Tinea capitis in Europe: new perspective on an old problem.

A survey of tinea capitis conducted under the auspices of the European Confederation of Medical Mycology showed that laboratories contributing to a voluntary scheme for reporting have recently been seeing a different pattern of scalp ringworm. The survey was conducted among 92 medical mycology laboratories across 19 European countries by postal questionnaire comparing the years 1987 with 1997. The survey shows an overall increase in the numbers of cases caused by anthropophilic infections, which, in 1997, were the dominant causes of scalp infection; the greatest increase was seen in laboratories covering urban populations and in African Caribbean children living in Europe. While the commonest infection remains Microsporum canis, the largest overall increase has been in Trichophyton tonsurans, which in 1997 was the second commonest cause of infection overall and the commonest in urban populations. The pattern of change is not uniform in Europe and while some cities have reported large increases in T. tonsurans others, e.g. in France, have seen more cases of infection due to T. soudanense and M. audouinii. While these figures do not necessarily reflect changes in the underlying prevalence of infection, the trends are important to recognize as the control measures for anthropophilic tinea capitis differ from those used in zoophilic infections. In particular there is a need for an increased level of surveillance and more advice on control given to primary care physicians, dermatologists and school health authorities.