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Favus

Favus — the fungus disease of smooth skin, a hair, nails, is rare internals.

Epidemiology

Infection occurs directly from the patient at close contact with it or through objects which it used (caps, scarfs, linen, clothes). Get sick with a favus, as a rule, at children's age. An infection source generally are mothers, grandmothers are more rare. Among adults most of patients make women. The favus can remain many years unnoticed and is diagnosed only during medical examinations. A disease less kontagiozno in comparison with a microsporia and a trichophytosis.

Etiology and pathogeny

The activator of a favus is the anthropophilous mushroom of Trichophyton schonleinii which is located in a hair.
Mycosis is more often observed at the weakened children who had various infections or having other associated diseases.

Clinical signs and symptoms of a favus

After the incubation interval equal to 2 weeks, the centers on pilar part of the head or smooth skin appear. A classical form of a favus of pilar part of the head is skutulyarny, characterized by formation of round saucer-shaped dry crusts of ocherous-yellow color, so-called skutul, sometimes they can be penetrated by a hair. Skutula are inclined to merge, forming the extensive continuous crusts having an unpleasant smell of a mold. At it is long the existing skutula under crusts the cicatricial atrophy of skin and persistent baldness develops. Hair become dry, dim, tarnish, elasticity and look as tow. The broken-off hair in the center are not observed. Except a classical form on pilar part of the head 2 more versions — impetiginous and squamous meet. The impetiginous form of a favus is characterized by formation of brownish-brown crusts which remind vulgar the impetigo or the eczematic process complicated by a bacterial infection. At a squamous form the plentiful lamellar peeling, scales of whitish-gray color, sometimes with a yellowish shade, reminding dandruff is observed. Under crusts and scales at these forms atrophic changes of skin are also found, hair are changed. The knowledge of these clinical kinds of a favus of pilar part of the head is very important as they timely are not diagnosed and for many years patients remain infection sources.
On smooth skin of a trunk, extremities, persons can arise the defeat centers, various on a clinical picture. Except a skutulyarny form, on skin the centers reminding the centers of a superficial trichophytosis in the form of rings with the hyperemic roller and a peeling in the center are quite often formed. Other kind of a favus in the form of poorly shelled centers of the wrong outlines, with indistinct borders, insignificant erubescence is often observed. As a rule, they are multiple, develop at the weakened faces and are quite often mistakenly regarded as seboreida.
Defeat of nail plates meets more often at adults, at the same time in the thickness of a nail the spot which, gradually increasing is formed yellowish color, takes all plate. The configuration of a nail plate a long time does not change, then the nail is thickened, deformed and begins to crumble. Usually nails of brushes, and nails of feet — only at the patients suffering from the started favus forms are surprised. On skin of palms and a palmar surface of fingers the peeling without the inflammatory phenomena is observed, there can be cracks.
Without treatment the favus can proceed all life — since the childhood to extreme old age. At the same time in one cases process extends from one center on an extent by peripheral growth, in others the focal form of a disease at which on various sites of the head appears several centers of defeat which also have the peripheral growth and bent to merge is observed. At patients with serious associated diseases, including with endocrine disturbances or an immunodeficiency, process extends quickly. Within a short period of time it takes almost all pilar part of the head, only on its periphery in the form of a narrow strip there are not changed hair. Affects also smooth skin and nail plates, and at some and internals: lungs, digestive tract, brain, bones, etc. In other cases the favus center on the head very slowly increases in the amount of and can remain imperceptible within several years (especially with women) among healthy long hair. Atrophic changes of skin also develop differently: one patients quickly on extensive sites of pilar part have heads, at other patients even at long existence of crusts the cicatricial atrophy develops slowly.

The diagnosis and the recommended clinical trials

At a skutulyarny form of a favus of pilar part of the head the diagnosis is made on the basis of characteristic clinical manifestations and detection of a mushroom in a hair at microscopic examination; it has a characteristic morphological picture: in a hair, along with a thin and wide mycelium, there are disputes of a rounded and many-sided shape which are located randomly, chains or groups, vials of air and a droplet of fat meet. At other kinds of a favus and damage of smooth skin along with microscopic finds crucial importance has allocation of culture on a medium.

Differential diagnosis

The favus is differentiated with seborrhea, seborrheal eczema, a pyoderma, chronic generalized (granulematozny) candidiasis.

General principles of treatment of a favus

At all forms of a favus with defeat of pilar part of the head, at the multiple centers on smooth skin, involvement in process of vellus hair the complex treatment including antifungal drug of systemic action, outside anti-mycotic means, a sbrivaniye of hair of 1 times in 7 — 10 days is carried out.

Choice medicines:   Griseofulvin inside with a teaspoon of vegetable oil of 12,5 mg/kg/days (the adult; no more than 1 g/days) or to 18 mg/kg/days (children) in 3 receptions daily to the first negative analysis on mushrooms, then every other day during 2 weeks and 2 r / week during the following 2 weeks
Bifonazol, cream, locally 1 r / days during 4 — 6 weeks of a gila
Ketokonazol, cream or ointment, locally 1 — 2 r / days during 4 — 6 weeks or
Clotrimazolum, cream or ointment, locally 2 r / days during 4 — 6 weeks or
Oksikonazol, cream, locally 1 r / days during 4 — 6 weeks or
Salicylic acid of 3% / is gray 10%, ointment, locally in the evening
Iodine, 2% spirit tincture, locally in the morning during 4 — 6 weeks.

Alternative medicines:   Terbinafin inside after food of 250 mg
1 r / days (to adults and children with body weight> 40 kg), or 62,5 mg/days (to children with the body weight <20 kg), or 125 mg/days (to children with the body weight from 20 to 40 kg) 5 — 6 weeks. At widespread defeat on pilar part of the head amotio of a corneous layer of epidermis are carried out:
Salicylic acid / lactic or benzoic acid / vaseline, ointment (12,0 g / 6,0 g / to 100,0 g for adults; at children ointment is applied in a half dose), locally under a compress for two days.

Then:
Salicylic acid, 2% ointment, locally under a compress on 24 h. Then the bandage is removed, purge also an epilation of hair. Further appoint local and system antifungal medicines as it is described above.

At damage of vellus hair on smooth skin also carry out amotio of a corneous layer of epidermis of 10% by a milk and salicylic collodion:
Salicylic acid of 10,0 g, lactic or benzoic acid of 10,0 g, collodion elastic to 100,0 g, locally 2 r / days within 3 — 4 days. Then make a manual epilation of vellus hair and continue treatment antifungal medicines (see above).

Assessment of efficiency of treatment

Clinical and mycologic treatment is estimated on permission of clinical manifestations and negative takes of microscopic examination (3 analyses with 5-day breaks at defeat of pilar part of the head and 3-day at damage of smooth skin).

Forecast

The forecast of a favus favorable at timely diagnosis and adequate treatment.
Damages of internals can occur at the weakened and exhausted patients having a serious chronic illness and also at decrease in immunity at them: lungs, a digestive tract, covers and substance of a brain (encephalomeningitis) that does the forecast doubtful, especially at wrong diagnosis.

 
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