Search

Ahmed Zahr Allayali Department of Internal Medicine, Umm Al-Qura University, Makkah, Saudi ArabiaCorrespondence: Ahmed Zahr AllayaliDepartment of Internal Medicine, Umm Al-Qura University, Makkah, Saudi ArabiaTel +966530041029Email ahmedz98@hotmail.comAbstract: Hyperkeratotic spicules are rare cutaneous lesions associated with underlying systemic illnesses. In more recent times, facial spinulate demodicosis has been suggested as an etiological factor. Demodicosis is a common dermatological condition characterized by the presence of Demodex mites in the pilocutaneous follicles. This report describes the case of a 40-year-old otherwise healthy woman who reported having undetected facial follicular spicules as a result of demodicosis. The diagnosis was confirmed by physical examination and skin punch biopsy. Initial treatment with 5% permethrin did not resolve the rash. As such, 1% Ivermectin was prescribed, after which the rash resolved completely within 3 weeks.Keywords: spinulate, Demodex folliculorum, demodicosis

Background Degos disease is a very rare syndrome with multisystem vasculopathy of unknown cause. It can affect the skin, gastrointestinal tract, and central nervous system. However, other organs such as the kidney, lungs, pleura, and liver can also be involved. Case presentation A 35-year-old Hindu woman presented to our dermatology outpatient department with complaints of depigmented painful lesions. A skin punch biopsy taken from the porcelain white atrophic papules which revealed features of Degos disease. Conclusion The diagnosis of Degos disease is usually based on the presence of the pathognomonic skin lesions and a tissue biopsy demonstrating a wedge-shaped area of necrosis with thrombotic occlusion of the small arterioles. No specific treatment is currently available for this disease.

Introduction: Leprosy is chronic granulomatous disease caused by Mycobacterium leprae. Clinically diagnosed cases of leprosy can be evaluated by punch biopsy. It can be classified according to Ridley and Jopling Classification. Objective: To study the different spectrum of leprosy and its Bacillary Index (BI), evaluate the agreement between clinical and histopathological diagnosis. Materials and Methods: This is a hospital based cross sectional retrospective study done for the period of 6 months from January to June 2019. The data were subjected to kappa analysis by using SPSS version 24 to see the agreement between clinical and histopathological diagnosis. Results: Out of 62 cases of clinically diagnosed cases of leprosy three (4.83%) cases turned out to be other granulomatous diseases. According to Ridley and Jopling classification, clinical and histopathological agreement was seen in 38 (61.29%) cases. Agreement of 100% was seen in Indeterminate leprosy (IL) and Borderline tuberculoid leprosy (BT). The BI was more in Lepromatous leprosy (LL), Borderline lepromatous (BL) whereas IL, BT and Tuberculoid leprosy (TT) showed less BI. Overall there was moderate agreement between clinical and histopathological diagnosis (kappa- 0.505) which was statistically significant (p value

Small fiber neuropathy (SFN) is a prevalent neurologic syndrome. Testing methods have emerged in recent years to better diagnose it, including autonomic tests and skin punch biopsy. SFN can present in a non-length-dependent fashion and can be mistaken for syndromes such as fibromyalgia and complex regional pain syndrome. SFN is caused by a variety of metabolic, infectious, genetic, and inflammatory diseases. Recently treatments have emerged for TTR amyloid neuropathy and Fabry disease, and novel biomarkers have been found both in genetic and inflammatory SFN syndromes. Ongoing trials attempt to establish the efficacy of intravenous immunoglobulin in inflammatory SFN syndromes.

Sub-millimetre skin punch biopsy (called microbiopsy) is an evolving technique developed to obtain minimally invasive cutaneous sampling for molecular diagnosis and research. Up to date, it has been applied in skin oncology, such as melanoma and basal cell carcinoma (BCC), as well as for infectious diseases, such as viral warts and leishmaniasis. In upcoming years, it may have a prospective role in melanoma diagnosis, risk stratification and personalized therapeutics.

Pediatric pyoderma gangrenosum accounts for 4% of all cases A punch biopsy should be performed to rule out other skin diseases associated with painful chronic ulceration Systemic steroids and local wound care are the first line approach in treatment of pyoderma gangrenosum

Background We intended to study whether there is a meaningful difference in microscopic examination between dividing a biopsy section into two equal parts before tissue processing (first method) or after (second method). Methods A total of 400 cases were included in the study. Punch biopsies (PB) were cut into two pieces using the first method in 200 cases and just before paraffin embedding in another 200 cases using the second method. We microscopically evaluated the epidermal mesh view, the presence of a cross-cut hair follicle and bow shape because of epidermal angling, the presence of two pieces on the slide and if there was a difference of >2 mm between the parts, and the number of new sections and new slides. Results Cross-cut hair follicle (p = 0.018), epidermal mesh view (p = 0.036), difference of >2 mm between the parts (p = 0.008), the number of new sections (p < 0.001) and new slides (p < 0.001) were considerably higher when the first method was used compared with the second method. The presence of two pieces was less (p < 0.001) when using the first method. Conclusions We noted a meaningful difference in the quality of microscopic evaluation between the first and second methods. Better sections were obtained with the second method. In addition, the decrease in the number of new slides will reduce workload, archival work and cost.

A conventional skin punch biopsy instrument has a circular hollow blade, which can be used to make a full circular incision to evacuate subcutaneous abnormalities such as lipomas. Here, we present a modified punch instrument, in which the cutting element has a C-shape to form a pivotal skin fragment (miniflap) to access subcutaneous tissues. The "C" part comprises almost half of a circle. The C-punch incision gives access to subcutaneous abnormalities, while keeping a connecting neck to the surrounding skin, which allows for efficient resealing of the skin surface. Therefore, there is less potential for subsequent scarring.

Patient: Male, 49 Final Diagnosis: Melanoma Symptoms: Rash Medication: — Clinical Procedure: — Specialty: Dermatology Objective: Rare disease Background: Primary care physicians and internal medicine specialists frequently encounter a variety of rashes. Many of these cases look and feel typical of common entities, resulting in the potential for misdiagnosis. Case Report: This is a case of a zosteriform rash where the surprising true diagnosis of metastatic melanoma was confirmed with bedside skin punch biopsy. Possible mechanisms involve direct cutaneous injury, neuronal, and dorsal root ganglia involvement in metastases. Conclusions: Skin biopsy is indispensable especially when there is a lack of clinical response or deterioration in the clinical condition. The pathophysiology of zosteriform metastasis is unclear.

Purpose Neutrophilic dermatosis of the hands is an inflammatory skin condition related to Sweet syndrome that responds to corticosteroids. It commonly affects the dorsum of the hand and often mimics infection, with violaceous inflammatory papules and plaques that may ulcerate. The aim of this study was to review the clinical presentation of neutrophilic dermatosis of the hands. Methods A retrospective review was undertaken of all cases of neutrophilic dermatosis of the hands seen at a tertiary hospital in New South Wales, Australia, over a 5-year period. Results Seventeen cases were identified. The mean time to diagnosis was 9 days after lesion onset. Most cases were older adults (mean age, 71 years). The most common referral diagnoses were infection or a nonhealing wound and 65% of cases reported a history of trauma. The dorsal index finger was the site of involvement in 41% of cases. One case involved the palm. Histopathology reports were available for skin punch biopsy for 14 of 17 cases, which showed dermal neutrophilic infiltrate (93%) and epidermal involvement with necrosis, ulceration, or pustulation (64%). Six cases were treated surgically prior to the correct diagnosis and management being introduced. Conclusions Neutrophilic dermatosis of the hands was often misdiagnosed as infection. A history of trauma is common and may be misleading. Dermatological consultation and skin punch biopsy are useful in confirming the diagnosis, ideally prior to surgical management. Type of study/level of evidence Diagnostic IV.

Fibromyalgia is a clinical syndrome that currently does not have any specific pathological finding to aid in diagnosis. Therefore, fibromyalgia is most likely a heterogeneous group of diseases with similar symptoms. Identifying and understanding the pathological basis of fibromyalgia will allow physicians to better categorize patients, increasing prospective treatment options, and improving potential therapeutic endeavors. Recent work has demonstrated that approximately 50 % of patients diagnosed with fibromyalgia have damage to their small unmyelinated nerve fibers. A skin punch biopsy is a sensitive and specific diagnostic test for this damage as a reduction in nerve fiber density allows for the diagnosis of small fiber neuropathy. Small fiber neuropathy is a disease with symptoms similar to fibromyalgia, but it often has a definable etiology. Identifying small fiber neuropathy and its underlying cause in fibromyalgia patients provides them with a succinct diagnosis, increases treatment options, and facilitates more specific studies for future therapeutics.

Background: Patient anxiety about nail surgery relates mainly to pain associated with needle puncture, anesthetic flow during the procedure, and postoperative care, as well as possible past traumatic experience. Objective: The aims of this study were to compare anxiety levels among patients undergoing nail surgery and skin punch biopsy and to assess the effects of demographic characteristics on anxiety. Methods: Forty-eight consecutive patients who were referred to a dermatological surgery unit for nail surgery intervention (group 1) and 50 age- and sex-matched patients referred to the same unit for skin punch biopsy (group 2) were enrolled in the study. Patients’ anxiety levels were measured using Spielberger’s State-Trait Anxiety Inventory. Results: There was no significant difference in median anxiety level between group 1 (42.00; interquartile range, 6.50) and group 2 (41.00; interquartile range, 8.25) ( P = .517). The demographic factors of patient sex, educational status, and prior surgery showed no significant effects on anxiety levels. Conclusion: Nail surgery does not seem to cause significantly greater anxiety than skin punch biopsy.

ABSTRACT: In this Phase I study, healthy volunteers (n = 24) were randomly allocated to receive either one or two 0.2-g applications per day (12 h apart) of ozenoxacin 2% cream on three different areas of the back for 3 consecutive days. Ozenoxacin concentrations were measured in tape stripping samples (from the stratum corneum) and in skin punch biopsy samples (from the epidermis and dermis) taken predose from selected dosing areas on study days 2, 3 and 4. Ozenoxacin concentrations were high in the stratum corneum and were approximately twofold greater for the twice- versus once-daily application. Ozenoxacin concentrations were low in the epidermis and were higher for the twice- versus once-daily application. Ozenoxacin concentrations in the dermis were below the limit of quantitation on most study days.

We present a case report of a 49-year-old female with recently diagnosed chronic myeloid leukaemia, in chronic phase (CML-CP), presenting 10 days following commencement of imatinib with fevers, generalised rash, oedema, and systemic inflammatory response syndrome (SIRS) mimicking severe sepsis. Skin punch biopsy was compatible with drug reaction, with findings consistent with urticarial vasculitis. Although dermatological toxicities have been associated with imatinib, isolated cutaneous urticarial vasculitis with associated severe SIRS has never been reported in the literature. Rapid clinical resolution following the use of corticosteroid and cessation of imatinib in this patient strongly suggests the causative role of imatinib. Her higher initiation dose of 600 mg daily may have been a contributory factor. Ongoing adverse drug reaction surveillance is important to monitor serious and rare complications.

Aman inhis60spresentedwitha2-yearhistoryofprogressive skin tighteningandtheformationofmultipleasymptomaticpapulessymmetrically distributed on the extremities, face, andneck. He also developed mild dysphagia, intermittent voice hoarseness, and difficultyclosinghismouth,withdroolingwhileeating.Hereporteda9.1-kg weight loss owing to difficulty eating during the past year. Physicalexaminationrevealeddiffusehardeningof theskinwith multiple 1to 3-mm white to skin-colored papules on the dorsal aspectof thehands (Figure, A), arms, knees, posterior aspectof the neck, and posterior auricular area (Figure, B). Therewas decreased ability to pinch the skin on the forearms, and the oral aperture was slightly decreased at 3 cm. A 5-mm skin punch biopsy was performed on the right forearm for evaluation (Figure, C). What is your diagnosis?

Apreviouslywell 7-month-oldmale infant presented toour emergencydepartmentwith 1 week of loose stools, 4 days of fever up to 39.2°C, and 2 days of skin rash. His parents reported several pink papules that first appeared on his trunk and spread to his extremities within 24 hours. His increasing irritability and poor oral intake ledtohisadmission for furtherevaluation.Thepatient’s vaccinations were up to date. He had no history of perinatal infections, sick contacts, recent travel, or pets. The family lives in an apartment in New York City. Onphysical examination, thepatienthad fewer than20pinkpapulovesicles, somewith hemorrhagic crust, scattered on the upper chest, abdomen, lower back, and extremities (Figure, A and B). His palms, soles, and oropharynx were otherwise unremarkable. Laboratory test resultswerenotable for amild leukopeniawithawhitebloodcell count of4.6 × 109/L(normal,6.0-18.0 × 109/L)with18%monocytes.C-reactiveproteinwasslightly elevatedat3.38mg/L(normal

A case of eyelid skin atrophy caused by long-term application of topical ophthalmic corticosteroids for chronic uveitis is reported. Skin punch biopsy of the uveitic eye showed moderate atrophy of both epidermis and dermis (compared to normal skin on the other eye) resulting from a reduction in the three main fibrous components of the skin, namely type I and type III collagens, and elastic fibers. To our knowledge, this is the first report of skin atrophy in this association.

Severely painful feet are one of the most common problems seen by the peripheral neurologist. There are two articles in this issue on the use of skin punch biopsy for the study of unmyelinated sensory nerves as an approach to assessing this problem. The article by Herrmann et al. (p. 1634) shows that skin biopsy can define abnormalities not detected by sural nerve biopsy. A prospective study by Periquet et al. (p. 1641) shows that skin biopsy is the only way to identify diagnostic abnormalities in up to one-third of patients. The accompanying editorial by Kennedy and Said (p. 1614) considers the importance of the articles and suggests that skin biopsy should be used instead of sural nerve biopsy for diagnosis in …

REPORT OF A CASE A 22-year-old man presented with a 3-year history of a solitary red nodule on the dorsal aspect of his left great toe. The nodule arose shortly after the patient injured himself on a nail in his attic. The nodule initially grew rapidly, but then remained relatively unchanged for over 2 years. It was slightly tender and occasionally bled when traumatized. One year before he presented to us, he underwent treatment with an injection of a corticosteroid, which initially reduced the size of the lesion. However, the lesion quickly regrew. Examination of the patient's left great toe revealed a 1.8×1.2-cm dark red, slightly crusted and friable nodule containing a few small sinus tracts (Fig 1). A skin punch biopsy specimen revealed noncaseating dermal granulomas (Fig 2) and was negative for organisms with acid-fast bacilli and fungal stains. Tissue cultures for bacteria, fungi, and mycobacteria were also negative.

(CMML) Chronic myelomonocytic leukemia is not an uncommon leukemia occurring in elderly individuals. Cutaneous manifestations are unusual and portend a poorer prognosis. Touch imprints from a skin punch biopsy may help to quickly confirm clinical suspicions of an underlying leukemia or lymphoma.

Darier’s disease was described inependently by Darier and White in 1989 AD. Reported prevalence varies from 1/100,000 in Denmark to 1 in 30- 35,000 in northern England and Scotland.1 Darier’s disease has been reported from other parts of the world, however,there has been no reported cases in Nepal. It is an inherited autosomal dominat disease characterized by dark crusty lesions over the seborrheic areas of the skin. We are reporting a case of Darier’s disease in a Nepalese patient who developed skin leison’s over his face and body at the age of 12 years. We took skin punch biopsy from the leisons, which showed findings suggestive of Darier’s disease. Our case was treated with isotrerenoin and topical keratolytics. He responded with the given treatment within two weeks of therapy. DOI: http://dx.doi.org/10.3126/njdvl.v9i1.5770 NJDVL 2010; 9(1): 34-36

REPORT OF A CASE A 26-year-old woman had noted gradually progressive brown spots on her breasts and upper back over the previous five years. Although her main concern was the cosmetic appearance, she had noted occasional mild pruritus in the affected areas. Other physicians had told her the brown areas were due to eczematous dermatitis, but therapy with various topical steroid preparations had no effect. She was otherwise healthy, was taking no medications, and had no family history of any similar skin disorder. Physical examination revealed multiple 1- to 4-mm individual and confluent brown macules in a reticulate pattern on the breasts, around the lower neck, and on the mid upper aspect of the back (Figs 1 and 2). The affected areas on her breasts and neck were smooth, but the area on her upper back was slightly hyperkeratotic. Results of the rest of her skin examination were unremarkable. A skin punch biopsy