Psoriasis Superimposed on Vitiligo

Tin, Kyi Saw; Scurry, James; Dyall‐Smith, Delwyn

doi:10.1097/lgt.0b013e3182887155

Cited by 4 publications

(4 citation statements)

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“…25 The tricolor vulva of psoriasis superimposed on vitiligo may represent a Wolf response. 15 Another relevant example involves a patient with intertriginous rash and positive C. albicans culture who improved with antifungals, then recurred with a negative culture and responded to psoriasis treatment. 24 Interleukin-17 may be the link between psoriasis, candidiasis, and Koebner phenomena, to include Wolf isotopic response.…”

Section: Discussionmentioning

confidence: 99%

“…A subtype of koebnerization is the Wolf isotopic response, defined as the appearance of a new dermatosis in the same place as an unrelated lesion, initially described as infections or immune disorders within resolving herpes zoster 25 . The tricolor vulva of psoriasis superimposed on vitiligo may represent a Wolf response 15 . Another relevant example involves a patient with intertriginous rash and positive C. albicans culture who improved with antifungals, then recurred with a negative culture and responded to psoriasis treatment 24 …”

Section: Discussionmentioning

confidence: 99%

“…13 Histopathology of psoriasis and candidiasis both demonstrate corneal or subcorneal neutrophils, acanthosis, and dermal lymphocytic infiltrate. 14,15 Budding cells and pseudohyphae of candidal organisms in the stratum corneum (SC) may be seen in candidiasis but not psoriasis. 16 Organism detection is easier on periodic acid-Schiff (PAS) than hematoxylin and eosin (H&E) stains, but they may be sparse or absent even with obvious clinical and microbiologic disease.…”

mentioning

confidence: 99%

“…Histopathology of psoriasis and candidiasis both demonstrate corneal or subcorneal neutrophils, acanthosis, and dermal lymphocytic infiltrate 14,15 . Budding cells and pseudohyphae of candidal organisms in the stratum corneum (SC) may be seen in candidiasis but not psoriasis 16 .…”

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confidence: 99%

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Clinicopathologic Overlap of Vulvar Psoriasis and Candidiasis

Day,

Chapman-Burgess,

Scurry

2024

J Low Genit Tract Dis

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Objectives The study’s aim is to assess if vulvar psoriasis and candidiasis may be distinguished by clinical presentation and histopathologic appearance. Methods The pathology database identified biopsies with corneal or subcorneal neutrophils, acanthosis, and dermal lymphocytic infiltrate. Exclusions were age younger than 18 years and unavailable or uninterpretable slides. Clinical data included demographics, comorbid conditions, symptoms, examination, microbiology, treatment, and response. Histopathologic review documented site, thickness, and characteristics of stratum corneum and epidermis, distribution of neutrophils, and infiltrate. Cases were stratified by microbiologic presence or absence of Candida albicans. Results Biopsies from 62 women with median age of 60 years were associated with C. albicans on vulvovaginal culture in 28 (45%), whereas 26 (42%) were negative, and 8 (13%) lacked microbiologic assessment. Swab-positive women were more likely to have diabetes, receive prereferral estrogen, and report vulvar pain. Specialist clinical impression was candidiasis in 33 (53%), psoriasis in 11 (18%), comorbid candidiasis and psoriasis in 7 (11%), dermatitis in 10 (16%), and unknown in 2 (3%). Visible fungal organisms occurred in 16 (26%) cases and were associated with diabetes and satellite lesions. Other than presence of organisms, there were no histopathologic differences stratified by microbiologic result. Conclusions The histopathologic triad of corneal/subcorneal neutrophils, acanthosis, and dermal lymphocytic infiltrate is common to vulvar psoriasis and candidiasis, and clinical features do not reliably distinguish between them. Microbiologic assessment and single-agent treatment are useful strategies to clarify the diagnosis.

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Section: Discussionmentioning

confidence: 99%