Elsevier

Dermatologic Clinics

Volume 28, Issue 2, April 2010, Pages 197-200
Dermatologic Clinics

Diagnosis
How to Take Skin Biopsies for Epidermolysis Bullosa

https://doi.org/10.1016/j.det.2009.12.002Get rights and content

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Basic Materials

  • Rubber eraser or pencil with rubber eraser (to induce a new blister)

  • Suture set containing tissue forceps, needle holder, and scissors

  • Biopsy punches (2 mm, 3 mm)

  • Suture material (4-0 or 5-0 nonabsorbable or absorbable sutures)

  • Antiseptic, nonstick dressings.

IF mapping

  • Normal saline (0.9% sodium chloride) solution or liquid nitrogen (for storage <24 hours) is ideal6

  • Michel medium (for storage from 24 hours to 6 weeks ).6, 7

Electron microscopy

  • 2.5% glutaraldehyde or appropriate fixative.

Preparing the patient

As in all surgical procedures, before any biopsy, informed consent must be taken from the patients or from parents in case the patient is a minor.

Choose an area of skin that seems clinically unaffected but preferably adjacent to the site where the patient usually gets blisters (ie, on the arms or legs). In neonates with more extensive forms of EB, a nonblistered site that has been freshly rubbed, such as the lower abdomen or the upper inner arm just above the elbow, is usually suitable. Skin

The skin biopsy procedure

Clean the selected area of skin with an antiseptic or alcohol and drape it. Anesthetize with 1% lignocaine (and adrenaline to minimize bleeding) to raise a bleb (Fig. 3). When this procedure is preplanned in a child, a cream of a eutectic mixture of local anesthetics may be applied under occlusion to the site for 2 hours beforehand to minimize the discomfort.10

Perform a 3-mm punch biopsy using a twisting movement from the rubbed area (Fig. 4) and place it in Michel's solution (the same

Instructions for patients postprocedure

As with any skin biopsy procedure, advise the patient to keep the area dry for the first 24 hours. The biopsy site may be dressed daily with an antibiotic ointment and nonstick dressing. The sutures are to be removed in a week's time if nonabsorbable sutures were used. Arrange to see the patients again when the results are available, usually in 1 or 2 weeks postprocedure.

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References (10)

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    Ideally, a fresh blister should be induced by firmly applying a pencil eraser to an area of skin nearby the blistered skin, and rotating it laterally back and forth until mild erythema appears.13 It is recommended to wait at least 5 min for a blister to develop microscopically before taking the biopsy.13 As described above, many different subtypes of EB, including mild and severe variants, can present with blistering at birth.

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