TINEA IMBRICATA

Synonyms.—Tokelau ringworm; Scaly ringworm; Bowditch Island ringworm;
Chinese ringworm; India ringworm; Burmese ringworm; Malabar itch; Gune (Fox);
Cascadöe (Meederwort); Herpes desquamans (Turner); Lafa Tokelau; Tinea circinata
tropica; Le peta; Buckwar.

Definition.—A vegetable parasitic disease of moist, tropical
countries, characterized by the formation of patches composed of con­
centrically arranged, imbricated, scaly rings.

Ill-defined accounts of this peculiar malady are found in the contri­
butions of voyagers, but the first accurate description is that by Fox,¹
a United States medical officer, in 1841. Since then other careful re­
ports have appeared, among which the more recent by Königer,²
McCall Anderson,³ Roux,⁴ Bonnafy and Mialaret,⁵ Manson,⁶ Nieuwen-
huis,⁷ Tribondeau,⁸ Henggeler and others.⁹

¹ Fox, “Narrative of the United States Exploring Expedition, 1838-42, under
command of C. Wilkes,” vol. v, p. 401, cited by Corlett, Bangs and Hardaway’s
American Text-Book.

² Königer, Virchow’s Archiv, 1878, vol. lxxii, p. 413.

³ McCall Anderson, Edinburgh Med. Jour., 1880, vol. xxvi, pt. i, p. 204 (with case
and fungus illustrations).

⁴ Roux, Traité prat, mal des pays chauds, 1888, vol. iii, p. 231 (cited by Corlett).

⁵ Bonnafy and Mialaret, Arch, de méd. navale, 1891, vol. lvi, p. 269.
⁶Manson, Brit. Jour. Derm., 1892, p. 5.

⁷ Nieuwenhuis, Archiv, 1898, vol. xlvi, p. 163.

⁸ Tribondeau, Arch, de med. navale, July, 1899, p. 5, Compt. rend, de la Réunion
Biologique de Bordeaux, Jan. 19, 1901, and Jan. 13, 1903.

⁹ Other recent valuable contributions on tinea imbricata are: R. Koch, “Frambœsia
tropica und Tinea imbricata,” Archiv, 1902, vol. lix, p. 5 (with case illustrations);
Wehmer, “Der Aspergillus des Tokelau,” Centralbl. f. Bakteriol., 1903, xxxv, p. 140;

Plate XXXI.

Tinea imbricata (courtesy of Dr. 0. Henggeler.)

TINEA IMBRICATA

1145

Symptoms.—The malady begins, according to Manson, at one
or sometimes at several points, as a brownish spot, slightly raised, and
which gradually, in the course of a few weeks, increases in size by
peripheral extension to almost ½ inch in diameter, when the central epi­
dermal covering breaks and the epidermis cracks from the center toward
the border, becomes somewhat detached centrally, and bent upward.
Soon this spot is surrounded by a brownish zone about ¹/₁₆ inch wide,
which in turn shows the epidermic detachment and curling at its
inner side, and so the malady spreads. The renewed epidermis of the
central part of the patch goes again through the same process, and in
this manner the ever-increasing area is made up of several or more con­
centrically arranged, imbricated, shingled-like rings. When several
such patches are close together, fusion takes place, and the concentric
regularity is broken and the pattern becomes more complicated, although
the gross features of the epidermic shingles are maintained. The erup­
tion may, in the course of months, invade a great part of the surface.
The skin beneath the curling epidermis is noted to be paler than the gen­
eral surface, whereas at the part attached the surface is, as already indi­
cated, somewhat darker. It will be seen that “all the scales are arranged
so that the free border of each is toward the center of the circle or system
of circles to which it belongs, and that the attached border is, therefore,
toward the periphery. The effect is something like the rings of light and
dark surface on watered silk.” According to Königer, the patches may
at first consist of concentrically arranged, small, itchy papules, which
subsequently exhibit the scaliness. In some extreme cases the ring-like
configuration is lost, the whole surface appearing as if covered with
branny scaliness, and presenting a picture resembling that of a mild
ichthyosis, with which it has sometimes been confused (Henggeler).
As a rule, there are no distinct evidences of inflammatory action. While
the malady is persistent, chronic, and progressive, there is no effect
upon the general health. There may be a variable degree of itching.

Etiology and Pathology—The cause of the malady, which is
of contagious nature, is a vegetable parasite closely similar to the tricho-
phyton. In fact, Nieuwenhuis, Sabouraud, and some others believe
the fungus to be the large-spored trichophyton of animal origin. For
this reason some have considered it as an aggravated or unusual form of
ringworm, a view, however, that is not in consonance with the observa­
tions of those who come in contact with the disease. Manson’s inocula­
tion experiments always produced the same type, and in 2 instances he
inoculated one arm with the ringworm fungus and the other with that

Jeanselme, La pratique Dermatologique, 1904, vol. iv, p. 445; Bassett-Smith, Jour. Trop.
Med., 1904, p. 265; Paranhos (new process for microscopic diagnosis), Jour. Trop.
Med., 1905, p. 341; Henggeler, Monatshefte, 1906, vol. xliii, p. 325 (in Sumatra; a full
critical exposition, with bibliography and an excellent illustration, herein reproduced).
It has been generally believed that this peculiar disease was confined to the
Eastern Hemisphere, but Paranhos (Jour. Trop. Med., 1904, p. 153 and Paranhos and
Leme, ibid., 1906, p. 129), of Brazil, states that it also occurs in certain tropical parts of
South America—in the States of Goyaz, Minas, Matto-Groso, and San Paulo. Cas-
tellani (“Note on Tinea Imbricata and its Treatment,” Jour. Cutan. Dis., 1908, p. 400,
with good case illustration) also records its occurrence in Ceylon, having had 11 cases
under observation.

1146

PARASITIC AFFECTIONS

of tinea imbricata, the resulting diseases having the distinguishing char­
acters of their respective species. Tribondeau, Bassett-Smith, Paranhos,
Wehmer, and Henggeler consider the fungus as belonging to the asper-
gillus.¹ Castellani² has found a plurality of fungi in this type of ringworm,
called by him the “endodermophytons.” The malady is not uncommon
in tropical countries, requiring for its development heat and moisture.
While seen at any age, children are especially liable.

The fungus is found in much greater abundance than that of ring­
worm, although the gross features are admittedly much alike.³ Its
chief field of invasion is the lower part of the corneous layer. The
stronger hairs and their follicles are not attacked; Königer states that
it appears to cause falling of the body hair, but Manson cannot confirm
this, although not able positively to deny it. The rapid development of
the organism from the point of invasion apparently causes the separation
of the horny layer from the rete and the formation of the uplifted scales.

Diagnosis.—The peculiar, shingled-like characters of the con­
centric scaly rings are quite characteristic and serve to distinguish
it from tinea circinata. The latter seldom presents any pronounced
scaliness, and, while rarely there may be two or three rings, they are
lacking in the other features of those of tinea imbricata, besides usually
presenting distinctly inflammatory signs. Moreover, tinea circinata
is never extensive, while tinea imbricata sometimes involves a great
part of the surface.

Prognosis and Treatment—The disease is usually readily
cured, the fungus lying superficially, but, as Manson states, owing to
its profusion and the great extent of surface involved, and consequent
saturation of the patient’s garments with the fungus elements, relapses
very generally occur. The latter can be prevented, however, by burning
or boiling the clothing worn during the treatment. Manson finds the
application of iodin liniment the most satisfactory remedy, applying
it to a part of the body at a time. Castellani commends Manson’s
treatment, and also lauds the application of a solution of resorcin in com­
pound tincture of benzoin—30 to 60 grains (2.-4.) to the ounce (32.).
Bonnafy and Mialaret speak well of sulphur fumigations repeated at
intervals for a period of two months or so. Nieuwenhuis refers to the
efficacy of petroleum rubbed on once or twice daily for fourteen days,
no bath being taken during the treatment. Almost any of the parasit­
icides advised in ringworm will, in fact, suffice if thoroughly employed;
a 3 to 10 per cent, chrysarobin salve cautiously used often being resorted
to in obstinate cases. As prophylactic measures may be mentioned
extreme cleanliness, the disinfection of the underwear, and oiling of the
body.

¹ Tribondeau suggested the name of “lepidophyton” for the fungus; Wehmer, that
of “aspergillus lepidophyton” or “aspergillus Tokelau.”

² Castellani, Jour. Trop. Med. and Hygiene, March 15, 1911, p. 11 (successful
inoculation with cultures).

³ In the microscopic examination the same method may be employed as in ringworm.

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