|Year : 1990 | Volume
| Issue : 2 | Page : 137-138
Favus in a Haryana village
PK Nigam, JS Pasricha, Uma Banerjee
P K Nigam
Source of Support: None, Conflict of Interest: None
A 26-year-old female, resident of a rural area of district Gurgaon (Haryana), had asymptomatic sulphur - yellow, cup-shaped lesions, typical of favus, on her scalp for the last 5 years. Some of the nails were also affected. KOH examination of scrapings from the scalp lesions and the nails were positive for fungus. Culture from both these sites showed T. Schoenleinii. This is a case of favus occurring in a non-enderaic area.
Keywords: Facus. Non-endemic
|How to cite this article:|
Nigam P K, Pasricha J S, Banerjee U. Favus in a Haryana village. Indian J Dermatol Venereol Leprol 1990;56:137-8
Favus is a relatively severe fungal infection of the scalp classically caused by Trichophyton schoenleinii More Details, and rarely by T. violaceum and M. gypseum., The infection is commonly acquired during childhood, and it' untreated, it can persist throughout the life. The disease is characterized by the presence of sulphur-yellow, inverted-cone or cup-shaped crusts known as scutula or godet and a mousy odour. Healing leads to scarring alopecia. Lesions play occur on any part of the body including the nails, the affection of which is indistinguishable from onychomycosis caused by other dermatophytes., Favus is relatively common in the countries adjacent to the Mediterranean, south eastern Europe, southern ,Asia, Greenland and south Africa. Sporadic cases, however, occur throughout the world representing importation of the disease. In India, favus is frequently observed in the Kashmir valley, but it has never been reported from any other part of our country. Recently, we saw a typical case from a village in Haryana.
| Case Report|| |
A 26-year-old female, admitted for a caesarian section, was referred for multiple, mildly itchy, foul smelling, crusted lesions on the scalp, present for the last 5 years. Initially, the lesions started as a few pustules on the left temporal area, from where these progressed gradually in a centrifugal manner. Various indigenous topical preparations had been of no benefit.
Examination revealed multiple, confluent, yellow, cup-like depressions of 3-5 mm diameter, the edges of which were slightly raised above the surface. Such lesions were present on the scalp especially the temporal area and the vertex [Figure - 1]. Removal of this scutulum with a forceps left an erythematous, moist base. Areas of cicatricial alopecia with a few remnant hairs were visible in between the lesions. Some of the nails were brittle and had striations, sub-ungual deposit, onycholysis and partial loss of nail plate. There was no other abnormality. Under Wood's lamp, the hairs fluoresced dull-green. Microscopic examination of scrapings from the nail and scutulum in 10%, KOH was positive for fungus, and culture from both these sites revealed Trichophyton Schoenleinii .
The patient had been residing in a rural area of district Gurgaon (Haryana) and had never gone away. She was keeping cattle but there was no history of a similar disease in the family, neighbours or cattle. Examination of the mother of the patient and her husband and child revealed no abnormality.
| Comments|| |
T. schoenleinii is essentially a human pathogen with a low degree of infectivity. The infection is transmitted usually from person to person through close contact or infected fomites. In our patient, there was no history of such disease in any of the family members or relatives and examination of the available family members did not reveal evidence of a similar disease.
Favus has not been observed in this part of our country before. Occurrence of an endemic disease in a non-endemic area can be attributed to one of the following situations : (1) if the patient had visited or lived in an endemic area in the past, (2) if an infected patient from the endemic area had come and lived with the patient for some time, or (3) if there is an unidentified focus of infection in this area. Our patient was an uneducated village lady who had never travelled beyond her village. Neither did she ever had any visitors from the Kashmir valley. Thus, the most plausible explanation iii this case seems to be that there are unidentified foci of favus in certain areas. It will thus be necessary to be alert and look for such cases even in those areas where such cases have not been recorded so far.
| References|| |
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|2.||Conant NF, Smith DT, Baker RD et al : Manual of Clinical Mycology, Second ed, WB Saunders Co, Philadelphia, 1954; p 316. |
|3.||Stein DH : Fungal, protozoa and helminth infections, in : Pediatric Dermatology, Vol 2, Editors, Schachner LA and Hansen RC : Churchill Livingstone, New York, 1988; p 1417. |
|4.||Marquis L : Fungi, fragile, fastidious, fascinating, Ind J Dermatol Venereol Leprol, 1986; 52 :251-261. |
[Figure - 1]