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Skin Biopsy, the Allergists’ Tool: How to Interpret a Report

  • Allergic Skin Diseases (L Fonacier, Section Editor)
  • Published:
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Abstract

Inflammatory dermatoses are frequently encountered by the allergist, and histologic evaluation achieved through skin biopsy can be of tremendous value clinically. There is no substitute for a thorough history and physical exam; however, the skin biopsy is a simple, in-office procedure with little risk of complication that can provide invaluable information when a diagnosis is uncertain. Histopathologically, many inflammatory eruptions can look similar or overlap, but information provided by the dermatopathologist can help the clinician render or refine the clinical diagnosis and guide management. This review will discuss descriptive elements contained in the pathology report to provide a framework that can be used by the allergist to comfortably and confidently diagnose inflammatory dermatologic conditions.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Alguire PC, Mathes BM. Skin biopsy techniques for the internist. J Gene Int Med. 1998;13(1):46–54. Provide great detail about the mechanics and site selection of skin biopsies in order to get the best yield from the tissue specimen.

    Article  CAS  Google Scholar 

  2. Blakeman JM. The skin punch biopsy. Can Fam Physician Medecin de famille canadien. 1983;29:971–4. Provide great detail about the mechanics and site selection of skin biopsies in order to get the best yield from the tissue specimen.

    CAS  PubMed  Google Scholar 

  3. Sina B, Kao GF, Deng AC, Gaspari AA. Skin biopsy for inflammatory and common neoplastic skin diseases: optimum time, best location and preferred techniques. A critical review. J Cutan Pathol. 2009;36(5):505–10. Provide great detail about the mechanics and site selection of skin biopsies in order to get the best yield from the tissue specimen.

    Article  PubMed  Google Scholar 

  4. Al-Mohammedi F, Crawford RI, Martinka M. Biopsies of facial dermatoses made simple. Arch Pathol Lab Med. 2014;138(4):550–2.

    Article  PubMed  Google Scholar 

  5. Boyd AS, Neldner KH. How to submit a specimen for cutaneous pathology analysis. Using the ′5 D’s’ to get the most from biopsies. Arch Family Med. 1997;6(1):64–6. Discusses important information to give the dermatopathologist to get the best, most specific information in a pathology report.

    Article  CAS  Google Scholar 

  6. Alsaad KO, Ghazarian D. My approach to superficial inflammatory dermatoses. J Clin Pathol. 2005;58(12):1233–41.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Justiniano H, Berlingeri-Ramos AC, Sanchez JL. Pattern analysis of drug-induced skin diseases. Am J Dermatopathol. 2008;30(4):352–69. Overview of reaction patterns and histologic features of various inflammatory dermatoses.

    Article  PubMed  Google Scholar 

  8. Fung MA, Barr KL. Current knowledge in inflammatory dermatopathology. Derm Clin. 2012;30(4):667–84. vii. Information about inflammatory dermatoses.

    Article  CAS  Google Scholar 

  9. Akdis CA, Akdis M, Bieber T, et al. Diagnosis and treatment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/American Academy of Allergy, Asthma and Immunology/PRACTALL Consensus Report. Allergy. 2006;61(8):969–87.

    Article  CAS  PubMed  Google Scholar 

  10. Clarke P. Why am I so itchy? Aust Fam Physician. 2004;33(7):489–94.

    PubMed  Google Scholar 

  11. Gunasti S, Marakli SS, Tuncer I, Ozpoyraz N, Aksungur VL. Clinical and histopathological findings of ‘psoriatic neurodermatitis’ and of typical lichen simplex chronicus. J Euro Acad Dermatol Venereol : JEADV. 2007;21(6):811–7.

    Article  CAS  Google Scholar 

  12. Joshi R. Interface dermatitis. Indian J Dermatol Venereol Leprol. 2013;79(3):349–59.

    Article  PubMed  Google Scholar 

  13. Sehgal VN, Dogra S, Srivastava G, Aggarwal AK. Psoriasiform dermatoses. Indian J Dermatol Venereol Leprol. 2008;74(2):94–9.

    Article  PubMed  Google Scholar 

  14. Joffe RA. An assist to the next (10th) edition of Lever’s Histopathology of the Skin. Am J Dermatopathol. 2009;31(1):26–30.

    Article  PubMed  Google Scholar 

  15. Gupta K. Deciphering spongiotic dermatitides. Indian J Dermatol Venereol Leprol. 2008;74(5):523–6.

    Article  PubMed  Google Scholar 

  16. Fung MA. The clinical and histopathologic spectrum of “dermal hypersensitivity reactions,” a nonspecific histologic diagnosis that is not very useful in clinical practice, and the concept of a “dermal hypersensitivity reaction pattern”. J Am Acad Dermatol. 2002;47(6):898–907. A recent review of dermal hypersensitivity reaction, a more recently recognized histologic “reaction pattern” that spans a wide differential diagnosis.

    Article  PubMed  Google Scholar 

  17. Wold L, Chen JK, Lampel HP. Hand dermatitis: an allergist’s nightmare. Curr Allergy Asthma Rep. 2014;14(11):474.

    Article  PubMed  Google Scholar 

  18. Brady SP. Parakeratosis. J Am Acad Dermatol. 2004;50(1):77–84.

    Article  PubMed  Google Scholar 

  19. Murphy M, Kerr P, Grant-Kels JM. The histopathologic spectrum of psoriasis. Clin Dermatol. 2007;25(6):524–8.

    Article  PubMed  Google Scholar 

  20. Dourmishev LA, Dourmishev AL. Syphilis: uncommon presentations in adults. Clin Dermatol. 2005;23(6):555–64.

    Article  PubMed  Google Scholar 

  21. Moriello KA. Diagnostic techniques for dermatophytosis. Clin Tech Small Anim Pract. 2001;16(4):219–24.

    Article  CAS  PubMed  Google Scholar 

  22. Nigen S, Knowles SR, Shear NH. Drug eruptions: approaching the diagnosis of drug-induced skin diseases. J Drugs Dermatol : JDD. 2003;2(3):278–99. A review of how to approach a suspected drug eruption.

    PubMed  Google Scholar 

  23. Peroni A, Colato C, Zanoni G, Girolomoni G. Urticarial lesions: if not urticaria, what else? The differential diagnosis of urticaria: part II. Systemic diseases. J Am Acad Dermatol. 2010;62(4):557–70. quiz 71–2. A review of how to approach urticaria.

    Article  PubMed  Google Scholar 

  24. Stibich AS, Schwartz RA. Papular urticaria. Cutis. 2001;68(2):89–91.

    CAS  PubMed  Google Scholar 

  25. Clark AR, Jorizzo JL, Fleischer AB. Papular dermatitis (subacute prurigo, “itchy red bump” disease): pilot study of phototherapy. J Am Acad Dermatol. 1998;38(6 Pt 1):929–33.

    Article  CAS  PubMed  Google Scholar 

  26. Schaefer P. Urticaria: evaluation and treatment. Am Fam Physician. 2011;83(9):1078–84.

    PubMed  Google Scholar 

  27. Stewart 2nd GE. Histopathology of chronic urticaria. Clin Rev Allergy immunol. 2002;23(2):195–200.

    Article  PubMed  Google Scholar 

  28. Charlesworth EN. Urticaria and angioedema: a clinical spectrum. Ann Allergy, Asthma Immunol: Off Publ Am College Allergy, Asthma, Immunol. 1996;76(6):484–95. quiz 95–9.

    Article  CAS  Google Scholar 

  29. Kaplan AP. What to do with refractory urticaria patients. Curr Allergy Asthma Rep. 2011;11(3):189–91.

    Article  PubMed  Google Scholar 

  30. Sais G, Vidaller A, Jucgla A, Servitje O, Condom E, Peyri J. Prognostic factors in leukocytoclastic vasculitis: a clinicopathologic study of 160 patients. Arch Dermatol. 1998;134(3):309–15.

    Article  CAS  PubMed  Google Scholar 

  31. Mathur AN, Mathes EF. Urticaria mimickers in children. Dermatol Ther. 2013;26(6):467–75.

    Article  PubMed  Google Scholar 

  32. Carlson JA. The histological assessment of cutaneous vasculitis. Histopathology. 2010;56(1):3–23.

    Article  PubMed  Google Scholar 

  33. Goeser MR, Laniosz V, Wetter DA. A practical approach to the diagnosis, evaluation, and management of cutaneous small-vessel vasculitis. Am J Clin Dermatol. 2014;15(4):299–306.

    Article  PubMed  Google Scholar 

  34. Chang S, Carr W. Urticarial vasculitis. Allergy Asthma Proc: Off J Reg State Allergy Soc. 2007;28(1):97–100.

    Article  Google Scholar 

  35. Schmidt E, Zillikens D. Modern diagnosis of autoimmune blistering skin diseases. Autoimmun Rev. 2010;10(2):84–9.

    Article  CAS  PubMed  Google Scholar 

  36. Schmidt E, Zillikens D. The diagnosis and treatment of autoimmune blistering skin diseases. Deutsches Arzteblatt Int. 2011;108(23):399–405. I-III.

    Google Scholar 

  37. Patricio P, Ferreira C, Gomes MM, Filipe P. Autoimmune bullous dermatoses: a review. Ann N Y Acad Sci. 2009;1173:203–10.

    Article  CAS  PubMed  Google Scholar 

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Conflict of Interest

Drs. Keeling, Gavino, and Gavino have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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Authors and Affiliations

  1. Department of Dermatology, Dell Medical School, The University of Texas at Austin, 601 E. 15th Street, Austin, TX, 78701, USA

    Brett H. Keeling & Alde Carlo P. Gavino

  2. McGovern Allergy and Asthma Clinic, 4710 Bellaire Boulevard, Suite 200, Houston, TX, 77401, USA

    Aries Caesar P. Gavino

Authors
  1. Brett H. Keeling
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  2. Aries Caesar P. Gavino
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  3. Alde Carlo P. Gavino
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Correspondence to Brett H. Keeling.

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This article is part of the Topical Collection on Allergic Skin Diseases

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Keeling, B.H., Gavino, A.C.P. & Gavino, A.C.P. Skin Biopsy, the Allergists’ Tool: How to Interpret a Report. Curr Allergy Asthma Rep 15, 62 (2015). https://doi.org/10.1007/s11882-015-0560-y

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  • DOI: https://doi.org/10.1007/s11882-015-0560-y

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