Images in Clinical Tropical Medicine Bakua: Tinea Imbricata in the Solomon Islands

Tinea imbricata or tokelau is a chronic superficial mycosis caused by Trichophyton concentricum.1 The disease is endemic in the Pacific, including on the Solomon Islands, where it is known as bakua. The disease predominantly affects individuals living in poor rural communities with limited access to hygiene. It is estimated that between 10 % and 20 % of individuals in some Pacific countries are affected. Tinea imbricata begins in childhood and affects both sexes. Skin lesions can affect the whole body, but the limbs and torso are most commonly involved. Lesions begin as concentric, annular plaques with or without erythema (Figure 1). Over time, multiple overlapping lesions develop (Figure 2). Pruritus is frequent. The florid nature of tinea imbricata can make infection socially stigma-tizing. The disease has a classical appearance, and diagnosis is clinical, although fungal scrapings and culture are possible