Favus – a disease of mikotichesky character at which smooth skin is surprised. Hair, nails and internals are surprised seldom. Incidence is very high in the countries with roast and a humid climate. In our country diagnose generally in the central and southern regions, in areas where low temperatures prevail, meets extremely seldom. Treatment of a favus usually includes system antimikotichesky therapy, processing of affected areas of skin and removal of the crumbled nail plates.
Favus – a disease of mikotichesky character at which smooth skin is surprised. Hair, nails and internals are surprised seldom. Incidence is very high in the countries with roast and a humid climate. In our country diagnose generally in the central and southern regions, in areas where low temperatures prevail, meets extremely seldom.
Etiology and mechanism of infection favusy
The activator of a favus is the fungus of Trihophyton schonleinii which parasitizes only on the person, and therefore infection by means of animals is excluded. In the main way of transmission of infection is contact and household. At close contact with the person sick favusy and at contact with its things (objects of personal use, bathing accessories, clothes and linen) there is also a most percentage part of infitsirovaniye.
As has chronic slow character, children at contact with mothers and grandmothers as women make the most part of patients favusy catch generally. Because less , in comparison with other fungal diseases, it a long time remains unnoticed though sick people continue to infect people around. As a rule, it is diagnosed incidentally during passing of medical examinations or at the request for medical care.
Entrance gate for the activator of a favus is skin, and therefore microinjuries, grazes, raschesa and other violations of integrity of integuments are provocative factors. Decrease in the general immunity and protective functions of skin, the hypovitaminoses, chronic diseases proceeding with intoxication or a kakheksiya increase risk of infection favusy. Violations of food and a metabolic disorder are noted practically at all patients favusy. After infection the fungus can extend as on an extent, and gematogenno. In the latter case defeats favusy are noted in internals. The weakened children and children after the postponed infectious diseases are most subject to infection favusy.
The activator of a favus breeds in a horn layer of epidermis. Characteristic of a favus of a skutula also the dispute of a fungus, slushchenny epithelium and skin fat are congestions of a mycelium. In process of distribution of a favus of a skutul becomes surrounded with leukocytes and exudate with the destroyed epithelium cages. Further the activator of a favus gets in a term and causes development of the infiltrate consisting of lymphocytes and fibroblast. At a final stage at a favus the irreversible atrophy of epidermis, destruction grease develops and sweat glands, collagenic fibers and elastichesky fabrics melt and postfavusny hems are formed.
Clinical manifestations of a favus
The incubatory period at a favus makes two weeks then the first centers of defeat on smooth skin and/or a hairy part of the head appear. The Skutulyarny form of a favus is classical and is diagnosed in most cases defeats by Tr fungus. schonleinii. The main clinical manifestations at a skutulyarny form of a favus is formation of dry round crusts of a saucer-shaped form of yellow or okhryany color with deepening in the center. A hairy part of the head, smooth skin is surprised, it is rare – nails, in isolated cases at a skutulyarny form internals are surprised.
Sometimes skutula are at the place of a hair follicle, then they are penetrated by a hair. Skutula, formed at a favus, are inclined to merges to formation of continuous crusts. In process of progressing of a favus will join a musty unpleasant smell of a granary mold. In the absence of adequate therapy of a favus under crusts the cicatricial atrophy of skin begins to develop, in especially started cases persistent postfavusny baldness is observed. Sites of atrophied skin smooth, brilliant with the thinned horn layer. Hair on the sites struck favusy become dim, lose elasticity and gloss, are inclined to fragility and to section. At the begun baldness the remains of hair look as tow scraps. Feature of a current of a favus is that at baldness hair drop out, but do not break off as at other fungal diseases. At the same time hair always remain in a regional area. Sometimes hair look gray-haired because of a dispute of a fungus of a favus, this symptom is swept most up at people with dark hair.
The impetiginous current of a favus is characterized by emergence of brownish-brown crusts which are externally similar to vulgar impetigo. At a skvamozny form of a favus there are scales of whitish-gray color, affected areas are inclined to a plentiful peeling of lamellar character. Sometimes scales have a yellowish shade or are similar to dandruff that complicates diagnostics of a favus. Atypical clinical forms of a favus often remain unnoticed, and meanwhile such patients also support constants the epidemiological center of a favus.
At the exhausted and weakened patients, at patients with hypovitaminoses and endocrine violations, in the presence of intoxication connected with tuberculosis and at immunodeficiencies proceeds more aggressively. Extensive and deeper damages of skin are noted, mucous membranes and lymph nodes are involved in process. In especially hard cases at a favus the brain as meningoentsefalit and digestive tract with the advent of numerous erosive and ulcer defects is surprised.
Damages of nails at a favus diagnose for adults more often, generally process passes to nails because of an autoinfitsirovaniye. At first in the thickness of a nail plate the spot which gradually increases and grows is formed yellowish color, will not close all plate yet. The long time at a favus of nails a configuration of a nail plate does not change. But in the absence of timely treatment of a favus the nail begins to be thickened, is deformed and painted. On skin of palms and on the palmar surface of fingers the peeling without the inflammation phenomena is noted, cracks which are quite often again infected join later.
Diagnostics of a favus
The clinical picture allows the dermatologist to suspect existence of a fungal disease and to direct the patient to the mycologist. But only at attentive survey and at a skutulyarny form of a favus it is possible to make precisely the diagnosis on the basis of only visual data.
At microscopy of hair, pieces and scrape on mushrooms of skin of a hairy part of the head changes, characteristic of a favus, disputes of a mushroom and a mycelium are found. At defeats favusy in hair the thin and wide mycelium is found, disputes of a mushroom have the rounded and many-sided shape, are located randomly both groups, and chains, vials of air and inclusion of droplets of fat meet.
As auxiliary methods of diagnostics of a favus Dermoscopy and luminescent diagnostics can be used. If the obtained data are not enough for diagnosis, then resort to cultural crops with allocation of culture of a fungus on nutrient medium. Favus it is necessary to differentiate with seborrhea, seboreyny eczema, piodermiya and generalized granulematozny candidiasis.
Treatment of a favus
At defeats favusy a hairy part of the head, at a generalized form of a favus with involvement in process of pushkovy hair hair in the center of defeat shave off once a week and carry out antifungal processing of a hairy part of the head.
Locally use antifungal ointments with tsiklopiroksy which is active concerning all types of fungi, or other modern medicines having high activity and low toxicity. As in most cases at a favus of local treatment it is not enough, course treatment is carried out, reception of an itrakonazol inside is often appointed. Crusts on a hairy part of the head at first soften lotions from vaseline oil and after an otsloyka of a horn layer of epidermis apply antifungal ointments. If the nail bed is struck, then appoint or varnishes with antifungal components, or if coloring of a nail began, carry out surgical removal of the struck nail plates and apply ointments and creams. At the same time carry out the all-strengthening therapy, appoint immunomodulators, reception of vitamins.
Treatment of a favus long, but in the absence of damages of internals the forecast favorable. However if postfavusny baldness began, then it usually has irreversible character. Efficiency of treatment estimate after absence a dispute and a mycelium at a microscopic research. Three negative results with an interval in 5 days speak about full treatment.
Prevention of a favus consists in regular medical examinations, in carrying out disinfection in the epidemiological center and in survey of contact persons.