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Therapeutics in Dermatology
A reference textbook in dermatology

Sycosis

9 July 2012, by STOEBNER P.-E. & MEUNIER L. & MEYNADIER J.

Sycosis is a rare form of hair follicle inflammation mainly affecting the beard area. It may be caused by staphylococcal or fungal infection.

1 - CLINICAL REMINDER [2, 6]

It is most common in men aged 30 to 50 years old.

Staphylococcal sycosis affects the upper lip, the chin, the cheeks and the area directly beneath the nostrils. It often arises after inoculation with a razor or rhinitis (sycosis beneath the nostril). It starts as tiny, superficial areas of ordinary folliculitis which gradually spread to form extensive patches of follicular pustules on raised, red skin. These patches are excoriated, oozing, peeling and crusted. The lesions may also be more infiltrated and made up of thick nodules covered in suppurating pustules and holes. The term sycosis or "fig-like ulcer", from the Greek sykon, is believed to stem from this appearance. 

Dermatophytic sycosis is most often reported in rural areas amongst animal farmers. Unlike staphylococcal sycosis, it arises on one side of the face only or, at the very least, is asymmetrical and does not affect the upper lip. The plaques are also more clearly defined and may have a vine-like appearance. They are less inflamed and painful and the hairs in the area are dull, fragile, broken and surrounded by a greyish, scaly sheath at their base. In practice, these distinctive features are often absent and dermatophyte infection is often suspected on the basis of the raised appearance of the suppurating plaques which form round, globular inflammatory tumours. The most common causes are zoophilic dermatophytes, particularly Trichophyton mentagrophytes and T. verrucosum; Microsporum canis is much rarer. Anthropophilic dermatophytes are less common (T. violaceum, T. megninii, etc.) and are transmitted by direct or indirect human contact. A fungal infection elsewhere on the body (T. rubrum) may also be transferred to the face. Geophilic dermatophytes present in the earth (M. gypseum) may also be a source of contamination [6].

Lupoid sycosis is a deep-seated, chronic and cicatricial beard folliculitis. It is resistant to conventional treatments. It characterised by its slow progression, regular spread and its central zone of cicatricial alopecia (hypertrophic or atrophic).

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