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Having Skin Biopsy Monday
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8 posts in this topic

I'm having my itchy, itchy rash biopsied on Monday (by the nurse practitioner, not the doctor, there is a months long wait to see him). The NP doesn't think it's dh, she says it doesn't look like it. She agrees with any of the 3 things my first dermo told me - lichen simplex chronicus, eczema or scabies and said the only way to know for sure is to biopsy.

But she isn't looking for dh and I want to make sure a biopsy for that is done and I know it has to be a certain way. At the risk of offending her, I plan to take a piece of paper with exactly what needs to be done written out so I can be sure it will be done.

Please educate me!! How is this test done? Is there a specific name for the test? All I know is the biopsy should be taken near a lesion, not on, right? But there must be more. Let me know.

Thanks, Jane

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This is the best description I've found, and a reputable source.

http://emedicine.medscape.com/article/1062640-workup#2

What is needed is called a "punch biopsy", I believe. I would request two to be taken - because that's what my derm (who has done this before) advised. It will require a stitch at each site.

I never had it done, even with a willing derm, BECAUSE by the time we figured out what it was the thing went away. He told me to go in during the next outbreak and NOT TO GLUTEN MYSELF ON PURPOSE. The only new outbreak I've had was very scant and it was a holiday.

He did tell me it's better to take it on a new outbreak, or area where the rash is new because the rash degrades the iga. In my case, that was a particular problem since the rash had repeatedly blown up over 3 years in the same spot. The edges were blurred so finding "clear skin" was a particular problem.

Anyway, that's all I know about the biopsy. Good luck to you and keep us posted.

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And you have to make sure she tells the lab to look for dh. There is a special staining they have to do for it. And if the lab is not told to test for dh then they will not because they don't test the biopsy for dh unless they know they are supposed to; it's not something they do as a matter of course & you will have wasted your time & money.

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Jane, I'm really not sure that this is something a nurse practitioner should be doing??? :unsure: Esspecially one who does not believe she is looking for DH. :rolleyes:

Here is the procedure:

http://celiacdisease.about.com/od/commoncomplicationsofcd/a/Dermatitis-Herpetiformis-Diagnosed-With-Skin-Biopsy.htm

Dermatitis Herpetiformis Skin Biopsy Looks for IgA Under The Skin

When biopsying skin to determine if a rash is dermatitis herpetiformis, doctors look for deposits of Immunoglobulin A under the skin in a particular pattern. This distinctive granular IgA pattern is the hallmark of dermatitis herpetiformis.

To see these deposits, the physician must remove a sample of skin, stain it with a dye and examine it under a fluorescence microscope. If IgA deposits are present and in the correct pattern, then the person has dermatitis herpetiformis.

What To Expect From Your Dermatitis Herpetiformis Skin Biopsy Procedure

Dermatologists usually use what's called a "punch biopsy" to remove the skin and test it for dermatitis herpetiformis.

After injecting a local anesthetic, your dermatologist will use a tiny, cookie-cutter-like punch to remove a 4mm sample of skin. The incision can be closed with one stitch and generally heals with very little scarring.

It's important to have your dermatitis herpetiformis skin biopsy performed by someone who has diagnosed the skin condition before and knows how to do the biopsy. The skin sample must be taken from skin directly adjacent to the suspected dermatitis herpetiformis lesion, as opposed to directly from the lesion, since inflammation in the lesion can destroy the IgA deposits.

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And you have to make sure she tells the lab to look for dh. There is a special staining they have to do for it. And if the lab is not told to test for dh then they will not because they don't test the biopsy for dh unless they know they are supposed to; it's not something they do as a matter of course & you will have wasted your time & money.

Exactly. And they can't use the same sample they've run for another test. It's a seperate test.

And I also agree this might be over the NP's head unless she's prepared for it. She may have no clue what to do.

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Thank you for the info. Do you know - is the "special staining" something that is done in the office at the time the sample is taken or is done later by the lab?

Jane

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Thank you for the info. Do you know - is the "special staining" something that is done in the office at the time the sample is taken or is done later by the lab?

Jane

I'm not sure. I am pretty sure they put something in it at the time of biopsy - but I don't know if it's the stain.

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Don't let the NP actually do it unless she agrees to, in advance, ask for the DH testing on the samples.

Walk out, if you have to. Don't fall for the, "we have to do this first, by process of elimination." These doctor's offices love to run as many tests as possible to string out a diagnosis as long as possible, then tell you there is nothing "wrong" and come back 6 months from now or next year, to pad their bottom line, assuming you're having this done in the U.S.

"The skin sample must be taken from skin directly adjacent to the suspected dermatitis herpetiformis lesion, as opposed to directly from the lesion, since inflammation in the lesion can destroy the IgA deposits."

__________

"And they can't use the same sample they've run for another test. It's a separate test. "

This means when she takes the little bit of sample it needs to go into its very own test tube for that test....

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