don't notice improvement with topical treatment. Most cases of beard ringworm require prescription antifungal medicine and an individualized treatment plan. In some cases, affected tissue and hair may have to be removed to allow the area to heal.

Understanding Why Barber's Itch Happens

Barber's itch is a form of dermatophytosis. It occurs due to an infection caused by dermatophytes, fungi that require keratin for growth. Keratin is a protein found in soil. It is also found in hair, nails, and the outermost layers of the skin, where these infections typically occur.

The medical term tinea barbae describes features of the infection. The term tinea means fungal infection. Tinea infections are further classified by the site of the infection. The Latin term barbae refers to the fact that it is classified as an infection that occurs in the beard.

Depending on the mode of transmission, dermatophytes are classified as anthropophilic (from humans), zoophilic (from animals), and geophilic (from soil). Barber's itch is a relatively rare disease that usually occurs from direct contact with an animal infected with fungi from the Trichophyton species, a type of dermatophyte.

The zoophilic dermophytes most associated with barber's itch include:

• Trichophyton verrucosum

• Trichophyton mentagrophytes complex

Barber's itch occurs when zoophilic Trichophyton are transmitted from animals to humans by direct contact with infected animals, usually livestock, or objects contaminated by the animals. This infection is an occupational disease of farmers, veterinarians, and their family members.

Human-to-human transmission occurs mostly indirectly involving material such as loose strands of hair and shed skin cells. Previously, using a common razor or blade during shaving before single-use razors became widely available caused it more often.

Why Barbers Use Alcohol

After a shave, barbers traditionally apply alcohol or aftershave lotions that contain a combination of alcohol and a moisturizer. In addition to freshening and moisturizing your skin, these products close pores in your skin and help prevent irritation that results in razor burn.

Barber's Itch Not Improving

Because barber's itch can mimic other skin conditions, getting an accurate diagnosis is important to the success of your treatment. Though fungal infections are relatively common in the skin, hair, and hair follicles, tinea barbae is a rare condition, so misdiagnosis is common.

In addition to a physical examination and medical history, tinea barbae is diagnosed by examining plucked hairs, skin scrapings, or biopsy under a microscope on a potassium hydroxide (KOH) wet slide. Diagnosis can also be confirmed with a fungal culture test, which involves growing an organism in a laboratory for identification.

Treatment of beard ringworm requires an oral antifungal medication for six weeks or longer. The most common treatment involves one of the following antifungals:

• Gris-PEG (griseofulvin) at a dosage of 500 milligrams (mg) to 1 gram orally once daily until two to three weeks after the condition has clinically cleared

• Terbinafine (250 mg orally once a day)

• Sporanox (itraconazole) (200 mg orally once a day)

For severely inflamed lesions, a short course of the corticosteroid prednisone may be added to the antifungals to reduce the risk of scarring. It is taken at a dose of 40 mg orally once a day for adults and then tapering over two weeks.

Summary

Barber's itch, also known as tinea barbae or beard ringworm, is a fungal infection that can often be traced to contact with infected animals such as cows and horses. It affects the beard and mustache area, including the neck, cheeks, and chin, in men who grow facial hair.

The name beard ringworm describes the appearance of round skin lesions that form a rash in the affected area. Because it is rare and mimics other skin conditions, barber's itch is often misdiagnosed. It is commonly confused with bacterial folliculitis, a disease caused by a staph infection.

Prescribed oral antifungal drugs are the best way to treat barber's itch. Without treatment, lesions can become inflamed. In extreme cases, inflamed lesions called kerions can occur, causing scarring and permanent hair loss.

Read the original article on Verywell Health.