Get email alerts Get Celiac.com E-mail Alerts  




Celiac.com Sponsor:
Celiac.com Sponsor:




Ads by Google:






   Get email alerts  Subscribe to FREE Celiac.com email alerts

Having Skin Biopsy Monday
0

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

0

Share this post


Link to post
Share on other sites


Ads by Google:

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.

0

Share this post


Link to post
Share on other sites

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.

0

Share this post


Link to post
Share on other sites

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.

0

Share this post


Link to post
Share on other sites

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.

0

Share this post


Link to post
Share on other sites




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

0

Share this post


Link to post
Share on other sites

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.

0

Share this post


Link to post
Share on other sites

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....

0

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!


Register a new account

Sign in

Already have an account? Sign in here.


Sign In Now
0

  • Forum Statistics

    • Total Topics
      104,090
    • Total Posts
      920,307
  • Topics

  • Posts

    • Hi, No, I do not have celiac  disease. I have an ankylosing spondylitis which is an auto-immune disease provoking an inflammation of the joints. Under the advice and supervision of my doctor and the professor at the hospital I follow a gluten free & casein free diet, which is extremely successful in preventing inflammatory events. And I've been doing so, strictly, for more than 6 years. So I'm not Celiac, but I can tell you that I react strongly every time I take gluten even in small amounts. Even soya sauce, which according to this website has an almost zero dose of gluten, is a lot too much for me. Nevertheless I allow myself to eat food which has been processed in a factory which processes gluten. To conclude, I would say that when you are travelling, especially in a country where celiac disease is scarcely known, you should be twice as careful as when you're going out at home. In the end you can never guarantee that the cook has cleaned his pan after using soya sauce and so on... You can only bet
    • Along those lines, many Americans are now pursuing gluten-free eating. Gluten ... Diagnosis of celiac disease typically requires a history and physical ... View the full article
    • No!  Once you fill the tub, if you sit in it for 3 minutes or you stay for 10... It doesn't change the amount or cost of the water.  That's only relevant if you have 3 kids to cycle thru that same water.  Is your hub bathing in the same water after you? Lol  And even if you add some more hot and stay longer....well...it's much cheaper than perscription meds, vodka or a substance that is legal in a few states.     Of course this only pertains to those of use with running water.... If you make your hub haul water from the creek or well and heat it over a fire....
    • Whether it is bona fide dermatitis herpetiformis, or severe eczema or hives or what have you, we all want to know how to stop the incessant itching.  Through all my research, the solution comes down to one thing: a good long soak in the tub-- with baking soda or Epsom salts or some kind of herbal tea, followed by a rub down in thick expensive lotion.  I don't know about you, but I was brought up to "get in, get done get out."  A long soak in the bath was a frivolous luxury, and a waste of time and hot water.  So now I'm having this awful breakout from forgetting to read a label and got wheated.  And every night I've been soaking in a baking soda bath to relieve the itching and aid my recovery.  And it's been hard! (But it's been very helpful too)  It has been hard to reconcile this "frivolous luxury and waste of time" as medically necessary!  Fortunately I've had no judging, and only support from my husband, who has had a similar upbringing.  Does anyone else struggle with this?
    • His son, Eli, had been misdiagnosed with celiac disease, so the family tried some gluten-free foods. After adding quinoa (KEEN-wah) to their diet, ... View the full article
  • Upcoming Events

  • Blog Entries

  • Recent Status Updates

    • HappyMom623

      I have Tangled problem! I want all the things Rapunzel Related....including Flynn Rider 😂 but seriously. I have like 8 shirts I want.
      · 0 replies
    • AprilBeth2013

      RT @MarkDever: “But the work is God’s and we do not fear the final results. ‘The heathen shall be given to His Son for His inheritance,’ .…
      · 0 replies
    • silk

      I have celiac disease and have been gluten-free for almost 10 years.  I am extremely sensitive to gluten, noting that I react within 15 minutes of contact and in fact the doctor suspects that there may also be an actual wheat allergy at play but have never bothered to be tested since I avoid it like the plague!  I am curious to know if anyone else reacts to flax or inulin?  My symptoms with those two are almost identical to gluten so I have to really watch for that in gluten-free breads and baking and recently discovered after the fact that flax was in the juice I was drinking. I know that people with gluten issues can have other problems as well and in fact I also avoid milk products.  Even after 10 years, and although it has become a way of life, it's still frustrating to have to read every ingredient on every label.😞
      · 2 replies
  • Who's Online (See full list)

  • Member Statistics

    • Total Members
      61,117
    • Most Online
      1,763

    Newest Member
    cdliac3855
    Joined