Favus Clinical Presentation

  • Author: Jacek C Szepietowski, MD, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 23, 2012
 

History

Favus usually begins on the scalp, often in childhood, and persists for many years as unsightly, crusted plaques. According to the severity of the disease, 3 main stages are described.

  • First stage: Only erythema of the scalp is seen, primarily around follicles. Hairs are not loose or broken.
  • Second stage: Formation of scutula is seen with the beginning of hair loss.
  • Third stage: The most severe stage involves large areas of the scalp (at least one third); extensive hair loss, atrophy, and scarring result. Formation of new scutula at the periphery of plaques is common.
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Physical

The scutulum, a yellow cup-shaped crust that surrounds a hair and pierces its center, is characteristic. Scutula form a dense plaque, each composed of mycelia and epidermal debris. Often, a secondary bacterial infection occurs in the plaque. Plaque removal leaves an erythematous moist base. The dense masses of yellow crusts may be solitary or numerous, and in patients who are severely affected, involve the entire scalp. A mousy odor typically is present. Glabrous skin may show similar yellow crusting.[15]

On glabrous skin, favus is a papulovesicular and papulosquamous eruption in which typical scutula may be evident. As an onychomycosis, tinea favosa resembles other forms of tinea unguium.

In addition to typical scutular favus on the scalp, several atypical manifestations of favus have been described.

  • Favus pityroides mimics dandruff or seborrheic dermatitis. Numerous small-to-large scales are present. On the surface, scales are loose; however, deeper layers are attached strongly to the base. Removal of scales uncovers reddish, moist, and scarring areas of skin.
  • Favus psoriasiformis is a psoriasis-imitating favus, both on the scalp and on glabrous skin. Instead of yellowish scutula, patients present with whitish scales mimicking the typical lesions of psoriasis.
  • Favus follicularis is characterized by cone-shaped wax-colored papules around the follicles. Hair shows the typical features of favus.
  • Favus impetigoides is characterized by yellowish (honey-colored) crusts imitating impetigo that are located on the scalp. Frequently, they form larger plaques that do not improve with antibacterial treatment. The characteristic mousy odor and dull hair suggest the diagnosis of favus.
  • Favus papyroides is characterized by small loci on the scalp that are covered by a brittle substance similar to parchment. Beneath, typical small scutula may be present.
  • Favus herpetiformis is an atypical variant of favus corporis. Round, erythematous, scaling plaques with small papules, vesicles, pustules, and/or crusts on the border are located on the trunk and extremities. This form of favus shows an annular shape and resembles the lesions typical of tinea corporis.

See the images below.

Tinea favosa of the scalp shows erythematous lesioTinea favosa of the scalp shows erythematous lesions with pityroid scaling. Some hairs are short and brittle. Favus of the scalp shows extensive lesions with scFavus of the scalp shows extensive lesions with scarring alopecia. Black man, aged 45 years, with favuslike yellow crBlack man, aged 45 years, with favuslike yellow crusting of scalp. Potassium hydroxide and fungal culture were negative.
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Causes

Primarily caused by T schoenleinii, favus rarely may be caused by T violaceum, T mentagrophytes var quinckeanum, or M gypseum. Although vertical transmission may occur, family attack rates are highly variable. Most evidence suggests that favus is not a highly contagious disease.

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Contributor Information and Disclosures
Author

Jacek C Szepietowski, MD, PhD  Professor, Vice-Head, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University; Director of the Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Poland

Disclosure: Stiefel GSK Company Salary Employment; Orfagen Consulting fee Consulting; Maruho Consulting fee Consulting; Astellas Consulting fee Consulting; Abbott Consulting fee Consulting; Leo Pharma Consulting fee Consulting

Coauthor(s)

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Specialty Editor Board

Franklin Flowers, MD  Chief, Division of Dermatology, Professor, Department of Medicine and Otolaryngology, Affiliate Associate Professor of Pediatrics and Pathology, University of Florida College of Medicine

Franklin Flowers, MD, is a member of the following medical societies: American College of Mohs Micrographic Surgery and Cutaneous Oncology

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Paul Krusinski, MD  Director of Dermatology, Fletcher Allen Health Care; Professor, Department of Internal Medicine, University of Vermont College of Medicine

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous Chief Editor, William D. James, MD, to the development and writing of this article.

References

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  4. Besbes M, Cheikhrouhou F, Sellami H, Makni F, Bouassida S, Ayadi A. Favus due to Trichophyton mentagrophytes var. quinckeanum. Mycoses. Sep 2003;46(8):358-60. [Medline].

  5. Garcia-Sanchez MS, Pereiro M Jr, Pereiro MM, Toribio J. Favus due to Trichophyton mentagrophytes var. quinckeanum. Dermatology. 1997;194(2):177-9. [Medline].

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  8. Pawlowicz A. Epidemiology of tinea capitis, particularly tinea favosa in the Poznan region. Postepy Dermatol (Poznan). 1996;13:347-400.

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  12. Prochnau A, de Almeida HL Jr, Souza PR, Vetoratto G, Duquia RP, Defferrari R. Scutular tinea of the scrotum: report of two cases. Mycoses. May 2005;48(3):162-4. [Medline].

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  22. Szepietowski J. Dermatomycoses and onychomycosis. A practical guide. Medycyna Praktyczna, Krakow. 2001.

 
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Tinea favosa of the scalp shows erythematous lesions with pityroid scaling. Some hairs are short and brittle.
Favus of the scalp shows extensive lesions with scarring alopecia.
Typical fluorescence under Wood lamp examination.
Favus, wax montage. Courtesy of Professor Dr Feliks Wasik, Dermatology, Medical University of Wroclaw, Poland.
Black man, aged 45 years, with favuslike yellow crusting of scalp. Potassium hydroxide and fungal culture were negative.
Culture of Trichophyton schoenleinii on Sabouraud agar. Courtesy of Anna Pawlowicz, PhD, and Professor Barbara Raszeja-Kotelba, MD, Dermatology, University School of Poznan, Poland.
Culture of Trichophyton schoenleinii on Sabouraud agar. Note pleomorphism of the culture. Courtesy of Anna Pawlowicz, PhD, and Professor Barbara Raszeja-Kotelba, MD, Dermatology, University School of Poznan, Poland.
Microculture of Trichophyton schoenleinii shows dichotomic branching and terminal swelling. Light-field microscopy, original magnification X 1000. Courtesy of Anna Pawlowicz, PhD, and Professor Barbara Raszeja-Kotelba, MD, Dermatology, University School of Poznan, Poland.
Microculture of Trichophyton schoenleinii shows characteristic dichotomic branching. Light-field microscopy, original magnification X 1000. Courtesy of Anna Pawlowicz, PhD, and Professor Barbara Raszeja-Kotelba, MD, Dermatology, University School of Poznan, Poland.
Microculture of Trichophyton schoenleinii shows numerous terminal chlamydospores. Light-field microscopy, original magnification X 1200. Courtesy of Anna Pawlowicz, PhD, and Professor Barbara Raszeja-Kotelba, MD, Dermatology, University School of Poznan, Poland.
Infected hair filled with hyphae shows bubbles of gas and gas tunnels (light field microscopy, original magnification X 2300).
 
 
 
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