P314 Atypical clinical manifestations and epidemiology of favus in southeast China in the last 15 years and a review of case studies

POSTER SESSION 2, SEPTEMBER 22, 2022, 12:30 PM - 1:30 PM: OBJECTIVE: We aimed to report cases of favus in southeast China in the last 15 years and evaluate clinical and epidemiological characteristics of them, and review the cases reported in the past 10 years worldwide. METHODS: Analyze the basic information, lesion characteristics, disease course, treatment, and prognosis of five cases of favus which were all diagnosed by clinical manifestations and mycological examination in Huashan Hospital of Fudan University. Searched the PubMed, Wanfang, Weipu, and CNKI databases and summarized the literature and case reports related to Trichophyton schoenleinii infection of past 10 years. RESULTS: There were five cases diagnosed as favus in the last 15 years in Huashan Hospital. The pathogenic fungi were all Trichophyton schoenleinii, which was confirmed by culturing and ITS sequencing identification. The five patients were all females and lived in southeast China, of which three were from Jiangxi province, one was from Zhejiang province, and one was from Shaanxi province. Favus is not only seen in children, but also in adults. Three of them were affected in childhood, and the others got in adolescence. The classical lesion of favus was a cup-shaped yellow crust on the scalp centrally pierced by dull grey hair. Affected skin is characterized by a mousy or cheesy odor. However, in these five cases, the skin lesions were without the typical clinical manifestations but often manifested as follicular pustules with underlying erythema, covered with scales and left sequelae such as alopecia and scarring. They were treated with oral terbinafine or itraconazole and achieved good efficacy. In the past 10 years, there have been 43 cases of infection with Trichophyton schoenleinii worldwide, located in Xinjiang, Kaifeng, Kunming, Guangxi region of China, Iran, Tunisia, Kosovo, Kashmir, Turkey, and Mie County in Japan. In nine individual case reports, eight were female and one was male. Four cases were without typical yellow crust. Trichophyton schoenleinii not only infected the scalp, it can also infect the face, extremity, and trunk in patients without immunodeficiency. CONCLUSION: There are still a small number of infections of Trichophyton schoenleinii over the world. However, the clinical manifestations of favus in southeast China tend to be atypical due to factors such as improved sanitation and host immunity, so it has raised the difficulty to obtain proper diagnosis and treatment. Therefore, the doctors should pay great attention to this and make early identification with the help of mycological examination methods to prevent irreversible consequences such as scars and alopecia.