Chronic Recurrent Dermatophytosis in the Tropics: Studies on Tinea Imbricata in Indonesia / 대한의진균학회지

Dermatophytosis is one of the major public health problems in tropical countries, especially the chronic recurrent type. Tinea imbricata (TI), a dermatophytosis caused by Trichophyton concentricum (TC), is endemic in several remote and isolated areas in Indonesia. This dermatophytosis is unique due to its predominant genetic predisposition, which leads to chronic recurrent conditions among the affected. Moreover, hot and humid climate, low socio-economic conditions, lack of hygiene, inadequate treatment due to difficult access to health care facilities, and persistent source of re-infections, are among other factors that maintain the chronic-recurrent state. Studies on TI in Indonesia have been done since the 1960s, encompassing the epidemiology, clinical features, and efficacy of antifungal treatment. Griseofulvin is still the mainstay treatment, but relapse rates are high. The latest effort in reducing relapse includes the training of healthcare providers and provision of fungal disinfectant for clothing and bedding to patients in West Papua in addition to standard treatment. Higher cure rate was achieved at the end of treatment and the four-month follow-up in comparison to previous studies. Parallel studies on the same patient populations showed that: 1. clothing and bedding were fomites and potential sources of re-infections; 2. sodium hypochlorite worked well as a fungal disinfectant, followed by anionic detergent and pine oil containing cleaner; 3. terbinafine was the most effective antifungal agent for TC in vitro, followed by griseofulvin; itraconazole, and fluconazole were less effective. In conclusion, to eradicate TI in endemic areas, appropriate and affordable antifungal treatment, concurrent with health education and efforts to identify and eradicate the source of re-infections are very important.

Tinea Imbricata: Case series on three patients in Sarangani, Philippines

The imbricata or Tokelau ringworm is an unusual superficial dermatophytosis caused by the anthropophilic Trichophyton concentricum. Three cases of the Tinea imbricata observed at the Municipal Health Office of Kiamba, Sarangani Province, Philippines are reported in this study. All three patients were from an indigenous ethnic group of Sarangani Province and lived in isolated upland communities. Patient 1 was a 30 year old male, Patient 2 was a 40 year old female, and Patient 3 was a 19 year old female. Lesions lasted - 27 years, - 25 years, and 2 years, respectively. All patients presented with characteristic expensive polycyclic to serpiginous scaling lesions, with areas of sparing. Microscopic examination of skin scrapings prepared with potassium hydroxide revealed the characteristic broad, branched, septate, irregular hyphae. Trichopyton concentricum, the causative agent, was isolated in one of the patients using Mycobiotoc agar. Histopathologic examination on 2 of the patients revealed acute and chronic inflammation, and Periodic Acid Schiff- positive fungal hyphae. All patients were started on Griseofulvin 500mg tab once daily. The case series presented here is the first account of Tinea imbricata in the Philippines since the 1990s.