bullous or vesicular tinea

TINEA (DERMATOPHYTE INFECTION) ASSOCIATED WITH INCIPIENT SUBEPIDERMAL VESICLE FORMATION

Dermatophyte infections are associated with such a wide variety of reaction patterns that it is the practice in my laboratory to have a periodic acid-Schiff stained slide prepared on every biopsy that comes in with a papulosquamous or inflammatory dermatosis differential diagnosis.

Bullous or vesicular lesions of tinea may result from spongiotic vesiculation, subepidermal vesiculation, or a combination of the two. Needless to say, the subepidermal variant can cause confusion if one is not aware of this possibility. The absence of necrotic individual keratinocytes and the presence of polymorphonuclear leukocytes are hints that a subepidermal vesicle traversed by stringers of delicate fibers probably is not erythema multiforme.

This is a biopsy of a solitary, erythematous plaque within which there were small blisters and over which there were a few pustules.

Scan power view showing an incipient subepidermal blister. There is a scale/crust that contains polymorphonuclear leukocytes over the right side of the picture. Superficial and deep perivascular infiltrates are composed mostly of lymphocytes though there are a few PMN's in the superficial dermis of the right side of the picture.

A low power view. Neither enlarged keratinocytes nor necrotic keratinocytes are present. Stringers of fibrillar material form a web traversing the space between the epidermis and superficial reticular dermis. Blood vessels of the superficial vascular plexus are in this zone.

A high power view of the superficial dermis near the right side of the scan power picture. PMN's as well as lymphocytes are present. Eosinophilic leukocytes are not seen. Extravasated RBC's are seen, but there is no evidence of vascular necrosis.

A high power view of the stratum corneum as seen in a periodic acid-Schiff stained section. Numerous hyphae are present.

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	Scan power view showing an incipient subepidermal blister. There is a scale/crust that contains polymorphonuclear leukocytes over the right side of the picture. Superficial and deep perivascular infiltrates are composed mostly of lymphocytes though there are a few PMN's in the superficial dermis of the right side of the picture.
	A low power view. Neither enlarged keratinocytes nor necrotic keratinocytes are present. Stringers of fibrillar material form a web traversing the space between the epidermis and superficial reticular dermis. Blood vessels of the superficial vascular plexus are in this zone.
	A high power view of the superficial dermis near the right side of the scan power picture. PMN's as well as lymphocytes are present. Eosinophilic leukocytes are not seen. Extravasated RBC's are seen, but there is no evidence of vascular necrosis.