What is the treatment for sycosis barbae?

Treatment of Sycosis Barbae

Oral antibiotics for 6 weeks are the first-line treatment for sycosis barbae, with doxycycline 100 mg twice daily, minocycline 50 mg twice daily, or oxytetracycline 500 mg twice daily being the preferred options. 1

Diagnosis and Classification

• Sycosis barbae is a deep-seated follicular infection of the beard area that can be classified into two main types:

  • Bacterial sycosis (most commonly caused by Staphylococcus aureus) 2
  • Fungal sycosis (tinea barbae, caused by dermatophytes) 3

• Differential diagnosis is crucial as treatment differs significantly between bacterial and fungal etiologies 2

Treatment Algorithm for Bacterial Sycosis Barbae

First-line Treatment:

• Oral antibiotics for 6 weeks: 1
  • Doxycycline 100 mg twice daily OR
  • Minocycline 50 mg twice daily OR
  • Oxytetracycline 500 mg twice daily

Adjunctive Therapy:

• Topical low/moderate potency corticosteroids to reduce inflammation 1
• Consider systemic corticosteroids (e.g., prednisone 0.5-1 mg/kg for 7 days) for severe inflammatory cases 1

For Refractory Cases:

• Consider isotretinoin at low doses (20-30 mg/day) 1
  • Note: Isotretinoin should not be used concurrently with tetracyclines due to risk of cerebral edema
  • Dermatology consultation is recommended before starting isotretinoin 1

Treatment Algorithm for Fungal Sycosis Barbae (Tinea Barbae)

First-line Treatment:

• Systemic antifungal therapy for 6-8 weeks: 4
  • Terbinafine OR
  • Itraconazole OR
  • Fluconazole 50 mg daily 5

For Kerion-type Lesions:

• Consider adding systemic corticosteroids to reduce inflammatory response 2
• Avoid surgical intervention which can worsen inflammation and scarring 2

Monitoring and Follow-up

• Reassess after 2 weeks of treatment 1
• If symptoms worsen or do not improve, consider:
  • Obtaining bacterial/fungal cultures to confirm diagnosis 1
  • Switching antimicrobial therapy based on culture results
  • Evaluating for underlying conditions (e.g., diabetes) 4

Special Considerations

• For cases with suspected fungal etiology, obtain skin scrapings and fungal cultures before initiating treatment 3
• Discontinue any topical corticosteroids if fungal infection is suspected, as they can worsen the condition 4
• For refractory cases of lupoid sycosis (chronic scarring form), PUVA therapy combined with co-trimoxazole has shown success 6

Prevention

• Advise patients to:
  • Use clean, single-use razors 3
  • Avoid sharing personal grooming items
  • Consider treating pets if zoonotic transmission is suspected 5, 3