The n e w e ng l a n d j o u r na l
Images in Clinical Medicine
Carrick Burns, M.D.
Johannah Valentine, M.D.
Naval Medical Center San Diego
San Diego, CA
carrick.t.burns.mil@mail.mil
2272
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of m e dic i n e
LindseyR. Baden, M.D., Editor
Tinea Imbricata
A
n 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). The rash was pruritic and progressively
spread to involve approximately 70% of the body-surface area. Her brother had
similar skin findings. Previous courses of oral griseofulvin and terbinafine had
led to temporary resolution of the rash. A clinical diagnosis of tinea imbricata was
made. Tinea imbricata, a rare, superficial fungal infection caused by Trichophyton
concentricum, is endemic to the South Pacific and regions of Central and South
America. The lesions, which are often pruritic, are most commonly seen on the
torso and limbs but can develop on any part of the body. The infection tends to
follow a chronic or recurrent and relapsing course, although it is not invasive. The
differential diagnosis for these skin findings includes erythema gyratum repens,
a paraneoplastic phenomenon. The patient was treated with griseofulvin to clear the
active infection and with topical, dilute vinegar soaks to prevent recurrence. Unfor-
tunately, follow-up of the patient was not possible owing to her remote location.
DOI: 10.1056/NEJMicm1516757
Copyright 2016 Massachusetts Medical Society.
n engl j med 375;23nejm.org December 8, 2016
The New England Journal of Medicine
Copyright 2016 Massachusetts Medical Society. All rights reserved.