Favus B35.0

Authors: Prof. Dr. med. Peter Altmeyer, Prof. Dr. med. Martina Bacharach-Buhles

Last updated on: 03.01.2021

Synonym(s)

Braided beef; dermatomycosis favosa; favus alopecia; Favusalopecia; Favus alopecia; Head Grind; Hereditary beef; Mushroom beef; Scutula; tinea capitis favosa; tinea favosa

Definition
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Rare special form of tinea capitis, with highly chronic inflammation of the scalp leading to scarred alopecia ( pseudopélade state) with formation of characteristic shield-shaped crusts containing mycelium (scutula).

Pathogen
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Trichophyton schoenleinii, a fungus belonging to the dermatophytes. Transmission from person to person, low contact.

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Occurrence/Epidemiology
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The favus is very rare in Central Europe and is occasionally introduced by persons from endemic areas (North Africa, Southern and Eastern Europe, Iran, Russia).

Manifestation
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Occurs mainly in infants and toddlers. Poor hygienic conditions and strong headgear promote infection. With increasing age the receptivity of the skin to the favus decreases. Adults hardly ever become ill.

Localization
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Capillitium, very rarely infestation of face and extremities.

Clinical features
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Initially erythema covered with fine grey-white scales, with expansion of the fungal colonies yellowish crusts develop in the hair follicles. Enlargement to the so-called scutulae (= bowl-shaped dented, 0.5 to 2.0 mm large, partially confluent yellow crusts, pierced in the centre by 1 or 2 hairs) also called favuscutulae. Exudation, impetiginization, penetrating smell of "mouse urine". The herd fluoresces grey-green in wood light. After healing, scarred alopecia with single tufts of hair in the atrophic areas (favus alopecia). Obligation to report!

In rare cases, clinical pictures reminding of Tinea amiantacea develop (Anane S et al. 2012).

Histology
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The Scutulae are pure cultures of Trichophyton schoenleinii (mycelium, spores) mixed with cell detritus and fats. Detection of the fungal mycelium also in the area of hair shafts and sebaceous glands (PAS staining).

Diagnosis
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Clinical (clinic + wood light), microscopic and cultural pathogen detection.

Therapy
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Without therapy, the disease continues to progress centrifugally for years, leaving behind a central scar.

External therapy
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Crust-removing external agents can be helpful, such as 2% salicylic acid ointment(e.g. Salicylvaseline Lichtenstein, R228 ). Possibly broad-spectrum antifungals such as 2% clotrimazole creams / ointments R056 or ketoconazole solution(e.g. Terzolin). Apply bandages.

Internal therapy
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Standard therapy with griseofulvin (e.g. Likuden M), children: 10 mg/kg bw/day, adults: 500-1000 mg/day p.o. Therapy duration: 2 weeks, intake with high-fat meal. Due to the side effects of griseofulvin, the use of azole antimycotics, especially itraconazole (e.g. Sempera Kps.) 100-200 mg/day p.o. is increasingly recommended (duration of therapy according to the clinic).

Progression/forecast
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Without adequate therapy decades of possibly lifelong course, but spontaneous healing after puberty is also possible.

Literature
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Anane S et al (2012) Tinea capitis favosa misdiagnosed as tinea amiantacea. Med Mycol Case Rep 2:29-31.
Kaposi M (1976) Favus . In Virchow R (ed) Handburch der speciellen Pathologie und Therapie. Publisher F. Enke, Stuttgart pp.592-593.
Niczyporuk W et al (2004) Tinea capitis favosa in Poland. Mycoses 47:257-260.
Poppe H et al. (2013) Pitfall scarring alopecia: favus closely mimicking lichen planus. Mycoses 56:382-384.