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].

• Chronic Infection

  Adoptive transfer of immunity to dermatophyte infection by lymphoid cells from donors with acute or chronic infections. Immunology 53:465–472, 1984. PubMed Google Scholar 8. Castellani A: Further researches on the hyphomycetes of tinea imbricata. [link.springer.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]

• 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]

• Vietnamese

  Русский (Russian) ಕನ್ನಡ (Kannada) 한국어 (Korean) עברית (Hebrew) Український (Ukrainian) اردو (Urdu) Magyar (Hungarian) मानक हिन्दी (Hindi) Indonesia (Indonesian) Italiano (Italian) தமிழ் (Tamil) Türkçe (Turkish) తెలుగు (Telugu) ภาษาไทย (Thai) Tiếng Việt (Vietnamese [synonyms.net]

• Turkish

  Deutsch (German) العربية (Arabic) Français (French) Русский (Russian) ಕನ್ನಡ (Kannada) 한국어 (Korean) עברית (Hebrew) Український (Ukrainian) اردو (Urdu) Magyar (Hungarian) मानक हिन्दी (Hindi) Indonesia (Indonesian) Italiano (Italian) தமிழ் (Tamil) Türkçe (Turkish [synonyms.net]

• Scaly Rash

  An 18-year-old woman presented with a concentric, scaly rash on her arms, trunk, and legs that involved approximately 70% of the body-surface area. Her brother had similar skin findings. [doi.org]

  An 18-year-old Fijian woman presented with a 3-year history of a concentric, scaly rash on her shoulders; the rash was also present on her trunk, arms, and legs (not shown). [nejm.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]

  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]

• Lichenification

  Areas of lichenification develop after chronic excoriation. As this infection is superficial, patients do not have accompanying constitutional symptoms. [visualdx.com]

  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]

• Excoriation

  Areas of lichenification develop after chronic excoriation. As this infection is superficial, patients do not have accompanying constitutional symptoms. [visualdx.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]

• Neglect

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

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].

1. Hay RJ, Ashbee HR. Superficial mycoses. In: Burns T, Breathnach S, Cox N, Griffiths C, ed. Rook's Textbook of Dermatology. 8th ed. Singapore: Wiley-Blackwell; 2010;36.5–36.68.
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.