Asymptomatic dermatophyte scalp carriage: laboratory diagnosis, epidemiology and management

Asymptomatic carrier is defined as an individual who has dermatophyte-positive scalp culture without signs or symptoms of tinea capitis. The prevalence of asymptomatic carriage differs from region to region with a rate of 0.1-49%. Anthropophilic dermatophytes, Trichophyton tonsurans and Trichophyton violaceum, have been generally associated with high rates of asymptomatic carriage. Hence, the presence of dermatophytes on healthy scalp hairs of children may be a potential source of infection for schoolmates, playmates and/or households. Although it was also reported in adults, most carriage has been observed in children especially among those between 4 and 8 years of age, while male to female ratios vary between studies. It is still unclear, whether carriers should be treated with topical antifungal shampoos or oral antifungals or both, as some studies indicate that some untreated cases become culture-negative after 2-12 months. This review provides details on related dermatophyte fungi, laboratory diagnosis, epidemiology, ways of spreading as well as treatment and follow-up results of asymptomatic carriage. An integration into the school health programs is proposed, which will render the possible dealing of the subject in a comprehensive and reasonable manner.