Inflammatory plaques and follicular pustules in the beard area are most consistent with which diagnosis?

• A. Tinea barbae
• B. Folliculitis
• C. Pseudofolliculitis barbae
• D. Eczema

Answer: (A)

Beard-area fungal infection caused by dermatophytes presenting as inflammatory plaques with follicular pustules. This pattern is characteristic of tinea barbae, where fungus invades hair follicles in the bearded region, producing tender, erythematous plaques with scaling and pustules around follicles, and sometimes hair breaking. This distinguishes it from bacterial folliculitis, which lacks the broader inflammatory plaques and scaly margins; pseudofolliculitis barbae, which stems from shaving irritation and shows papules/pustules in shaved areas rather than true fungal-driven plaques; and eczema, which features dry, itchy eczematous patches without follicular pustulation. Diagnosis can be supported by KOH preparation showing fungal hyphae and culture, and treatment requires systemic antifungals for beard involvement (for example, terbinafine or itraconazole) rather than topical antibiotics alone.