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].

• Malnutrition

  Dietary influences, iron deficiency, and malnutrition have been cited as associated factors, but their precise role has not been determined. [medigoo.com]

  Peters WE: Tinea imbricata and malnutrition. Trans Roy Soc Trop Med Hyg 51:197–198, 1960.CrossRefGoogle Scholar 36. Petrini B, Kaaman T: T lymphocyte subpopulations in patients with chronic dermatophytosis. [link.springer.com]

  […] autosomal recessive pattern with a minority of autosomal dominant cases. [61] Most patients have specific antibodies to T. concentricum, thus suggesting that there is a decrease in the cellular immunity. [62] Dietary influences, iron deficiency, and malnutrition [idoj.in]

• Chronic Infection

  Hay RJ : Chronic dermatophyte infections. I. Clinical and mycological features. Br J Dermatol 106:1–7, 1982.PubMedCrossRefGoogle Scholar 26. Hay RJ: Fungal infection, Mackie RM : Immunodermatology. [link.springer.com]

  generalized chronically persistent rubrophytia, tinea corporis generalisata and dry-type T. rubrum infection. [idoj.in]

• 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

  […] tinea imbricata--a study on Goodenough Island, Papua New Guinea. ( 6464115 ) Hay R.J....MacNamara K. 1984 27 Immune responses of patients with tinea imbricata. ( 6849824 ) Hay R.J....MacNamara K. 1983 28 Tinea imbricata, filariasis, hydrocoeles and wound [malacards.org]

• Arthritis

  Kim, Concentric targetoid scaly plaques in a patient with severe rheumatoid arthritis, International Journal of Dermatology, 57, 8, (913-914), (2018). Jenifer S. A. Wu, Marcos C. Florian, Douglas A. [doi.org]

• Skin Lesion

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

  The diagnosis is mainly clinical, based on the characteristic skin lesions. [eurekaselect.com]

  The skin lesions are characteristically concentric and lamellar (imbricata: in Latin, tiled) plaques of scale. Predisposing conditions include humidity, inheritance, and immunologic factors. [ncbi.nlm.nih.gov]

• Erythema Annulare

  The papules then spread centrifugally to form annular and/or concentric rings that can extend to form serpinginous or polycyclic plaques with or without erythema. [eurekaselect.com]

  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]

  Treatment, diagnostics and prophylaxis are discusse… Trichophyton tonsurans infection manifesting as multiple concentric annular erythemas. [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

  Athlete's foot causes itching, burning and cracked skin between your toes. Jock itch causes an itchy, burning rash in your groin area. [icdlist.com]

• Neglect

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

  Despite the increasing prevalence of cutaneous dermatophytosis across the world, and especially in tropics, research in this area has often been neglected. [idoj.in]

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].

Temporary remissions and limited access to antifungal medications make its treatment a pressing public health concern. Anecdotal reports about the use of Senna alata leaf decoction as treatment exist. [idexlab.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]

Studies on TI in Indonesia have been done since the 1960s,encompassing the epidemiology, clinical features, and efficacy of antifungal treatment. Griseofulvin is still the mainstay treatment, but relapse rates are high. [kci.go.kr]

treatment, recurrence rates are high, and a more efficacious treatment regimen is needed. [ajtmh.org]

Well-organized Major Infectious Diseases chapters break down content by etiologic agent and epidemiology, clinical signs and their pathophysiology, physical examination findings, diagnosis, treatment and prognosis, immunity, prevention, and public health [books.google.ro]

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]

Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]

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 [pdfs.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.ro]

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]

Well-organized Major Infectious Diseases chapters break down content by etiologic agent and epidemiology, clinical signs and their pathophysiology, physical examination findings, diagnosis, treatment and prognosis, immunity, prevention, and public health [books.google.ro]

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]

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

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. [nejm.org]

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

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.