Why a Skin Biopsy?

Farmer, Evan R.

doi:10.1001/archderm.136.6.779

Cited by 12 publications

(6 citation statements)

References 8 publications

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“…6,7 Zhou et al 8 demonstrated in a retrospective study that the decision to treat did not depend on skin biopsy findings, that the decision to treat depended on clinical severity, and that the biopsy findings correlated poorly with the clinical severity, as a result concluding that skin biopsy plays a limited role. Even complex decision tree analysis has revealed that in populations in which the prevalence of aGVHD is greater than 30%, such as BMT services, the best outcomes are attained when no skin biopsy is performed and the patients are simply treated for aGVHD.…”

Section: Discussionmentioning

confidence: 99%

Quantitative Analysis of Eosinophils in Acute Graft-Versus-Host Disease Compared With Drug Hypersensitivity Reactions

Weaver

Bergfeld²

2010

The American Journal of Dermatopathology

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Acute graft-versus-host disease (aGVHD), if not detected and treated early, is a common cause of morbidity and mortality. Drug hypersensitivity reactions (DHRs), the most frequent clinical and histopathological mimickers of early aGVHD, are often still distinguished from aGVHD by the presence of eosinophils within the inflammatory infiltrate on skin biopsy. Distinguishing these entities is important because the delay of appropriate treatment of aGVHD may lead to advanced stages of the disease process with a poor prognosis. To determine whether the existence or amount of eosinophilic infiltrate could be used to differentiate these entities, we employed a quantitative method of analyzing eosinophils in skin biopsies of rashes from patients with aGVHD and DHR. Eosinophils were counted in 50 high-power fields (HPFs) in skin biopsies of patients with clinical grade >or=2 aGVHD (+aGVHD), with clinical grade <2 aGVHD (-aGVHD), and those with clinical DHR (+DHR). The average number of eosinophils per 10 HPFs (ave. eos/10 HPFs) increased throughout each group. The ave. eos/10 HPFs in +DHR was significantly different from both aGVHD groups (P < 0.001). The specificity to completely rule out aGVHD did not reach 100% until 16.0 ave. eos/10 HPFs was observed. There is a significant difference between the numbers of eosinophils found in differentiating DHR from aGVHD, but a very high number (>16.0 ave. eos/10 HPFs) is necessary to rule out aGVHD completely. Therefore, a quantitative analysis of eosinophils in all biopsies to rule out aGVHD would be of limited value and should only be considered in those biopsies with significant eosinophilia.

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Section: Discussionmentioning

confidence: 99%

Quantitative Analysis of Eosinophils in Acute Graft-Versus-Host Disease Compared With Drug Hypersensitivity Reactions

Weaver

Bergfeld²

2010

The American Journal of Dermatopathology

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“…Neither skin specimen showed the morphologic pattern of acute or chronic GVHD, as there were no vacuolizations, acantholyzes, basal edema, or increased lymphocytic infiltrates in the peripheral dermis or epidermis (24,25).…”

Section: Diagnosticsmentioning

confidence: 99%

Manifestation of Atopic Eczema in Children after Heart Transplantation in the First Year of Life

Niemeier

Passoth

Krämer

et al. 2005

Pediatric Dermatology

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Children undergoing heart transplantation in the first year of life appear in clinical observation to develop atopic eczema at an above-chance frequency despite immunosuppressive therapy with cyclosporine A. A clinical study was undertaken to clarify the extent to which those children develop atopic eczema with above-chance frequency. In this cross-sectional study, we examined 41 consecutive children after heart transplantation. Twenty-seven underwent heart transplantation in the first year of life, seven after the first birthday, and seven had cardiac surgery other than heart transplantation in the first year of life and served as a control group. Atopic eczema was diagnosed in 11 out of 27 children with heart transplant in the first year of life. No atopic eczema was diagnosed in the other two groups. Children undergoing heart transplant prior to the first birthday apparently develop atopic eczema more frequently than children whose surgery was performed after the first birthday, and also more frequently than children undergoing organ-preserving procedures, despite immunotherapy. It remains an open question whether a surgical procedure within the first months of life with subsequent immunosuppression causes an alteration in the reactivity of the immune system in these children compared to older children which promotes the occurrence of atopic eczema despite immunosuppression.

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“…It also remains the gold standard investigation, however, a number of variables impact the interpretation of skin biopsies [1]. Skin biopsies are performed most often either to arrive at a conclusive diagnosis or to evaluate the response to therapy [2]. Additionally, the biopsies may be performed for medicolegal reasons to confirm clinical suspicion.…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological Concordance in 2216 Cases of Skin Biopsy over One Year: An Indian Experience

Malik

Siraj

Sharma

et al. 2020

Cureus

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Introduction To determine the spectrum of diseases and the level of clinicopathological concordance in skin biopsies received over a period of one year. Methods A total of 2216 skin biopsy cases received over a period of one year at a tertiary care center were retrospectively analyzed. The cases were further divided into further categories in levels of concordance based on the agreement between the clinical and histopathological diagnosis rendered. Results Of the cases, 61.01% showed clinicopathological concordance. Cases with a descriptive pathological diagnosis, not matching the clinical diagnosis, constituted 31.54%, whereas 4.02% of cases had a definitive pathological diagnosis, which was discordant with the clinical differentials; 3.29% biopsies were inadequate. Conclusion This study highlights the clinicopathological concordance in all the biopsies received from dermatology. It emphasizes the importance of skin biopsies in arriving at the diagnosis. However, it is a tool that must be used judiciously. Skin biopsies are also pivotal in flagging malignancies that may mimic benign lesions.

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Why a Skin Biopsy?

Cited by 12 publications

References 8 publications

Quantitative Analysis of Eosinophils in Acute Graft-Versus-Host Disease Compared With Drug Hypersensitivity Reactions

Quantitative Analysis of Eosinophils in Acute Graft-Versus-Host Disease Compared With Drug Hypersensitivity Reactions

Manifestation of Atopic Eczema in Children after Heart Transplantation in the First Year of Life

Clinicopathological Concordance in 2216 Cases of Skin Biopsy over One Year: An Indian Experience

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