Editor’s Note: After four years of asking questions about PRP, the efforts of dermatopathologists remains an enigma. I have asked questions but the words I hear are like those spoken by adults in a Charlie Brown cartoon. All I hear is “Wah wah wah wah wah wah.” That’s when I feel like Snoopy.
The following post is just a first attempt at understanding what really goes on when a dermatopathologist looks at a slide through a microscope.
I will keep asking questions until Ginny Maxwell’s boys (Nathan and Joey) can make a PowerPoint presentation to their class in Lexington, South Carolina.
Biopsies— What happens to the biopsy sample?
Most skin biopsies are placed in formalin in a small pot and are sent to the lab for paraffin fixation, processing and histopathological examination.
✽ If considering deep fungal infection or mycobacteria, the sample may be divided so that one part of the sample is sent in formalin for histopathology and the other is placed on a saline-soaked gauze swab for microbiology.
✽ Samples for direct immune fluorescence are placed in transport media, snap frozen in liquid nitrogen, or sent “fresh” (eg placed on a moistened gauze swab in a sterile empty pot).
Editor’s Note: Why am I thinking about Winnie the Pooh and his honey pot. The fact is, I don’t have a clue what a biopsy pot looks like.
What affects the test
✽ Taking medicines, such as anti-inflammatory medicines, those used for fungal infections (antifungal medicines), and corticosteroid skin creams, can interfere with your test or the accuracy of the results.
Obtaining the results of the biopsy
✽ It usually takes about one or two weeks to obtain the result from the pathology laboratory, but can sometimes take longer if special stains or second opinions are required.
✽ The pathologist describes what is observed under light microscopy in several sections of the biopsy sample, and either makes a diagnosis or assists in differentiating between the suggested range of clinical diagnoses.
Editor’s Note: Here is where many PRP patients (active and in remission) and their caregivers start bouncing around like Tigger. Remember — we have an über-rare skin malady. Biopsies generally exclude the more common skin disorders.
Based on the first biopsy we know it is NOT psoriasis. The second biopsy excludes eczema. And the third biopsy eliminates seborrheic dermatitises a contender. By now the patient is “in full bloom, head to toe with islands of sparring. The dermatologist remembers a grand rounds in medical school and thinks “pityriasis rubra something”.
The plot thickens. The dermatologist writes the order for the dermatopathologist with SPECIFIC instructions to consider pityriasis rubra pilaris. The dermatopathologist finds whatever SIGN there is that only dermatopathologists can see and writes a finding. It is NEVER a statement like “You can take a diagnosis of pityriasis rubra pilaris to the bank!” Rather, the wording will be reflective, “The biopsy supports the clinical observations of the dermatologist.”
At least now the dermatologist can confirm the diagnosis to the PRP patient and caregiver and a proper treatment plan may be initiated.