Tinea capitis et barbae caused by Trichophyton tonsurans A retrospective cohort study of an infection chain after shavings in barber shops.

Müller, Valentina Laura; Kappa-Markovi, Korina; Hyun, Julia; Georgas, Dimitrios; Silberfarb, Gabriel; Paasch, Uwe; Uhrlaß, Silke; Nenoff, Pietro; Schaller, Jörg

BACKGROUND Tinea capitis is a highly contagious infectious disease caused by dermatophytes. In Central Europe it is mainly caused by zoophilic dermatophytes, as for example Microsporum (M.) canis or Trichophyton (T.) mentagrophytes, and increasingly by anthropophilic fungi. T. tonsurans was commonly related to the Tinea gladiatorum, where transmission occurred between infected persons or via contaminated floors. OBJECTIVE Reporting the transmission of this highly contagious dermatophyte for the first time via beard shaving and hairdressing in barber shops in Germany. PATIENTS AND METHODS 18 young male patients developed tinea capitis and/or barbae shortly after shavings of the beard and/or hair in a barber shop. Native, cultural and molecular diagnostics as well as tissue biopsies and resistance tests were performed of skin and hair samples. RESULTS In all samples T. tonsurans could be identified. The medical history and the clinical picture suggest a transmission through contaminated hairdressing tools. The patients were treated with terbinafine or itraconazole in combination with or exclusively with topical antimycotics. CONCLUSION The transmission and a resulting increase in the incidence of infections with T. tonsurans may be due to shavings with direct skin contact of insufficiently disinfected hairdressing tools. This path of infection has already been observed in Africa and is now being described for the first time in Germany. Knowledge of the pathogen and its transmission ways are essential to interrupt the chain of infection.