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E-CORRESPONDENCE
Year : 2013  |  Volume : 58  |  Issue : 5  |  Page : 411
Favus in an elderly Kashmiri female: A rare occurrence


Department of Dermatology, STD and Leprosy, Govt. Medical College, Srinagar, Jammu and Kashmir, India

Date of Web Publication30-Aug-2013

Correspondence Address:
Iffat Hassan
Department of Dermatology, STD and Leprosy, Govt. Medical College, Srinagar, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.117363

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How to cite this article:
Hassan I, Rather PA, Sajad P. Favus in an elderly Kashmiri female: A rare occurrence. Indian J Dermatol 2013;58:411

How to cite this URL:
Hassan I, Rather PA, Sajad P. Favus in an elderly Kashmiri female: A rare occurrence. Indian J Dermatol [serial online] 2013 [cited 2020 Dec 1];58:411. Available from: https://www.e-ijd.org/text.asp?2013/58/5/411/117363


Sir,

Tinea capitis, the fungal infection of scalp and hair is uncommon in adults than that in children. Likewise, Favus, a type of tinea capitis, mostly found in endemic areas like Kashmir in India, is most commonly found in children and rarely in adults. We are reporting a case of an elderly Kashmiri female presenting with favus, which is a rare occurrence.

A 60-year-old housewife from rural background was admitted in our department with Steven Johnsen syndrome (SJ syndrome) due to Nimsulide, in May 2012. On cutaneous examination, as an incidental finding, we found scarring alopecia over almost entire scalp and multiple, variable sized, yellow crusted lesions with depressed centers and raised edges over the vertex and occipital region [Figure 1]a and b. On probing, patient revealed that she has 4 years duration of yellowish crusts over the scalp that led to loss of hair. Patient has not taken any treatment for the same. There was nothing significant in the past, family, and drug history. No other family member had such involvement. Her socioeconomic status was below average. She had no features of compromised immune status. Her mucus membrane and nail examination were normal. Her complete blood count revealed increased eosinophil count probably because of drug-induced SJ syndrome. Her liver function tests, kidney function tests, urine analysis, X-ray chest, and electrocardiogram (ECG) were normal. Potassium hydroxide (KOH) examination under microscope showed multiple hyphae [Figure 2]. Skin biopsy of the crusted lesions showed numerous fungal hyphae [Figure 3]a and b. Culture in Sabouraud's dextrose agar showed heaped creamy white colonies of  Trichophyton schoenleinii More Details after 4 weeks of incubation [Figure 4]a and b. Patient was managed for Steven Johnsen syndrome and also put on oral Terbinafine 250 mg once daily. We report this case of adult onset favus as a rare occurrence, though Kashmir is an endemic area for favus in children.
Figure 1: (a and b) Yellow cup - shaped crusts (scutula) and scarring alopecia in patient of favus

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Figure 2: KOH wet mount showing fungal hyphae and spores (×40)

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Figure 3: (a and b) Histopathological examination of crusted lesions (scutula) showing fungal hyphae (arrows) and inflammatory infiltrate (H and E, ×4 for 3A and ×40 for 3B)

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Figure 4: (a and b) Culture in Sabouraud's dextrose agar showing heaped creamy white colonies of Trichophyton Schoenleinii after 4 weeks of incubation and (b) KOH mount from culture under ×40 showing hyphae

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Tinea capitis, predominant in preadolescent children, accounts for up to 92.5% of dermatophytosis in children younger than 10 years [1] and 4.9% of tinea capitis occurs in adults. [2] Tinea capitis is uncommon in adults [3] due to many reasons such as fungistatic-saturated fatty acids in sebum that appears at puberty, colonization by malassezia globosa that interferes with dermatophyte contamination and the thicker calibre of adult hair that protects against dermatophytic invasion. [4] Tinea capitis in adults has been reported to occur in patients who are immunosuppressed or HIV-infected. [5] However, there is not enough evidence to support this. Large family size, crowded living conditions, and low socioeconomic status may contribute to an increased chance of tinea capitis. Transmission occurs through infected persons, shed infected hairs, animal vectors, and fomites. [4] Other factors that contribute include contact with affected family members, hormonal differences, composition of sebum, and immunological deficiency. [4] A female predominance in the adult cases has been reported that remains unexplained. [6],[7]

Favus is a type of Tinea capitis, caused by Trichophyton schoenleinii and rarely by T. violaceum and Microsporum gypseum. [8],[9] Favus is relatively common in the countries adjacent to the Mediterranean, south eastern Europe, Southern Asia [9] Greenland, and south Africa. [10] Sporadic cases, however, occur throughout the world, representing importation of the disease. [9],[11],[12] Favus is a relatively rare disease in most parts of India except Kashmir valley where it occurs in endemic form. [13] Sporadic cases in nonendemic areas have also been reported. [14],[15],[16] It is characterized by the presence of sulfur-yellow cup-shaped crusts known as "scutula" or "godet" and results in scarring alopecia on healing. [8]

Kashmir valley is an endemic zone for favus in children. We report the case of favus in an elderly Kashmiri female and favus should be considered as a differential diagnosis for cicatricial alopecia even in adults, particularly in endemic areas.

 
   References Top

1.Kao GF. Tinea capitis. Available from: http://emedicine.medscape.com. [Last accessed on 2011 Jul 27].  Back to cited text no. 1
    
2.Pipkin JL. Tinea capitis in adults and adolescents. Arch Dermatol Syph 1952;66:9-40.  Back to cited text no. 2
    
3.Devliotou-Panagiotidou D, Koussidou-Eremondi T, Chaidemenos GC, Theodoridou M, Minas A. Tinea capitis in adults during 1981-95 in northern Greece. Mycoses 2001;44:398-400.  Back to cited text no. 3
    
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8.Conant NF, Smith DT, Baker RD, Callaway JL, Martin DS. Manual of clinical mycology. 2 nd ed. Philadelphia: WB Saunders Co.;1954 p. 316.  Back to cited text no. 8
    
9.Emmons CW, Binford CH, Utz JP. Medical mycology. 2 nd ed. Philadelphia: Editors Lea and Febiger; 1970. p. 116.  Back to cited text no. 9
    
10.Stein DH. Fungal, protozoa and helminth infections. In: Schachner LA, Hansen RC, editors. Pediatric Dermatology. Vol. 2. New York: Churchill Livingstone; 1988. p. 1417.  Back to cited text no. 10
    
11.Kumarh L, Dogra D, Banerjee U, Khanna N. Kerion in an elderly woman. Indian J Dermatol Venereol Leprol 2003;69:66.  Back to cited text no. 11
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13.Fungi ML. Fragile, fastidious, fascinating. Indian J Dermatol Venereol Leprol 1986;52:251-61.  Back to cited text no. 13
    
14.Nigam PK, Pasricha JS, Banerjee V. Favus in a Haryana village. Indian J Dermatol Venereol Leprol 1990;56:137-8.  Back to cited text no. 14
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15.Siddaramappa B, Hemashettar BM, Patil CS. Favus from South India. Indian J Dermatol Venereol Leprol 1991;57:43-4.  Back to cited text no. 15
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16.Gupta LK, Masuria BL, Mittal A, Sharma M, Bansal NK. Favus in a non-endemic area. Indian J Dermatol Venereol Leprol 1997;63:197-8.  Back to cited text no. 16
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