Tokelau on Naboo

Tinea imbricata in the Americas

PURPOSE OF REVIEW

The aim is to provide an overview on tinea imbricata, or Tokelau, a superficial mycosis caused by Trichophyton concentricum, a strictly anthropophilic dermatophyte with a well-defined geographic distribution and predisposing factors that include genetic, racial and immunologic susceptibility patterns and a specific environment.

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 of the disease, and the immunologic aspects that help to explain its clinical behavior. We also present a clinical description of the disease, the differential diagnosis and how currently some other emerging diseases such as syphilis in immunocompromised patients can mimic tinea imbricata. The therapeutic options are still griseofulvin and nowadays terbinafine, but the access to the treatments in the endemic zones and the changes in habits of the affected population make control and prevention of the disease difficult.

SUMMARY

Tinea imbricata, or Tokelau, remains an infrequent superficial mycosis restricted to endemic zones in the South Pacific islands (Polynesia and Melanesia), South Asia and some specific areas of South America. Migration phenomena and global changes in the climate may modify the incidence and characteristics of the disease.

Tinea imbricata or Tokelau

Tinea imbricata (TI) or Tokelau is a superficial mycosis caused by Trichophyton concentricum, an anthropophilic dermatophyte. 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 (imbricata: in Latin, tiled) plaques of scale. Predisposing conditions include humidity, inheritance, and immunologic factors. The diagnosis is usually made on clinical grounds, supported by skin scrapings and culture. Tokelau is a chronic and highly relapsing disease and, although no first-line treatment exists, best results are obtained with oral griseofulvin and terbinafine and a topical combination of keratolytic ointments, such as Whitfield's. TI is a disease model that allows the correlation of a series of environmental, genetic, immunologic, and therapeutic conditions.