Illustrated guide on skin biopsy in inflammatory diseases. Mikhail Valivach, MD, Pavlodar, Kazakstan

1. Guide on skin biopsy in
inflammatory cutaneous diseases
Mikhail Valivach, MD,
Head of cytomorphology division.
Pavlodar Regional Diagnostic Center
2015

2. • Punch biopsy is performed using a
circular blade attached to a pencil-like
handle.
• Punch diameters can be from 2 to 6
mm.
• Four mm punches are appropriate in
most cases of skin biopsy.

3. Punch

4. Choice of appropriate time
• Many of skin lesions have rapid dynamics.
• It is supposed that during first 18 hours since
lesion onset inflammatory changes have not fully
developed already.
• Changes reach maximum in 24-36 hours.
• In 48-72 hours primary inflammatory infiltrate
can dramatically change (for example,
lymphocytes and histiocytes can come instead
of neutrophils), and deposited immune
complexes can be destroyed by complement.

5. Choice of appropriate time
• The age of 24-36 hours is optimal for
biopsy of inflammatoty lesions!!!
• If this is not possible, then pathologist
should choose the most appropriate
lesion.

6. Selection of biopsy area
• Bullous lesions
• Biopsy of the edge of lesion. Even better
to make biopsy of erythema before
development of bulla.

7. Selection of biopsy area
Bullous lesions

8. Selection of biopsy area
Bullous lesions

9. Selection of biopsy area
Bullous lesions

10. Selection of biopsy area
Dermatitis herpetiformis
• Normally looking skin in 3 mm from a
vesicle.
• Better to make 2-3 biopsies.

11. Selection of biopsy area
Dermatitis herpetiformis

12. Selection of biopsy area
Dermatitis herpetiformis

13. Selection of biopsy area
Dermatitis herpetiformis

14. Selection of biopsy area
Porphyria and pseudoporphiria
• The edge of a fresh vesicle
(bulla).

15. Selection of biopsy area
Porphyria and pseudoporphyria

16. Selection of biopsy area
Porphyria and pseudoporphyria

17. Selection of biopsy area
Porphyria and pseudoporphyria

18. Selection of biopsy area
Suspected lupus erythematosus or
dermatomyositis
• Edge of an erythematous lesion. Fresh
elements are preferable.
• It is better to take additionally normally
looking skin.
• If you want to reveal “lupus band”, you can
expose skin to suberythematous dose of
ultraviolet and perform biopsy in 24 hours.

19. Selection of biopsy area
Suspected lupus erythematosus

20. Selection of biopsy area
Suspected lupus erythematosus

21. Selection of biopsy area
Suspected lupus erythematosus

22. Selection of biopsy area
Suspected lupus erythematosus

23. Selection of biopsy area
Suspected dermatomyositis

24. Selection of biopsy area
Suspected dermatomyositis

25. Selection of biopsy area
Suspected dermatomyositis

26. Selection of biopsy area
Suspected vasculitis
• Biopsy of a fresh element aged from 16 to 32
hours.
• It is better to take additionally normally looking
skin.
• Selection of biopsy area has a critical
significance for subsequent histological and
immunofluorescent tests. It is better to select the
area together with pathologist.

27. Selection of biopsy area
Suspected vasculitis

28. Selection of biopsy area
Suspected vasculitis

29. Selection of biopsy area
Suspected vasculitis

30. • We also recommend you to read the
article Punch Biopsy of the Skin. THOMAS
J. ZUBER, M.D. Am Fam Physician.
2002 Mar 15;65(6):1155-1158.
• The article is available online
http://www.aafp.org/afp/2002/0315/p1155.html

31. • Video on punch biopsy technique is
available in youtube.com use key words
the punch biopsy dermeducation

32. • Dear colleagues, with questions and
suggestions you can address to Mikhail
Valivach valivach@mail.ru

33. • Thank you for your attention!