Tinea imbricata (TI) is a mycosis affecting the outermost layer of the skin and hair. It is endemic in tropical parts such as the Pacific countries and Brazil due to the warm and humid climate which complements the requirements of life for the causative organism Trichophyton concentricum [1]. Moreover, this infection is more common in people living in poverty and unhygienic conditions. The onset of TI is in the youth and has a recurrent nature that affects the patient despite treatment. Both genders are affected equally, and the percentage of infected residents in endemic regions is about 10 - 20% [2]. Therefore it is beneficial to inquire about previous travels to these regions or contact with potential carriers of this infection.

The mycosis produces characteristic concentric, polycyclic, squamous patterns on the skin that overlap or imbricate, contributing to the characteristic name. It does not cause inflammation and has a tendency to develop a central clearing [3]. Lesions of TI can present with or without erythema and/or bothersome pruritus. Sites most frequently affected are the torso and extremities, nevertheless, the infection can spread to any location of the body [2]. Additionally, tinea imbricata is known to originate in the facial epidermis of children and successively spread to parts of the body previously described [4]. Patients may have a family history of this infection, as it is presumed that a defective immunologic response to Trichophyton concentricum antigens is of genetic origin [5]. Also, transmission of the fungi is rather effortless and involves physical contact with the infected and contact with surfaces containing the organism.

Patients may be erroneously prescribed a topical corticosteroid to treat a suspected eczema, but this can change the dynamics of mycosis due to the development of tinea incognito [6].

• Fishing

  With time, multiple overlapping lesions develop, and the plaques become lamellar with abundant thick scales adhering to the interior of the lesion, giving rise to the appearance of overlapping roof tiles, lace, or fish scales. [eurekaselect.com]

• Wound Infection

  infection. ( 6593962 ) Barss P. 1983 29 Jorge Lobo's disease (keloidal blastomycosis) and tinea imbricata in Indians from the Xingu National Park, Central Brazil. ( 7071925 ) Baruzzi R.G....Michalany N.S. 1982 30 Tinea imbricata in New Zealanders. [malacards.org]

• Erythema Annulare

  In acute presentation in can be confused with secondary syphilis, granuloma annulare and erythema annulare centrifugum. In chronic presentation it can look like ichtyosis and erythema gyratum repens. [genevadermatology.ch]

  […] lez D. 2011 11 Syphilis mimicking tinea imbricata and erythema annulare centrifugum in an immunocompromised patient. ( 19539866 ) Cotterman C....Ackerman L. 2009 12 Satter E.K. 2009 13 Trichophyton tonsurans infection mimicking tinea imbricata. ( 17397364 [malacards.org]

  Erythema annulare centrifugum StatPearls Internet. Treasure Island, FL: StatPearls Publishing 2019. open access plus Rights & PermissionsPrintExport Cite as Article Metrics PDF: 26 HTML: 6 EPUB: 1 PRC: 1 [eurekaselect.com]

  Differential diagnosis of TI includes other tineas (due to Epidermophyton floccosum, T. mentagrophytes, T. tonsurans and Microsporum audouinii), pityriasis versicolor “imbricata”, secondary syphilis, yaws, erythema annulare centrifugum, sarcoidosis and [medicaljournals.se]

  In Japan, any dermatophytosis other than favus or tinea imbricata is considered to be tinea, while outside Japan, favus and t… FREE Publisher Full Text Syphilis mimicking tinea imbricata and erythema annulare centrifugum in an immunocompromised patient [unboundmedicine.com]

• Lichenification

  Skin lesions may be lichenification due to scratching for long time, so that lesions may be non-concentric (Figure 2). [waitall.com]

  Areas of lichenification develop after chronic excoriation. As this infection is superficial, patients do not have accompanying constitutional symptoms. Diagnosis: The doctor will diagnose the condition by looking at the rash. [medigoo.com]

  Pruritus may be absent or mild or severe (12, 14): in the latter case, chronic scratching causes lichenification (14). [medicaljournals.se]

  Often acquired in childhood, tinea imbricata is a chronic disease and lichenification is extremely common due to pruritus. [unboundmedicine.com]

• Skin Rash

  Symptoms depend on the affected area of the body: Ringworm is a red skin rash that forms a ring around normal-looking skin. A worm doesn't cause it. Scalp ringworm causes itchy, red patches on your head. It can leave bald spots. [icdlist.com]

• Excoriation

  Areas of lichenification develop after chronic excoriation. As this infection is superficial, patients do not have accompanying constitutional symptoms. Diagnosis: The doctor will diagnose the condition by looking at the rash. [medigoo.com]

• Neglect

  Steer, Opportunities for Integrated Control of Neglected Tropical Diseases That Affect the Skin, Trends in Parasitology, 32, 11, (843), (2016). [www3.interscience.wiley.com]

To establish a diagnosis of tinea imbricata, a clinical evaluation, and observation of the classical appearance due to this infection (described in the "Presentation'' section) is usually sufficient. Microbiological culture and other tests for objective confirmation are seldom necessary but can be informative in situations where there is doubt or when a specific genus of fungi is required to be identified [7].

Mycological investigations are good tools for identifying the causative agent of the infection. A culture has to be grown in a specific medium i.e. Sabouraud dextrose agar medium with the addition of chloramphenicol, as well as cycloheximide. Under microscopic examination, a characteristic morphological structure of Trichophyton concentricum can be seen. The structural differences include short hyphae with septae and a presence of chlamydospores [8].

Biopsies can be performed for a histopathological examination. A finding confirming a T. concentricum infection includes hyphae invasion into the stratum corneum layer of the skin [8].

Polymerase chain reaction (PCR) can be performed with amplification of the ITS1-ITS2 region [7].

Cooper, Dermatophytosis (Tinea) and Other Superficial Fungal Infections, Diagnosis and Treatment of Human Mycoses, 10.1007/978-1-59745-325-7_20, (355-381), (2008). I. [www3.interscience.wiley.com]

Griseofulvin has been the mainstay of treatment for tinea imbricata (TI) for decades; however, there have been few reports of efficacy of newer antifungals in the treatment of this condition. [scienceopen.com]

LC often has rapid disease progression and poor prognosis. The mean interval between diagnosis of LC and death was reported as 3.8 and 4.8 months respectively in different studies [ 13, 14 ]. The interval time was 2 months for our patient. [clinical-pediatrics-dermatology.imedpub.com]

Diagnosis, treatment, and prognosis We had established that the etiologic agent was M. gypseum based on morphologic features, biochemical test results and molecular methods. [academic.oup.com]

[…] tinea [ tin e-ah ] ringworm ; any of numerous different fungal infections of the skin; the specific type (depending on characteristic appearance, etiologic agent and site) usually is designated by a modifying term. tinea bar bae ringworm of the beard, [medical-dictionary.thefreedictionary.com]

Etiology and Pathology—The cause of the malady, which is of contagious nature, is a vegetable parasite closely similar to the tricho- phyton. [doctortreatments.com]

Moreover, the new or previously very sporadic etiologic agents causing kerion have been recently observed in Croatia, such as T. tonsurans, mostly in wrestlers, so far. [aspergillus.org.uk]

RECENT FINDINGS: This review covers the most interesting aspects of the infrequent disease tinea imbricata, including the historical background, the epidemiologic aspects, highlighting the genetic and racial patterns of susceptibility to the acquisition [ncbi.nlm.nih.gov]

This review covers the most interesting aspects of the infrequent disease tinea imbricata, including the historical background, the epidemiologic aspects, highlighting the genetic and racial patterns of susceptibility to the acquisition of the disease [journals.lww.com]

In a concise and user-friendly format, it offers authoritative coverage of epidemiology, diagnosis, differential diagnosis, pathology, laboratory tests, management, and prevention for both common and rare conditions. [books.google.com]

Case Overview Tinea imbricata Member Rated 0 Patient case no. 10754 Date added 07 April 2010 Patient details Age Adult Location Iraq Localisation Upper limbs / upper arms Description Primary Lesions Plaque / erythemato-squamous Plaque Pathophysiology [dermquest.com]

Recent developments in understanding the pathophysiology of dermatophytosis have confirmed the central role of cell-mediated immunity in countering these infections. [idoj.in]

Stefano Veraldi*, Paolo Pontini and Gianluca Nazzaro Department of Pathophysiology and Transplantations, University of Milan, I.R.C.C.S. Foundation, Cà Granda Ospedale Maggiore Policlinico, IT-20122 Milan, Italy. [medicaljournals.se]

The therapeutic options are still griseofulvin and nowadays terbinafine, but the access to the treatments in the endemic zones and the changes in habits of the affected population make control and prevention of the disease difficult. [ncbi.nlm.nih.gov]

The patient was treated with griseofulvin to clear the active infection and with topical, dilute vinegar soaks to prevent recurrence. Unfortunately, follow-up of the patient was not possible owing to her remote location. [doi.org]

[…] and prevent superficial bacterial and fungal infections," Burns said. [livescience.com]

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2. Mason D, Marks M. Bakua: Tinea Imbricata in the Solomon Islands. Am J Trop Med Hyg. 2015;92(5):883.
3. Narayanasetty NK, Pai VV, Athanikar SB. Annular Lesions in Dermatology. Indian J Dermatol. 2013;58(2):157.
4. Bonifaz A, Vázquez-González D. Tinea imbricata in the Americas. Curr Opin Infect Dis. 2011;24:106–111.
5. Bonifaz A, Archer-Dubon C, Saúl A. Tinea imbricata or Tokelau. Int J Dermatol. 2004;43:506–510.
6. Dias MFRG, Quaresma-Santos MVP, Bernardes-Filho F, Amorim AG da F, Schechtman RC, Azulay DR. Update on therapy for superficial mycoses: review article part I. An Bras Dermatol. 2013;88(5):764-774.
7. Esposto MC, Lazzarini C, Prigitano A, Olivi A, Monti M, Tortorano AM. Trichophyton concentricum in skin lesions in children from the Salomon Islands. G Ital Dermatol Venereol. 2015 Oct;150(5):491-4.
8. Veraldi S, Pontini P, Nazzaro G. A Case of Tinea Imbricata in an Italian Woman. Acta Derm Venereol. 2015 Feb;95(2):235-7.