American Society of Dermatopathology
The ASDP’s mission is to improve quality of lives by continually advancing the theory and practice of dermatopathology. The PRP community shares their vision: “Reduce the burden of skin disease by promoting an accurate and efficient dermatopathologic diagnosis for everyone.”
The PRP Alliance has the ASDP on our radar.
Dermatopathology Service Providers
The American Academy of Dermatology’s annual meeting in San Francisco (March 20-23) provided an opportunity to meet with several companies who provide dermatopathologic services to private clinics and teaching hospitals. The April 2015 issue of On the Road… reports on ProPath, StrataDx, Aurora Diagnostics (DermDx), VisualDx and Cockerell Dermatology. There is a great deal to be learned from these folks.
Society to Improve Diagnosis in Medicine
Perhaps the most exciting news in the area of diagnosing PRP is a yet-to-be formalized relationship between PRPA and SIDM. Dedicated to reducing diagnostic error in medicine, founder Mark Graber is bringing patients, clinicians, health systems, educators and researchers together. The PRPA supports the effort to form a proactive coalition to improve the quality of the diagnostic process.
As published in On the Road… June 2015
Like many PRPers, Bill McCue’s version of pityriasis rubra pilaris was misdiagnosed as seborrheic dermatitis and mistreated with escalating quantities of prednisone. After a week in the hospital and a fifth biopsy, the “official” PRP diagnosis was rendered.
As Bill read the stories of fellow PRPers in the PRP-List daily digest, he recognized a frequent lament:
Why should it take so
long to diagnose PPR?
“In retrospect,” Bill recalls, “my first dermatologist did not have PRP on her radar screen. The symptoms I presented were consistent with seborrheic dermatitis.”
A biopsy in September and two in October did not confirm PRP. Moreover, a fourth biopsy performed at the Medical Center of Plano was also inconclusive. It was only when a new dermatologist ordered the fifth biopsy in late November and specifically included instructions for the lab to consider PRP that the results were classified as “a bit more characteristic and compatible with pityriasis rubra pilaris.”
The dermatopathology report included an important caveat: “Clinical correlation is recommended.” And that is the first answer to the question. We are told repeatedly that there is no “smoking gun” to be found in a skin biopsy. There is no “Gotcha” moment.
This reality begs another question: Are the characteristics of PRP really so elusive that they cannot be seen? Perhaps we need to interview 50 to 100 dermatopathologists as advocates of better PRP biopsies.
Assuming that a patient has PRP but the dermatologist has yet to make the diagnosis — or even suspects PRP:
✴How should a biopsy be performed to increase the likelihood of a timely PRP diagnosis.
✴What should the dermatopathologist be looking for?
Advocate: Relationship with dermatopathologist’s society
Advocate: article about diagnosing PRP
Advocate: instructing dermatopathologists to specifically look for PRP