Transepithelial elimination of late cutaneous vulvar schistosomiasis

Late cutaneous vulvar schistosomiasis (LCVS), which represents the cutaneous response to the deposition of schistosomal ova, is characterized by a range of clinical manifestations. Histopathological descriptions of LCVS have highlighted the hyperplastic epithelial reaction, and a few reports have alluded to the presence of intraepidermal bilharzial ova. Although transepithelial elimination (TEE), a well-known phenomenon whereby the skin rids itself of foreign, potentially dangerous substances, has been documented in a range of infectious processes, it has not been recognized as a distinct process in LCVS. This study not only documents TEE in 23 biopsies of LCVS but also correlates the role of the histopathological inflammatory reaction pattern, density of ova, and pseudoepitheliomatous hyperplasia in the pathogenesis of TEE. The importance of TEE as an additional, hitherto unrecognized mechanism of release and spread of schistosomal ova to the exterior is also highlighted.