Tinea pseudoimbricata: a narrative literature review and five new cases.

Background: Tinea pseudoimbricata is a variant of tinea incognito, with multiple erythematous concentric rings (ring in a ring) and pruritus. Misuse of topical corticosteroids is a major exogenous factor.

Objective: We provide an overview of published cases and report the first case series from Romania.

Patients and methods: A narrative review of the literature was conducted in PubMed and amended by ResearchGate. A series of pediatric cases from Romania with clinical suspicion of tinea pseudoimbricata was investigated by clinical examination, KOH preparations of skin scrapings, and mycological culture when possible.

Results: We collected 137 cases of tinea pseudoimbricata from the literature and added a series of 5 pediatric patients from Romania. Oral treatment with fluconazole was effective in all of them. Worldwide, most reports came from India (86%), 3.5% were from other Asian countries, 3.5% were from the Americas, and 7% were from Europe. M. canis and T. mentagrophytes were identified in 2 patients from Romania. T. mentagrophytes, T. rubrum, and T. tonsurans are the dominant species worldwide, but molecular diagnostics were available for only a minor part of cases.

Conclusion: Tinea pseudoimbricata is most common in India. This is the first case series on tinea pseudoimbricata from Romania. Tinea pseudoimbricata is an emerging disease in Europe. Identification of fungi has rarely been done by molecular mycology. This may have caused an overestimation of T. mentagrophytes and an underestimation of T. indotineae.