About Skin Biopsy Services

 There are currently over 100 different types of rheumatic conditions.  Some of these are degenerative like osteoarthritis, but the majority are caused by autoimmune processes.  Some of these include lupus and rheumatoid arthritis.

These autoimmune diseases often times affect the skin, nails, and mucosal membranes. A skin biopsy can be an important and crucial diagnostic and prognostic marker. The Center for Rheumatology is offering skin biopsy services from Dr. Jessica Chapman. Please schedule your appointment today. 

If a rash is suspected of being caused by a rheumatologic condition, we are equipped to evaluate the potential underlying condition AND quickly perform any necessary skin biopsy on site.

 

Conditions and Diseases 

 Rheumatology and the Skin

Autoimmune diseases often affect multiple organ systems, including the skin.  Some of these include:

  • Scleroderma
  • Calcinosis cutis
  • Morphea, also called localized scleroderma
  • Systemic lupus erythematosus
  • Cutaneous lupus
  • Dermatomyositis or polymyositis
  • Mixed connective tissue disease
  • Vasculitis
  • Raynaud’s
  • Sarcoidosis
  • Psoriasis with severe arthritis
  • Panniculitis
  • Eosinophilic fasciitis
  • Neutrophilic dermatoses 

Rheumatology and the Nervous System

At times, the nervous system may also be affected by autoimmune diseases. Some conditions like lupus and sarcoidosis can affect the brain.  But many other conditions can affect the small nerve fibers that supply the skin.  This is called small fiber neuropathy.

Small fiber neuropathy results from damage to the small, unmyelinated nerve fibers that transmit pain and temperature and control autonomic functions like sweating.

Often times, small fiber neuropathy can be missed with traditional nerve conduction tests.  Recently a new test that measures the density of the nerve fibers has been developed and validated.  It involves obtaining two small 3 mm skin biopsies.

Services  

Skin Biopsy

At times, a skin biopsy may be necessary to make a diagnosis.

What is a punch biopsy?

  • A punch tool about the size of a pencil eraser is used to obtain a sample of skin. 
  • This helps the pathologist look at all the layers of the skin: epidermis, dermis, and hypodermis/subcutaneous tissue.
  • This is the most common technique.

What is a shave biopsy of skin?

  • An instrument that looks like a razor is used to remove a small sample of skin.
  • It is often used to remove superficial lesions or raised lesions like vesicles and bullae.

 Epidermal Nerve Fiber Density Testing

What is Small Fiber Neuropathy? Small fiber neuropathy results from damage to the small, unmyelinated nerve fibers that transmit pain and temperature and control autonomic functions like sweating.

  • Nerve fiber density testing is an objective test.  It can provide peace of mind, documentation for diagnostic tests and treatments, and differentiate between different types of neuropathy.
  • It’s been estimated that 30 – 40% of patients diagnosed with fibromyalgia using the American College of Rheumatology diagnostic criteria, actually suffer from small fiber neuropathy.
  • Common symptoms of small fiber neuropathy:
    • Numbness
    • Tingling
    • Burning
    • Stinging
    • Hypersensitivity to pain
    • Testing for small fiber neuropathy involves two small 3 mm skin biopsies.  The skin is numbed with lidocaine and epinephrine and then a 3 mm piece of skin is removed using a punch instrument.  Sutures may be required.
    • The specimen is then sent to a board certified pathologist who will then examine, measure, and count the nerve fibers. 

Testing for Small Fiber Neuropathy

  • Testing for small fiber neuropathy involves two small 3 mm skin biopsies.  The skin is numbed with lidocaine and epinephrine and then a 3 mm piece of skin is removed using a punch instrument.  Sutures may be required.
  • The specimen is then sent to a board certified pathologist who will then examine, measure, and count the nerve fibers.

 

 

 ***Patient Instructions 

 Pre-Procedure Skin Biopsy Patient Information Download Pre-Procedure-Skin-Biopsy-Patient-Information.pdf.

Post Biopsy Skin Care Instructions  Download Post-Biopsy-Skin-Care-Instructions.pdf

 

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