Treatment of Favus (Tinea Capitis Favosa)
The recommended first-line treatment for favus is oral griseofulvin at a dose of 10 mg/kg/day (pediatric patients) or 500-1000 mg/day (adults) for at least 4-6 weeks, with treatment continuing until the infecting organism is completely eradicated as confirmed by appropriate clinical or laboratory examination. 1
Disease Overview
Favus is a chronic inflammatory form of tinea capitis typically caused by Trichophyton schoenleinii, most commonly encountered in the Middle East and North Africa. It is characterized by:
- Yellow, crusted, cup-shaped lesions ("scutula") composed of hyphae and keratin debris around follicular openings
- May result in cicatricial (scarring) alopecia if left untreated
- Infections fluoresce under Wood's lamp examination 2
Diagnostic Approach
Before initiating treatment, confirm the diagnosis through:
- Direct microscopic examination of infected hair/scalp scale in potassium hydroxide solution
- Fungal culture on appropriate medium
- Scalp biopsy in atypical cases
- Wood's lamp examination (favus infections will fluoresce) 2, 1
Treatment Algorithm
First-Line Therapy
- Oral griseofulvin:
- Adults: 500 mg daily (may require 750 mg-1000 mg/day for extensive infections)
- Children (>2 years): 10 mg/kg daily
- Duration: Minimum 4-6 weeks for tinea capitis, continuing until complete eradication 1
Alternative Therapies (for resistant cases or griseofulvin intolerance)
Terbinafine:
Itraconazole:
- 5 mg/kg/day
- Duration: 2-3 weeks 4
Fluconazole:
- 6 mg/kg/day
- Duration: 2-3 weeks 4
Adjunctive Therapy
- Topical antifungal agents (ketoconazole, isoconazole) should be used concurrently with systemic therapy 3
- Keratolytic shampoos to help remove scales and crusts
Treatment Considerations
- Treatment must continue until the infecting organism is completely eradicated as indicated by appropriate clinical or laboratory examination 1
- Post-treatment samples should be sent to ensure mycological clearance 2
- General hygiene measures should be observed to control sources of infection or reinfection 1
- Be aware that favus can cause permanent scarring alopecia if not treated promptly and adequately 6
Special Situations
Recurrent cases: Consider longer duration of therapy or alternative antifungal agent. A case report showed successful treatment of recurrent favus with terbinafine 250 mg/day for 4 weeks plus topical isoconazole and ketoconazole for 6 weeks 3
Atypical presentations: Favus may present without classic scutula and can be misdiagnosed as other scalp conditions (e.g., tinea amiantacea). Always perform mycological examination in cases of diffuse scaling of the scalp 6
Monitoring and Follow-up
- Clinical follow-up should be scheduled at 4,8, and 12 weeks from the start of therapy
- Mycological examination should be performed at the end of treatment to confirm eradication
- Monitor for potential side effects of antifungal therapy
Early and appropriate treatment is crucial to prevent permanent scarring alopecia, which is a common complication of untreated favus.