Track: Clinical Studies

Abstract:

Identification of dermatophytoses may utilize histologic clues but often requires stains to confirm the presence of fungus. We surveyed 86 cases of superficial cutaneous mycoses to assess histologic patterns of dermatophytoses and confirm/refute “histologic clues”. Each of the cases were assessed in regard to the presence or absence of surface changes, neutrophils in the stratum corneum, discrete pustule formation inthe epidermis, spongiosis, psoriasiform change, fungal elements visualized by light microscopy alone, and follicular involvement. Level of spongiosis and fungal burden were quantified (1+, 2+, 3+), and distribution and composition of inflammation was recorded. 94% of cases exhibited surface changes and 76% demonstrated both hyperkeratosis and parakeratosis. The “sandwich sign”, considered a clue, was present in 44% of cases. Neutrophils in the stratum corneum, another “clue” were notedin less than half of cases (48%). Spongiosis was ubiquitous, observed in 97% of cases. A discrete pustule was appreciated in the epidermis in 17%. The inflammatory infiltrate was variable, sometimes containing only mononuclear cells but sometimes containing neutrophils and/or eosinophils. 40 cases had follicles available for review; 28% had hyphae. 69% of cases had a high fungal burden (3+). There was a statistically significant relationship between neutrophils in the stratum corneum and the sandwich sign (p=0.002). In conclusion, we found that the histopathologic characteristics of dermatophytoses are protean in nature, thus, confirming the utilization of special stains as a helpful adjunct in evaluation of inflammatory dermatoses.

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Soon Bahrami