By Gary M. White, MD
Tinea imbricata or Tokelau is a superficial fungal infection caused by the dermatophyte Trichophyton concentricum. It is endemic in some islands of the South Pacific (Polynesia), South-East Asia, Central and South America, and Mexico, and is most often seen in individuals living in primitive and isolated conditions. The skin lesions are characteristically concentric and lamellar plaques of scale. Imbricata in Latin means "tiled". Some cases show an autosomal recessive inheritance pattern. Most patients have specific antibodies to T. concentricum, thus suggesting that there is a decrease in the cellular immunity. Dietary influences, iron deficiency, and malnutrition have been associated.
Widespread, concentric red, scaly rings are characteristic. As noted above, T. concentricum is usually isolated, but reports of a similar condition in patients overusing topical steroids have grown out T. mentagrophytes [Topical steroid-induced tinea pseudoimbricata: A striking form of tinea incognito. Int J Dermatol 2015;54:e192-3].
Given the widespread nature of the condition and the predisposition to recurrence, oral therapy is recommended, usually terbinafine at 250 mg/day. Topical agents may be used as adjunctive therapy. Oral griseofulvin and itraconazole are alternatives.
JAAD August 2013 Volume 69, Issue 2, Pages e41–e42
Homepage | FAQs | Use of Images | Contact Dr. White