Severe tinea barbae due to Trichophyton verrucosum infection in dairy farmers

Trichophyton verrucosum infection, which is acquired from the hide of dairy cattle, is the cause of tinea barbae, a severe pustular eruption on the face and neck. We present the cases of five patients, three of whom had severe pustular tinea barbae and two of whom had eruptions of the forearms. All five patients were dairy farmers. On physical examination, all five patients were afebrile and did not appear toxic. Peripheral leukocyte counts of the three patients with pustular tinea barbae were normal. Gram stain and bacterial cultures of the draining pustules were negative in all three cases. Potassium hydroxide preparation showed hyphae, and cultures yielded T. verrucosum in all three cases. Four patients received therapy with fluconazole, and one received therapy with griseofulvin; in all cases, the lesions healed. T. verrucosum can cause pustular tinea barbae in farmers that may be mistaken for a Staphylococcus aureus infection by clinicians, including infectious disease experts. The answer to a simple question, "Are you a dairy farmer?", may suggest the diagnosis of T. verrucosum in the proper clinical setting.