Most people probably won’t see any tub imbricate throughout your career. But after seeing the pictures of this week’s case, I’m convinced that if you ever encounter a situation like this in a consultation (or on an exotic trip) one day, you’ll be more than capable of diagnosing it correctly. the term”imbricate” from the Latin word imbrex, which means overlapping tiles.This superficial fungal disease is caused by Trichophyton concentricumThere are different nomenclatures depending on the geographical area: “Tokelau” in Oceania and India, “Rhone” in Mexico and parts of Central America, “Grillé” in Papua New Guinea, “Bakua” in the Solomon Islands and “Chimberè” in Brazil. It was first described by English explorer William Dampier in 1686 during his travels in the Philippines, but it was medically described by Manson in 1878.
ringworm imbricate It is popular in three places geographical area Specifically: Southwest Pacific (Melanesia, Polynesia, Tokelau, Solomon Islands, Fiji, Papua New Guinea, Indonesia, Samoa, Tahiti, New Zealand), Central and South America (Brazil, Mexico, El Salvador, Panama, Colombia, Guatemala) and Southeast Asia (China, Malaysia, Vietnam, Thailand, Philippines, India). In regions such as Melanesia, Polynesia and the Solomon Islands, an estimated 9% to 18% of the population is affected, with people living in remote communities being the most affected. The disease is usually acquired in early childhood and affects both sexes.
this spread It is spread through direct contact with an infected person, with transmission within households being the most common.they are considered Predisposing factors Hot climate, humid environment, closed clothing, malnutrition, poor hygiene, immune deficiency and genetic predisposition.The latter is considered particularly relevant because ringworm imbricate There are exceptions for non-residents, even if they come into contact with a sick person.
This superficial mycosis usually affects hairless skin, but the hair is not affected.he Trichophyton concentricum It produces proteases and keratinases that digest keratin, allowing it to penetrate into keratinized tissue. The hyphae invade the cuticle and keratin and expand centrifugally.
The initial skin lesions are multiple scaly, reddish-brown papules that spread centrifugally to form concentric rings and multi-ring plaques, with or without erythema. Over time, the lesions develop one after the other, giving them a very characteristic and distinct appearance. The most common sites are the extremities, trunk and face, but without treatment there is a tendency to spread throughout the body, almost always sparing the palms of the hands, soles of the feet, scalp and nails. Itching is common and can be severe. Lichenification is often another accompanying symptom of the clinical picture due to scratching.
he diagnosisIn this case, it is clinical, although to confirm it we can resort to direct examination by KOH, while mycological culture will provide us with a certain diagnosis in those doubtful cases.
he Differential diagnosis It can occur simultaneously with other ringworms, tinea versicolor, annular granuloma, cutaneous sarcoidosis, creeping erythema, centrifugal annular erythema, secondary syphilis and erythematous reticulomucinopathies.
this complication They are typical of any pruritic disorder, but we should not ignore the stigma it can generate in these communities, as well as residual post-inflammatory hyperpigmentation or hypopigmentation. If left untreated, the course is chronic and spontaneous remission is rare. On the other hand, reinfections occur frequently.
he treat If it were possible for us to treat these patients, it would be simple Terbinafine Oral treatment and griseofulvin are preferred and are a reasonable “Plan B”, although longer courses are sometimes required. Combined use with topical antifungals and keratolytic agents may improve cure rates.
Finally, thank you again Mark Corbacho Thanks for sharing with us the images illustrating this week’s case. I’m sure you won’t forget them. If you want to learn more, I recommend this 2019 article by Alexander Leung in Current Pediatric Reviews.
Today we say goodbye with this video from Palau, Micronesia (an area covered in ringworm, although I didn’t see any while I was there). In the jellyfish lake, the ones that don’t sting…
Jellyfish Lake, Palau, Micronesia. Sounds of Nature on Vimeo .