DERMATOPHYTE INFECTION WITH SUBEPIDERMAL VESICLE FORMATION (BULLOUS TINEA)
The number of different reaction patterns to
superficial fungus infections is so great that our lab routinely
performs a PAS stain on all specimens that are
associated with a clinical impression of any type of dermatosis. The
demonstration of yeast forms is not helpful, but the demonstration of
hyphae or pseudohyphae is indicative of a pathogen. The possibility of
there being an underlying dermatosis with secondary dermatophytosis can
only be excluded if the lesion/s clear/s following antifungal therapy.
This 57 year old female developed a crusted,
erythematous, vesicular-appearing lesion on the dorsum of one hand.
This cleared following antifungal therapy.
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Scanning power view showing a
scale/crust over the right side of the specimen. There is an incipient
subepidermal vesicle or bulla. Superficial and deep perivascular
lymphocytic infiltrates are present. |
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Low power view of the superficial part of the specimen. |
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High power view showing lymphocytes, polymorphonuclear leukocytes, very few eosinophilic leukocytes, and a few macrophages. |
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High
power view of a section stained with the periodic acid-Schiff stain.
Numerous hyphae are demonstrated. I make no attempt to identify the
species since most dermatophyte infections respond to modern antifungal
medications. |
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