Can Routine Histopathology Distinguish Between Vulvar Cutaneous Candidosis and Dermatophytosis?

Area of Science:

• Dermatology
• Mycology
• Pathology

Background:

• Vulvar cutaneous infections are commonly caused by Candida species (candidosis) or dermatophytes.
• Distinguishing between these fungal infections is crucial for appropriate management.

Purpose of the Study:

• To evaluate if routine histopathology can differentiate vulvar cutaneous candidosis from dermatophytosis.
• To assess the utility of multiplex polymerase chain reaction (PCR) in distinguishing these conditions.

Main Methods:

• Review of 24 vulvar biopsy cases diagnosed with cutaneous mycosis.
• Histopathological analysis using periodic acid-Schiff (PAS) and hematoxylin and eosin (H&E) stains.
• Multiplex PCR analysis for fungal identification.

Main Results:

• No distinct histopathological features differentiated Candida from dermatophytes.
• Organisms appeared as basophilic structures in the stratum corneum on H&E.
• PCR identified Candida in 21% and dermatophytes in 13% of cases.

Conclusions:

• Routine histopathology is insufficient for reliably distinguishing vulvar candidosis and dermatophytosis.
• Specific PCR assays also showed limited discriminatory power.
• A combination of high clinical suspicion and microbiological testing is essential for accurate diagnosis and management.