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The n e w e ng l a n d j o u r na l of m e dic i n e

Images in Clinical Medicine

LindseyR. Baden, M.D., Editor

Tinea Imbricata

Carrick Burns, M.D. n 18-year-old Fijian woman presented with a 3-year history of
Johannah Valentine, M.D. a concentric, scaly rash on her shoulders; the rash was also present on her
Naval Medical Center San Diego trunk, arms, and legs (not shown). The rash was pruritic and progressively
San Diego, CA 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.

2272 n engl j med 375; December 8, 2016

The New England Journal of Medicine

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Copyright 2016 Massachusetts Medical Society. All rights reserved.