Skin Biopsy Specimens Research Articles

Real-time Analysis of Skin Biopsy Specimens With 2-Photon Fluorescence Microscopy

Nonmelanoma skin cancers (NMSCs) are primarily diagnosed through paraffin section histologic analysis of skin biopsy specimens that requires days to weeks before a formal diagnosis is reported. Two-photon fluorescence microscopy (TPFM) has the potential for point-of-care diagnosis of NMSC and other dermatologic conditions, which could enable same-visit diagnosis and treatment. To demonstrate that TPFM imaging of NMSC can occur within minutes of obtaining biopsies and provide similar histological features to those of conventional histology and evaluate TPFM diagnostic performance with respect to conventional histology. This comparative effectiveness pilot study examined 29 freshly excised biopsies from confirmed NMSC lesions in patients presenting for treatment. Biopsies underwent imaging immediately with TPFM on site at Rochester Dermatologic Surgery (Victor, New York) between October 2019 and August 2021. The imaged biopsies were subsequently submitted for paraffin histology to produce coregistered images. Twelve of these coregistered image pairs (41.4%) were used as a training set. Fifteen (51.7%) were used in a masked evaluation by a board-certified dermatopathologist. Two (6.9%) were excluded from the study before evaluation because they could not be coregistered. Sensitivity, specificity, and accuracy of TPFM for NMSC biopsies were evaluated compared with conventional histology. Fourteen of the 15 biopsy specimens (93.3%) in the evaluation set were identically diagnosed with TPFM and paraffin histology. The TPFM had 100% sensitivity (95% CI, 48%-100%), 100% specificity (95% CI, 69%-100%), and 100% accuracy (95% CI, 78%-100%) for basal cell carcinoma diagnosis. For squamous cell carcinoma diagnosis, TPFM had 89% sensitivity (95% CI, 52%-100), 100% specificity (95% CI, 54%-100%), and 93% accuracy (95% CI, 68%-100%). For overall NMSC diagnosis, TPFM had a 93% sensitivity (95% CI, 66%-100%), 100% specificity (95% CI, 3%-100%), and 93% accuracy (95% CI, 68%-100%). Examination of the 1 discordant pair revealed mismatched imaging planes as the source of error. The results of this comparative effectiveness pilot study suggest that TPFM captures histological characteristics of NMSC that are present in conventional histology, which reveals its potential as a rapid, point-of-care diagnostic alternative that does not need extensive sample preparation or retraining for image evaluation. Further validation of TPFM imaging performed for a larger cohort is needed to fully evaluate its diagnostic accuracy and potential effect within the field.

34138 Clinical characterization and histopathologic correlation of erythroderma: A retrospective review

While the most common causes of erythroderma are benign inflammatory conditions, cutaneous T-cell lymphoma comprises up to 15% of erythroderma cases. Regardless of etiology, individuals with erythroderma may experience significant symptoms of pruritus, cold intolerance, and increased risk of infection. Thus, delay in accurate diagnosis may negatively impact patient outcomes and quality of life. Previous studies have shown that histopathology is nonspecific in up to 50% of skin biopsy specimens in the setting of erythroderma, posing a significant diagnostic challenge.

Clinicopathological Features of Cutaneous Findings of SARS-CoV-2 Infection.

Objective:In December 2019, severe acute respiratory syndrome coronavirus-2, which emerged in Wuhan, China, spread rapidly and created a pandemic. Coronavirus disease-2019 (COVID-19) can affect different organ systems, including the skin. Recently, COVID-19 cases with skin lesions of different clinicopathological features have been published. This study aimed to present the histopathological features of 19 COVID-19 cases with cutaneous findings and discuss them in light of the literature.Methods:Skin biopsy specimens of 19 patients with skin rashes associated with COVID-19 were evaluated histopathologically and clinically.Results:Clinical manifestations of rashes developed in eight female, seven male, and four pediatric patients with COVID-19. Urticaria/urticarial vasculitis (n=7), maculopapular eruption (n=7), panniculitis (n=2), purpuric eruptions (n=2), and livedoid-like lesions were noted. Histopathologically, besides the inflammatory findings, the most striking feature was that the vessels were more or less affected in almost all cases.Conclusions:Cutaneous lesions associated with COVID-19 are increasingly being reported. We believe that every data presented about this disease, which has many unknowns, will shed light on future research. Every case can lead us a new way.

Occupational Seborrheic Dermatitis in a Steel Worker.

PRECÍS Occupational seborrheic dermatitis is seldom reported. Occlusion under personal protective equipment, such as a flame-retardant balaclava, can predispose one to developing occupational seborrheic dermatitis. DISCUSSION A 38-year-old male steel worker presented to our outpatient dermatology practice with a several-year history of relapsing and remitting mildly pruritic coalescing red papules on the face, scalp, neck, and upper chest (Fig. 1). He reported minimal improvement with miconazole powder and hydrocortisone 1% cream. The rash did seem to be related to his occupation and cleared completely on vacation. A presumptive diagnosis of allergic contact dermatitis (ACD) was made, and the patient was given 60 mg of intramuscular triamcinolone acetonide and started on topical triamcinolone 0.1% cream twice daily. Three-millimeter punch biopsies of the occipital scalp and chest were obtained and showed mounds of scale crust containing neutrophils at lips of follicular ostia, spongiotic mild psoriasiform hyperplasia, and a perivascular mixed-cell infiltrate around dilated vessels in the upper part of the dermis, suggestive of seborrheic dermatitis (SD; Fig. 2).Figure 1: Steel worker with scaly coalescing red papules on the face, scalp, neck, and upper chest. Comparison of patient's rash and that of his PPE (a flame-retardant balaclava).Figure 2: Hematoxylin and eosin stain (×10) of punch biopsy of occipital scalp: mounds of scale crust containing neutrophils at lips of follicular ostia and spongiotic mild psoriasiform hyperplasia.On 2-week follow-up, the patient noted only moderate improvement. Given the temporal association with his occupation, he was instructed to bring in his personal protective equipment (PPE); his flame-retardant balaclava, which he wore daily, closely matched the distribution of his rash (Fig. 1). The patient reported wearing this balaclava 4 to 8 hours per day while working in a hot steel mill. The patient was treated with ketoconazole 2% shampoo daily, to be used both as a shampoo and body wash, and ciclopirox 0.77% solution twice daily. The patient reported complete resolution at 2 weeks and maintained resolution at 6 months with only intermittent ketoconazole shampoo use and without job change. While both allergic and irritant contact dermatitis were considered in this case, especially considering the potential overlap histopathologically between ACD and SD, we favor a definitive diagnosis of SD given the lack of significant eosinophils on biopsy, minimal pruritus, failure of ACD-directed therapy, and near-complete resolution on SD-directed therapy. Occupational SD is rarely reported. Flares of pre-established SD were reported in health care workers with increased mask use during the COVID-19 pandemic.1,2 Interestingly, SD also has an increased prevalence among mountain guides, thought to be secondary to long-term ultraviolet radiation–mediated immune suppression.3 With the onset of the digital age, there was concern that long-term occupational exposure to digital screens may cause or worsen SD.3 We posit that the occlusive warm environment under the patient's balaclava created an optimal environment for SD development. While the pathophysiology of SD is complex, it has been noted that SD is more common in warmer areas of the face.4 Similarly, cases of worsening SD in health care workers wearing face masks highlight the potential role of occlusion in SD pathogenesis.2 Occupational SD under PPE has not been reported outside health care professions but may be underreported or misdiagnosed as allergic or irritant contact dermatitis, because it was initially in this case. Suboptimal response to treatment and histologic analysis of skin biopsy specimens were key to an accurate diagnosis in this case. ZEBRA Occupational SD may be underreported and should be considered in cases of refractory SD and in professions where occlusive PPE is required, particularly in warmer environments.

Effect of Prior Diagnoses on Dermatopathologists’ Interpretations of Melanocytic Lesions

Medical second opinions are common, although little is known about the best processes for obtaining them. This study assesses whether knowledge of a prior physician's diagnosis influences consulting physicians' diagnoses. To measure the extent to which dermatopathologists' diagnoses are influenced by prior diagnostic information from another dermatopathologist. Dermatopathologists were randomly assigned to interpret 1 slide set of 18 melanocytic skin biopsy specimens in 2 phases (5 slide sets totaling 90 cases). Phase 1 interpretations were conducted without prior diagnostic information. After a washout period of 12 or more months, dermatopathologists' phase 2 interpretations were conducted with their identical slide set; for a random subset of cases in phase 2, participants were shown prior diagnoses by other dermatopathologists that were either more or less severe than their own phase 1 diagnosis of the case. Using the Melanocytic Pathology Assessment Tool and Hierarchy for Diagnosis tool, cases ranged from class I (benign) to class V (≥pT1b invasive melanoma). Data collection took place from August 2018 to March 2021, and data analysis was performed from March to December 2021. Prior diagnoses were actual diagnoses from board-certified and/or fellowship-trained dermatopathologists. A prior diagnosis was always in a more severe or less severe diagnostic class than the participant's phase 1 interpretation; more or less severe was determined by the randomization scheme. In the control condition of no prior diagnostic information, the participants were told that a prior diagnosis was not available. When exposure was to a prior diagnosis in a higher diagnostic class, the primary study outcome was whether a participant's diagnosis in phase 2 was in a higher diagnostic class than the participant's diagnosis in phase 1. When exposure was to a prior diagnosis in a lower diagnostic class, the primary study outcome was whether a participant's diagnosis in phase 2 was in a lower diagnostic class than the participant's diagnosis in phase 1. The effect of prior diagnostic information was measured using the relative risk (RR) of each outcome relative to the control condition of no prior diagnostic information, adjusted for the diagnostic class of the phase 1 diagnosis. Prior to data collection, it was hypothesized that participants would be swayed in the direction of prior diagnostic information. A total of 149 dermatopathologists (median [range] age, 47 years [34-76] years; 101 [68%] were male) provided 5322 interpretations of study cases. Participants were more likely to increase the severity of their diagnosis when the prior diagnosis was of greater severity compared with when no prior diagnosis was provided (RR, 1.52; 95% CI, 1.34-1.73); likewise, participants gave less severe diagnoses when prior diagnoses were of lesser severity (RR, 1.38; 95% CI, 1.19-1.59). Trends were similar among dermatopathologists who had previously stated they were "not at all influenced" by prior diagnoses. Prior diagnoses also swayed dermatopathologists away from correct diagnoses. In this randomized controlled trial, despite the preference of most dermatopathologists to receive prior diagnoses when providing second opinions, this information swayed them away from a correct diagnosis to an incorrect diagnosis.

A clinico-histopathological analysis and bacillary index in a study of skin biopsy of leprosy

Introduction: Leprosy is one of the leading causes of physical disabilities contributing to intense social stigma resulting in human discrimination. This chronic infectious disease caused by Mycobacterium leprae principally affects skin and peripheral nerve. It can also include muscle, eyes, bones, testis and internal organs. Histopathology study and bacillary index is important in understanding the disease progression, diagnosis, varied manifestation and complications. Method: All cases attending the skin OPD were examined clinically and skin biopsy specimen was obtained from clinically diagnosed cases of Leprosy and stained with Hematoxylin& Eosin and modifiedFiteFaraco (AFB). The clicical diagnosis correlated with histopathology in all 100 cases. Result: The age of the patients was ranged from 4 to 80 years. The male to female ratio patients was 3 to 1. Borderline Tuberculoid was the most common presentation. Highest parity was observed in BT and Histioid leprosy. Clinico- histopathological agreement was seen in 76(76%) cases. Conclusion: The clinical and histopathological features along with bacteriological index are useful than any single parameter in arriving definitive diagnosis and classification of the leprosy.

Skin Biopsy in Pediatric Oncology/Hematopoietic Stem Cell Transplantation Patients.

The aim of this study was to review the dermatopathological findings in skin biopsy specimens from pediatric oncology and hematopoietic stem cell transplantation patients over a 20-year period. Three hundred fifty-two skin biopsies from 240 patients were reviewed, and the findings were grouped into 6 categories: index neoplasms, nonindex neoplasms, infections, graft-versus-host disease, other treatment complications, and others. Among the index neoplasms identified on skin biopsy, the most common conditions were Langerhans cell histiocytosis (14 patients) and melanoma (7 patients), with other hematological malignancies and an array of soft-tissue tumors accounting for the bulk of the remainder. Neoplastic conditions common in general dermatopathological practice such as basal cell carcinoma and squamous cell carcinoma were uncommon, each being identified in only 1 patient younger than the age of 18, although basal cell carcinomas developing subsequently in young adult life were identified in 7 patients. Infections were common, with infectious agents or viral cytopathic effects (not including human papillomavirus) identified in 34 biopsies. A significant proportion (74%) represented invasive fungal infections, which are of very significant clinical importance. Biopsies performed for a clinical suspicion of graft-versus-host seldom showed histological features to suggest an alternative diagnosis, with only a single case suggesting a diagnosis of toxic erythema of chemotherapy identified.

030 Immune checkpoint inhibitor-induced bullous pemphigoid skin has elevated interleukin-4 and interleukin-13 expression and responds to IL-4R inhibition

Immune check point inhibitors (ICIs) have revolutionized the treatment of advanced malignancies but can induce skin toxicities including ICI-induced bullous pemphigoid (BP). The pathogenesis of ICI-induced BP is unclear and selection of effective treatment options that do not inhibit the anti-tumor response is a challenge. If cytokine expression in ICI-induced BP and conventional BP skin is similar, emerging therapies for conventional BP may be effective for ICI-induced BP as well. RNA-in situ hybridization was utilized to examine expression of IL4Rα ligands, IL4 and IL13, in formalin-fixed paraffin-embedded skin biopsy specimens from patients with conventional BP, ICI-induced BP, atopic dermatitis and normal, control skin.

Immunohistochemical Demonstration of Interleukin-17 Positivity in Skin Biopsy Specimens of Patients with Chronic Plaque Psoriasis and its Correlation with Severity of Psoriasis and Associated Metabolic Syndrome and Cardiovascular Changes

Background: Psoriasis is a chronic inflammatory disease which can be associated with metabolic syndrome and cardiovascular abnormalities. Objectives: The aim and objective of the study are to demonstrate interleukin-17 (IL-7) positivity in histopathological sections of psoriatic plaques and to correlate with metabolic syndrome and cardiovascular changes. Materials and Methods: Forty-seven patients with chronic plaque psoriasis with body surface area >10% and psoriasis area and severity index (PASI) score >12, in whom skin biopsy showed munro's microabscesses, were evaluated for IL-17 positivity (intensity and proportion) with associated metabolic syndrome according to the National Cholesterol Education Program adult treatment panel III criteria and cardiovascular comorbidities. A co-relation with PASI score was made. IL-17 intensity and proportion were graded with a score ranging from 0 to 3. IBM SPSS version 16.0 was used for statistical analysis and independent t-test and Chi-square test were used for proportion. Results: The mean age of patients was 43 years. A total of 15 (31.9%) female and 32 (68.1%) male patients were enrolled. The mean PASI score was 21.6. Metabolic syndrome was seen in 31 (65.96%) patients. There was statistically significant association with raised diastolic blood pressure in patients with metabolic syndrome (P = 0.042). The total number of patients with IL-17 positivity with metabolic syndrome was 21 (63.6%). Of these, 9 (42.9%) cases showed IL-17 positivity in the munro's microabscess, 14 (66.7%) cases in the rest of the epidermis, and 18 (85.7%) cases in the dermis. Conclusion: In our study, there was no significant difference in IL-7 positivity between patients with or without metabolic syndrome. Further studies need to be done with large sample size to confirm the significance.

PB2167: NGS CLONALITY TESTING FOR A DIFFERENTIAL DIAGNOSIS OF MYCOSIS FUNGOIDES

Background: Mycosis fungoides (MF) is a primary epidermotropic lymphoma of the skin, accounting for up to 75% of all skin lymphoproliferative diseases. Diagnosis of MF in the initial stage (Ia-Ib; IIa) or its erythrodermic forms (EMF) is a difficult task. In most cases, neither histological/immunohistochemical examination, nor PCR methods for determining clonality give a definite conclusion. It is known that in the early stages, the PCR method with fragment analysis (PCR-FA) makes it possible to detect T-cell clonality in 75% of cases. On the other hand, in non-tumor dermatoses (ND), clonal products are detected in 10-15% (false-positive result). However, next-generation sequencing (NGS) of the TCRG and TCRB genes may provide more accurate identification of the T cell clone and quantification of the clonal product at the lesion site. Aims: To compare the robustness of NGS and PCR-FA methods for T-cell clonality evaluation in MF and ND. Methods: Skin biopsy specimens and peripheral blood of patients with initial stages of MF (n-7), EMF (n-3), and ND (n-17) were included in the study. Evaluation of clonality for the TCRG and TCRB genes was carried out in parallel by the PCR-FA and NGS. Data processing and T-cell clone fraction/frequency calculation were performed according to the MiXCR protocol (https://github.com/milaboratory/mixcr). Results: PCR-FA and NGS gave the same results in all samples tested. T-cell clonality was detected in 6 out of 10 patients with MF and EMF. In these patients, the fraction of the dominant TCRG clone ranged from 5.5 to 83.4% (mean 32.3%), for TCRB - 6.1 to 47.9% (mean 20.8%). In 2/7 patients with MF and 2/3 with EMF, clonality was not detected, while the fraction of the dominant T-cell clone did not exceed 4.2%. In two patients with MF and no T-cell clonality, skin samples were examined at disease progression at 6 years and 3 years from the initial biopsy, and a dominant tumor clone was found. These dominant clones were represented by only 2.2% (TCRG) and 4.2% (TCRB) in the initial biopsy for one patient, and 0.26% for the second. In 3/7 patients with the initial stages of MF, a tumor clone was detected in the blood in the amount of 0.022-0.054%. All 3 patients with the minimal disseminated disease at the onset, rapidly progressed to the advanced stages of the disease. In the control group (ND) dominant TCRG clone fractions were 0.49-4.8% (mean 1.93%), for TCRB - 0.9-6.1% (mean 3.11%). The results are shown in Figure 1. Image:Summary/Conclusion: Despite a small sample of patients, the following trends were noted: 1 - patients with the initial stages of MF with similar clinical and histological features, are diverse in the number of tumor T-lymphocytes infiltrating the skin (from 0.26% to 83.4%); 2 - the initial stage of MF with the minimal disseminated disease, might have an unfavorable outcome; 3 - comparing to PCR-FA NGS might not provide further improvement in the specificity and sensitivity of T-cell clonality evaluation for the differential diagnosis in MF.

A Microcurrent Dressing Reduces Cutibacterium Acnes Colonization in Patients Undergoing Shoulder Arthroplasty or Arthroscopy: A Prospective Case Series.

Background: Cutibacterium acnes infections in the shoulder remain a significant concern in the setting of shoulder arthroplasty. Purpose: We sought to evaluate the efficacy of a microcurrent dressing in reducing C. acnes skin colonization and thereby reducing the risk of periprosthetic joint infection of the shoulder. Methods: This study was designed as a prospective case series. From October 2017 to February 2019, patients undergoing elective shoulder arthroplasty or arthroscopic shoulder surgery at a major academic medical center were offered enrollment; they signed an informed consent to participate. Patients under the age of 18, scheduled for revision shoulder arthroplasty, or with sensitivity or allergy to silver, zinc, or latex were excluded. Subjects underwent skin culture swab of the shoulder in the mid-point of the planned deltopectoral incision. The JumpStart (Arthrex; Naples, FL) microcurrent dressing was then placed over the area of the planned incision, and a full-thickness skin biopsy was harvested from the incision at the initiation of the surgical procedure. All specimens were cultured for C. acnes by the hospital's clinical microbiology laboratory with standard anaerobic technique. Results: Thirty-one subjects were enrolled in the study. Those who demonstrated no growth at baseline for the control specimen were excluded from further analysis (N = 11), given the absence of preoperative C. acnes colonization. Culture results from the 20 remaining subjects revealed significantly diminished C. acnes skin growth at the time of surgery compared to baseline. Sixty percent (12 of 20) of the subjects with positive skin swabs at baseline demonstrated no growth in the skin biopsy specimens at the time of surgery. There were no adverse events associated with the application of the microcurrent dressing. Conclusion: This prospective case series found that preoperative application of a microcurrent dressing resulted in significantly diminished C. acnes skin burden at the time of surgery in patients undergoing elective shoulder arthroplasty or arthroscopic shoulder surgery. Further study is warranted to investigate whether this preoperative intervention may contribute to a reduction in perioperative infections, including prosthetic joint infection.

Clinicopathological Study of Skin Adnexal Tumors with Special Emphasis on the Line of Differentiation

Background: Skin is a complex organ composed of epidermis, dermis and skin adnexa producing multitude of tumors. The skin adnexal neoplasms are classified into sub-groups, depending on their differentiation towards hair follicles, sebaceous, apocrine and eccrine glands. Clinically adnexal neoplasm presents as asymptomatic papules or nodules, having non-specific morphological appearance and therefore histopathology is the gold standard for their confirmatory diagnosis. The aim is to assess clinico-histopathological characteristic features of the skin lesions, subtype and to pick up certain subtle features that clinch the diagnosis towards their line of differentiation. Methods: The study has been conducted in the Department of Pathology, for a period of one year. The total numbers of cases with histopathological diagnosis of skin adnexal lesions are 105. Ethical clearance for the same has been obtained by the Head of Institution. Skin biopsy specimen are received and processed in the histokinette; paraffin embedded blocks made and stained with Hematoxylin & Eosin stain. Special stains when required have been used. Descriptive statistics have been used in analysis of the results. Result: The total number of cases with histopathological diagnosis of skin adnexal lesions is 105. Among them 99/105 cases (94.3%) are benign and malignant counterparts comprised of 6/105 cases (5.7%).Overall lesions with hair follicle differentiation comprised of 73.3% (77/105), followed by sebaceous differentiation of 15.3% (16/105) and eccrine differentiation of 11.4 % (12/105). Conclusion: This study emphasized that histopathological examination, plays an essential role in studying the skin adnexal tumors, owing to its indistinctive clinical presentation. Keywords: Adnexal, Eccrine, Skin, Tumor, Sebaceous, Apocrine

Ultrastructure abnormalities of collagen and elastin in Arab patients with arterial tortuosity syndrome.

Arterial tortuosity syndrome (ATS) is a rare autosomal recessive disease characterized by elongation and tortuosity of the large- and medium-sized arteries. ATS patients display features that are also found in Ehlers-Danlos syndrome (EDS) patients. ATS is caused by pathogenic mutations in the SLC2A10 gene, which encodes for the glucose transporter, GLUT10. This study aimed at examining the ultrastructure of skin for abnormalities that can explain the loose skin and arterial phenotypes of Arab patients with the p.S81R mutation in SLC2A10. Forty-eight patients with SLC2A10 mutation were recruited for this study. Skin biopsy specimens from three children with ATS and a healthy child were examined by electron microscopy to determine the ultrastructure of collagen and elastin. Histopathologic staining of sections from tissue biopsy specimens was also performed. Large spaces were observed among the collagen fibrils in the skin biopsy specimens obtained from ATS patients, suggesting disorganization of the collagen structures. Furthermore, elastin fiber contents and their thickness are reduced in the skin. In small muscular arteries in the skin from ATS patients, discontinuous internal elastic lamina, lack of myofilaments, and disorganized medial smooth muscle cells with vacuolated cytoplasm are present. The disorganization of collagen fibrils and reduced elastin contents in the skin may explain the loose skin phenotype of ATS patients similar to the EDS patients. The lack of elastin in small muscular arteries may have contributed to the development of arterial tortuosity in these patients.

Cyclic High Negative-Pressure External Volume Expansion Reduces Daily Device Application Time With Similar Effects on Recipient Site Preparation in a Murine Model.

Introduction: Recipient site preparation using external volume expansion (EVE) increases graft survival in large-volume fat grafting. To improve patient compliance with using the device, we tested a new cyclic high negative-pressure (CHNP) mode that involves 1 h/day at -55 mm Hg, cycled between 1-second negative-pressure activation, followed by a 2-second deactivation period in an animal model. Material and Method: A miniaturized EVE device was applied to 30 8-week-old male Sprague-Dawley rats. The rats were assigned to 3 groups (no pressure for the control group, conventional -25 mm Hg for 8 h/day for conventional EVE, and CHNP mode for the CHNP group). After 28 days, micro-computed tomography was performed and skin biopsy specimens were obtained. Results: The CHNP group showed a 6.6-fold increase and the conventional EVE group showed a 4.4-fold increase in volume compared to the control group. Hematoxylin and eosin staining showed a similar increase in subcutaneous tissue thickness in both EVE groups, compared to the control group. Masson's trichome and proliferating cell nuclear antigen staining showed significantly higher collagen deposition and subdermal adipocytes in EVE groups. Immunohistochemistry against platelet endothelial cell adhesion molecule 1 showed 2.5- and 2.7-times higher vessel density in the conventional and CHNP EVE groups, respectively. There was no statistically significant difference in subcutaneous tissue thickness, collagen deposition, subdermal adipocyte proliferation, and vessel density between the 2 EVE groups. Conclusion: CHNP produced comparable results in recipient site preparation (subcutaneous tissue thickening and angiogenesis) compared to the conventional protocol, while markedly reducing the daily wear-time from 8 hours to 1 hour. Although further clinical data must be acquired, our new pressure setting seems promising and provides a more patient-friendly pre-expansion environment.

Periorbital rash and scaly plaques in a 13-year–old boy

Periorbital rash and scaly plaques in a 13-year–old boy

Eruptive superficial porokeratosis in a patient with nephrotic syndrome

A 34-year-old female was referred to our department, complaining of multiple asymptomatic lesions that appeared two weeks previously. The patient had active nephritis with nephrotic syndrome and was treated with immunosuppressive therapies. Physical examination revealed multiple well-circumscribed rounds of flat brownish plaques with slightly elevated borders, some of which were covered by scales. The number of lesions was nine in total. Skin biopsy specimens showed dyskeratotic cells in the thinned epidermis with cornoid lamella, and the absence of a granular cell layer. The development of porokeratosis was considered to be related to immunosuppressive therapy or the activity of nephritis.

Correlating clinical and laboratory diagnostic modalities in the diagnosis of epidermolysis bullosa in a resource-poor setting.

Mutational analysis and immunofluorescence antigen mapping (IFM) are recommended as the laboratory tools of choice for diagnosing EB. In the past, transmission electron microscopy (TEM) was considered the gold standard, and more recently, clinical diagnostic matrix (CDM) has shown good concordance with next-generation sequencing (NGS). In this prospective diagnostic study, a skin biopsy was taken for TEM and IFM in consecutive patients with EB (aged >6 months) diagnosed clinically with CDM. Wherever possible, mutational analysis was done using targeted NGS. Of the 80 patients diagnosed with CDM, skin biopsy specimens of 42 patients were assessed using TEM, and of 59 patients using IFM. NGS was done in 39 patients. Taking NGS as the gold standard for diagnosing EB (n=39 patients), the concordance with CDM, TEM, and IFM were estimated at 84.6% (33/39), 78.5% (11/14), and 76% (19/25) respectively. CDM showed a substantial agreement with NGS (k=0.69, p < 0.001). In comparison to NGS, the highest concordance was seen with CDM followed by TEM and IFM in diagnosing major subtypes of EB.

Do histopathological features correlate with systemic manifestations in dermatomyositis? Analysis of 42 skin biopsy specimens from 22 patients.

Understanding whether specific histopathologic features on skin biopsy are predictive of systemic associations in dermatomyositis (DM) would be useful to guide clinical screening. Through retrospective medical record search, clinical and laboratory findings of patients with DM were documented. Existing skin biopsy slides were re-reviewed blindly. Of all biopsy specimens (n=42), the most frequent histopathological finding was vacuolar interface dermatitis (95%). Other features included perivascular lymphocytic infiltrate (71%), increased dermal mucin (40%), vessel wall thickening (12%), follicular plugging (9.5%), and dermal sclerosis (7%). Neutrophilic infiltrate was observed in three biopsies from a patient with adalimumab-associated DM. Vasculitis was not observed. There was no statistically significant difference in the presence of any histopathological feature and that of various systemic manifestations (i.e., myopathy, interstitial lung disease [ILD] and malignancy). However, we observed that dense lichenoid infiltrate rather than pauci-inflammatory changes correlated with severe itching (p < 0.001). Patients with MDA-5 antibodies were significantly more likely to have vasculopathy than those without (p= 0.029*). No dermatopathologic feature was reliably predictive of myopathy, ILD, or malignancy. This finding implies that, regardless of histopathologic findings, patients should be screened for associated conditions as clinically indicated.

Unveiling idiopathic guttate hypomelanosis: pathology, immunohistochemistry, and ultrastructural study.

AbstractBackgroundIdiopathic guttate hypomelanosis (IGH) is a pigment disorder of unknown etiology. Despite its high prevalence and the unaesthetic appearance of the lesions, there are relatively few histological studies on this disorder. This is an important gap to understanding its pathogenesis.ObjectivesTo assess the microscopic structure of IGH lesions compared to normal adjacent skin areas and the possible interaction between melanocytes and the subjacent dermis.MethodsIn this cross‐sectional study, we took biopsy specimens of hypochromic lesions and adjacent normal skin from 20 patients with IGH. We analyzed the fragments using routine stains, immunohistochemistry, and electron microscopy.ResultsWe found superficial dermal fibrosis in 90% (18/20) of our IGH cases and unreported keratinocyte cytoplasmic changes on electron microscopy.ConclusionOur results suggest an interaction between melanocytes and the subjacent dermis in IGH. These findings can help to understand melanocyte biology and the pathogenesis of other achromic lesions.

Culture of Cutaneous Leishmania from Skin Biopsy Specimens.

This protocol describes the culture of Leishmania parasites from skin biopsy samples of patients with cutaneous lesions. The use of antibiotics to prevent bacterial contamination of these cultures increases the ability of researchers to collect isolates for various research purposes, including genetic analysis and in vitro and in vivo experiments. © Published 2022. This article is a U.S. Government work and is in the public domain in the USA. Basic Protocol: Culture of Leishmania from skin biopsy specimens.