Combs and hair-trimming tools as reservoirs for dermatophytes in juvenile tinea capitis.

Sir, Dermatophytes are a group of closely-related fungi that are able to invade keratinized tissue (skin, hair and nails) of humans and animals to produce an infection, dermatophytosis, commonly referred to as ringworm or tinea. Important factors leading to the different clinical forms are the infecting fungus, the site infected, the keratinization at that site, and the immune status of the host (1). Tinea capitis refers to dermatophytosis of the scalp and is caused by invasion of the stratum corneum through close contact with an infected person, often in the same household, or with an animal such as a cat (2). Fungal conidia are shed in the air, and may, in theory, remain viable for long periods on combs, brushes, blankets and telephones (3). In Sweden tinea capitis occurs to a limited extent, but is over-represented in children belonging to families emigrated from Africa ("exotic tinea") (4). A study in 2004 showed an increase in Stockholm during the past decade, most commonly caused by Trichophyton violaceum, corresponding with the increased immigration from East Africa (5). Most Swedish children with exotic tinea capitis have never been outside Sweden, so they must have attracted their dermatophytes from domestic contacts. The aim of the study was to investigate further whether hair-trimming tools or combs act as a reservoir for dermatophytes in the home environment of young patients with tinea capitis.