- Skin fungal infection wave: Are barbershops being scapegoated?
Rumors have been circulating for weeks. The skin fungus Trichophyton tonsurans is spreading and can lead to nasty abscesses and permanent hair loss. Barbershops are said to be the main drivers of this infection wave, where contaminated razor blades are supposed to pass on fungal spores from one customer to the next. It is speculated that there is not enough disinfection there, that customer contact is too high, and that the staff is insufficiently trained.
There are calls for infection hygiene monitoring by health authorities. However, there is neither official documentation of infection numbers nor one hundred percent proof that the infections have occurred in barbershops. Are barbershops being made the scapegoat here, or do the blame assignments actually have a justification? Prof. Dr. Hans-Jürgen Tietz knows about skin fungi. He heads the mycoclinic, an institute for fungal diseases, in Berlin. He speaks of "terrifying panic mongering" in connection with the reporting on Trichophyton tonsurans. He answered the most important questions about the topic for the Stern.
Is the skin fungus Trichophyton tonsurans a new problem?
No.
Trichophyton tonsurans is not new. The thread fungus has been spreading in Germany since the 1990s. It was once brought in as a souvenir by wrestlers who brought it back from competition trips to the United States, which is why the fungus is also called ringworm or mat fungus, explains Prof. Dr. Hans-Jürgen Tietz to Stern. "In German wrestling, Trichophyton tonsurans is still an unsolved problem. You could say that the whole Bundesliga is infected," says the expert in mycology.
It is spread there through very intense skin contact or contaminated soil. However, experts like Tietz have recently observed an increase in affected people who are not wrestlers. Barbershops are coming into focus. But wrestling is not the only source. The fungus also enters on the heads of children from Africa. Furthermore, there are indications that the fungus is widespread in the Turkish population. However, there are no exact numbers for this either, says Tietz.
Is it easy to get infected?
No.
Trichophyton tonsurans is anthropophilic, which means it is transmitted from person to person. "The fungus is contagious, but not highly contagious," Prof. Tietz clarifies. Compared to that, it is unlikely to get infected by normal skin contact with Trichophyton tonsurans, according to Prof. Tietz. It's different with another skin fungus, the cat fungus. "If you stroke a cat on Mallorca, even light skin contact can lead to an infection. The cat fungus is very contagious," says the expert.
The specialist in microbiology and specialist in skin infections assumes that a skin injury, so to speak as a kind of entrance gate, is indispensable for an infection. This includes even small scratches or cuts that can also occur in a barbershop or hairdressing salon. If the devices used are not cleaned sufficiently, it is possible that the transmission of fungal spores occurs via the razor blades.
How many infected people are we talking about currently?
We don't know.
Since 2001, fungal infections no longer need to be reported to health authorities. "And if there's no reporting obligation, there are no numbers - neither for athlete's foot, vaginal yeast infections, or Trichophyton tonsurans," says mycologist Tietz. The numbers can only be estimated. Tietz himself has been observing the increase in infections for three to four years. He is not alone. Almost every dermatologist he exchanges with reports cases.
"In Germany, there are about 4,000 dermatologists. If each has two to three cases, we get about 10,000 cases. And that's a low estimate," he says. The University Hospital Erlangen now reports cases of Trichophyton tonsurans to the responsible health authority. The chief physician of the dermatology clinic there, Dr. Petra Wörl, speaks of a tenfold increase in cases in an interview with the "ApothekenUmschau". Dermatologist Martin Schaller from the University Hospital Tübingen told the "Spiegel" that the skin fungus is now found three to five times more often there than five years ago. He speaks of a "European epidemic".
Does an infection with the skin fungus Trichophyton tonsurans need to be treated?
Yes.
The pathogen naturally enters the skin or is introduced into the skin, for example by a razor or a comb. After about ten days, circular spots, so-called "ringworm", appear on the skin, which itch. Although the symptoms are often mistaken for a bacterial cause, they are a sign of a skin fungus, explains Tietz. "If the symptoms are ignored, it can lead to the next stage where the fungus enters the hair follicle and infects the hair follicle."
As a result, the hair falls out, leaving a circular bald spot. If the fungus is not treated, these spots can remain bald permanently. It can also happen that the fungus spreads and eventually the entire head is bald or other body parts are affected. Prof. Tietz therefore advocates for early diagnosis.
Because, according to the expert: "The good news is that the fungus can be treated very well with tablets, for example. Then the hair loss does not remain." A thorough therapy immediately interrupts the infection chain, so that there is no transmission of the pathogen - to the environment or other people. Therapy can take several weeks, but in most cases, those affected are no longer contagious after about a week. The problem: Many patients only go to the doctor weeks or even months after the infection.
There have also been cases where abscesses have occurred on the head. Such inflammations were not a symptom of the fungus before. The specialist in microbiology therefore assumes that the skin fungus has transformed, that it may now be a new, more unpleasant variant of Trichophyton tonsurans.
Can the fungus also affect internal organs?
No.
The fungus mainly causes inflammation on the scalp, but can also affect the entire body. In that case, it is called Tinea capitis. Since the fungus, like all skin fungi, feeds on keratin, and this does not occur inside the body, it cannot affect the entire system.
According to Prof. Tietz, several factors combine to facilitate an infection with the fungus in barbershops: On the one hand, they are places of social gathering that are usually highly frequented. The more customers, the higher the probability that one of them can be seen as a source of infection. On the other hand, instruments can become contaminated by working on a customer with skin fungus. Additionally, fine shaving can lead to injuries that in turn facilitate an infection.
Determining where an infection occurred is difficult. However, Prof. Tietz does not believe it is a coincidence that many of the currently infected have the fungus behind their ear. "That's still not a hundred percent proof that the infection occurred in a barbershop, but it's likely," says the expert. He suspects: "The fungus has made the jump from the mat to the barbershop, or hairdressing salons." Researchers in Duisburg had already found in 2020 that the fungus can be transmitted through contaminated hair cutting devices.
Is poor hygiene a factor in the spread of the skin disease?
Yes.
To avoid the spread of fungal spores, disinfection of instruments between customers is necessary. In barbershops, but also in conventional hairdressing salons. However, expert Tietz doubts whether this always happens in practice. Although disinfection is at least theoretically part of the German master regulations for hairdressing salons, unlike barbershops.
Is there a solution to the current skin fungus problem?
It's a bit of a yes and no.
The simple answer: The instruments used should be disinfected after each customer. How feasible this is in daily work and how verifiable for the customer whether disinfection has been carried out correctly is questionable. However, health departments could monitor the shops in terms of health hygiene. Customers who want to be on the safe side can also take another measure. "The idea is a bit far-fetched, but practical. It's like the 'morning-after pill'. Those who are anxious but don't want to miss out on the haircutting art in the barbershop can wash their hair prophylactically at home with an anti-fungal shampoo afterwards," says Prof. Tietz.
Based on the provided text, here are two sentences that contain the words 'Health and safety':
- Considering the spread of Trichophyton tonsurans and the concerns about barbershops, there are calls for improved health and safety measures and infection hygiene monitoring by health authorities.
- In response to the concerns about the potential spread of fungal infections in barbershops, implementing strict health and safety protocols, including regular disinfection and adequate staff training, is crucial.
