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Why is it important to carefully examine the stratum corneum?


Dr. Mona Abdel-Halim

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I have seen a case that presented with a history of psoriasis for which she received topical steroids. The patient used to improve on topical steroids so she kept re-using them again and again. Since 1 year she claimed that the lesions started to progress to involve larger areas of her body and became resistant to treatment. I saw the skin biopsy in a routine signing out session before seeing the patient clinically. The findings were totally that of nonspecific spongiotic dermatitis with foci of parakeratosis. I could not make a definite diagnosis so I asked to see the patient clinically. Luckily enough, I perceived a hint of annularity in some areas. I started to think of dermatophytosis. I checked the slides again, but this time with high magnification of the stratum corneum and oil immersion examination. There I found them beautifully residing in the stratum corneum, fungal hyphae and spores!!!

Ever since then, I decided to pay utmost respect to the stratum corneum!!! I should check it very carefully especially in cases with chronic rashes not responding to usual treatments to exclude the possibility of Tinea incognito.
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