Medical Care
Although favus is not highly contagious, several family members may be affected, and all should be treated simultaneously. Treatment outcome depends on the stage at which the disease is arrested. Severe long-lasting disease can cause irreversible scarring alopecia. A Chinese traditional plant-derived medicine for favus may be of value and merit development as a modern drug. [27]
In most patients, favus involves hair; therefore, the disease requires systemic treatment. Additional topical agents, such as shampoo (2% ketoconazole, 2.5% selenium sulfide), lotion, and cream may be helpful. X-ray epilation no longer is used. General hygiene of the scalp must be improved, and debris and crusts must be removed.
Favus usually is controlled by griseofulvin, the standard treatment of tinea capitis; however, a longer treatment course than usual for tinea capitis may be advisable. Currently, favus is uncommon; therefore, no clinical trials with newer antifungals are available. In vitro studies indicate that T schoenleinii is sensitive to newer antifungal drugs, similar to other dermatophytes. Terbinafine, itraconazole, and fluconazole in a similar dosage schedule to tinea capitis may eradicate the fungus and cure the disease. [28] In young children, the terbinafine tablet may be split and hidden in food. [29] A 2017 study favored the use of terbinafine and ketoconazole. [30]
Prevention
Breaking the lifestyle chain associated with malnutrition, neglect, and poverty can prevent this infection and possibly deter recurrence.
Long-Term Monitoring
Monitor patients and their families for favus in regions where lifestyles are associated with malnutrition, neglect, and poverty.
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Tinea favosa of the scalp shows erythematous lesions with pityroid scaling. Some hairs are short and brittle.
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Favus of the scalp shows extensive lesions with scarring alopecia.
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Typical fluorescence under Wood lamp examination.
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Favus, wax montage. Courtesy of Professor Dr Feliks Wasik, Dermatology, Medical University of Wroclaw, Poland.
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Black man, aged 45 years, with favuslike yellow crusting of scalp. Potassium hydroxide and fungal culture were negative.
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Culture of Trichophyton schoenleinii on Sabouraud agar. Courtesy of Anna Pawlowicz, PhD, and Professor Barbara Raszeja-Kotelba, MD, Dermatology, University School of Poznan, Poland.
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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.
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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.
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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.
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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.
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Infected hair filled with hyphae shows bubbles of gas and gas tunnels (light field microscopy, original magnification X 2300).
