What is a skin biopsy?

Histopathology of melanoma from the thigh
If you’ve been to a dermatologist, the issue of a skin biopsy may have come up. What is a skin biopsy? A skin biopsy allows the physician to make a diagnosis of a rash or a worrisome skin lesion (e.g. when your doctor suspects a skin cancer). It’s a procedure during which a small piece of skin is cut and then sent to a pathologist. A pathologist is a doctor that looks at the cells of the tissue and makes a diagnosis (when possible). A potential order of events is as follows:

1. Your physician explains the procedure and obtains your consent to do the procedure.
2. The area may be photographed.
3. The area is cleaned and numbed with an anesthetic medication. You will feel a prick and some stinging as the medication is injected into your skin.
4. A small piece of skin is obtained either by a scalpel, a special biopsy blade, or by a cookie cutter like device.
5. Depending on how much and how the skin is taken, stitches may be placed. If stitches aren’t placed, bleeding may be stopped by application of certain chemicals or via a cautery device.
6. The area is bandaged.
7. Wound care is reviewed.
8. The tissue is sent to a pathologist to help render a diagnosis.

Step 4 alludes to the different types of skin biopsies. A shave biopsy is usually done with a blade and do not require stitches. A punch biopsy uses a special cookie cutter device to obtain skin. Stitches frequently are placed when a punch biopsy is taken.

Do you have “chicken skin” of your arms and legs?

Image by Irja

A lot of people have rough small bumps of their arms, thighs and buttocks. These bumps can be skin colored or reddish and have unfortunately been likened to “chicken skin” and can feel like sandpaper. They represent a condition called keratosis pilaris. This is a benign condition which is inherited from mom

or dad, but it can prove to be a cosmetic nuisance and can occasionally itch too. There are several things that you can do to get smoother skin over these affected areas. Using a loofah sponge can help flatten and make these bumps less rough. Moisturizers, lactic acid containing lotions (such as AmLactin or LacHydrin), or lotions and creams containing urea, salicylic acid, alpha-hydroxy acids, tretinoin or tazarotene can help as well. This condition is chronic though (there’s no cure) so you do have to keep up with these maintenance measures if you want to keep the keratosis pilaris in check. However, because it’s a benign condition, there’s no medical necessity for treatment.

Does jogging make you itch?

courtesy of Flickr user ceiling
Does jogging make you itch? I remember those mile runs in grade school when my thighs would end up with a strange tingly itchy slightly swollen feeling and covered with faint pink blotches. Turns out that this is a condition called vibratory urticaria. It’s caused by mast cells which get stimulated by vibration to release histamine and other contents. In this case the histamine and contents inside of mast cells leads to itching, swelling and redness. While many people report vibratory urticaria happening with jogging, it can also occur when operating machinery such as lawnmowers, jackhammers, etc. I just have a mild case of vibratory urticaria. Some people can develop more intense swelling or a life-threatening condition called anaphylaxis with exercise. Rise in body temperature itself can also cause urticaria (hives) and occlusion of hair follicles after exercise can cause folliculitis. So there are all sorts of skin conditions that can happen with exercise!

Infected wound?

This weekend, I covered the dermatology on-call pager for the hospital and clinic. I frequently get calls from patients who have had a procedure such as a biopsy or surgical excision performed and want to know whether the wound is infected. Some signs that your wound may be infected are:

– presence of pus (whitish yellowish slightly thick fluid)
– redness around the wound, especially if it spreads
– warmth around the wound
– increasing pain, pain out of proportion to findings
– swelling
– fevers or chills

These are just guidelines for things to look out for. If you had a recent procedure and are worried about potential infection, call the provider who did the procedure or seek medical attention to have the wound evaluated. If the wound is infected, a culture (swab) from the wound may be taken, and you may be placed on an antibiotic. The wound may need to be opened and drained as well if there’s evidence of an abscess (infected fluid collection).

Digging for clams? Beware the clam digger’s itch (aka swimmer’s itch)

courtesy of Cornellier
The last time I went digging for clams was when I was about 8 years old. But that’s not because I knew anything about clam digger’s itch or developed clam digger’s itch after this isolated experience. This skin condition is also known as swimmer’s itch. It’s caused by a type of organism called a schistosome (a parasitic worm) whose larvae infect your skin when you’re in an infected lake or body of water. Fortunately this parasite can’t survive inside your skin. Instead, they die and leave behind itchy red or red-purple bumps in areas of exposed skin. This is in contrast to the Seabather’s eruption which occurs in areas under the swimsuit. So next time you go clam digging (e.g. this weekend), have on the proper gear to cover up!

Sea urchins – prickly critters of the sea

courtesy of Kirt L. Onthank
While we’re on the topic of marine life, I’m reminded of a wonderful past summer trip to the Big Island of Hawaii. A few friends and I had the opportunity a few years back to travel to the Big Island for a wonderful conference and after the conference, we traveled along the beautiful Kona coast enjoying gentle breezes, pristine white, green and black sand beaches, turtles, colorful fish and… sea urchin! Well, actually, one of us didn’t quite enjoy sea urchin. Somehow I managed not to step on the prickly black critters but my friend Josh wasn’t so lucky. He ended up with some of their prickly spines embedded in the bottom of his feet. Being medical students at the time, we figured we could treat this ourselves. With standard eyebrow tweezers, he carefully pulled out the spines. The wounds were pretty superficial and they got less painful over the next few days. Josh is now a neurosurgeon and probably doing much more complex surgeries.

Now, if you were to get a puncture wound from a sea urchin spine, you might want to go to a clinic and get it checked out. These wounds can get infected, and if they’re near a joint, you can develop arthritis.

Cruising in the Caribbean? Beware the seabather’s eruption.

Hopefully this hasn’t happened to you during your summer vacation, but if it does, you’ll know what it is! I recently saw someone who came in with itchy pink bumps of the torso and buttocks in a one-piece swimsuit distribution. Turns out it was “Seabather’s eruption” — aka “sea lice” which is actually caused by larvae! The culprits are either tiny little thimble jellyfish larvae in the waters off of Florida, Mexico and the Caribbean, or sea anemone larvae in the waters off of Long Island, NY. After you emerge from the water, these little critters get trapped under your swimsuit. Your body then develops a sensitivity reaction to these larvae. Thus the itchy rash in the swimsuit areas.

The seabather’s eruption typically occurs between May and August so we’re right at the tail end of the season for this rash. Now, if you get an itchy rash after a dip in the ocean, you might know what you have! (And no, this does not mean that you should necessarily go for a dip in the nude. But if you do, remember your sunscreen. If it’s during the day.)

Former sun worshipper? You may have actinic keratoses.

If you are a former sun worshipper, you may be no stranger to the actinic keratosis (abbreviated as AK). AKs are usually gritty skin colored, pink or red growths of the skin showing up on sun-exposed areas like the face, scalp, back of hands, etc. They’re more than just a cosmetic concern though. AKs are pre-cancers, meaning that a fraction of them evolve into squamous cell carcinomas (cancers) of the skin. Fortunately, there are many options for treating AKs. Most commonly, dermatologists use cryotherapy (the liquid nitrogen cold spray which is -196 degrees celsius!) to get rid of these spots. Creams such as 5-fluorouracil (brand names of Efudex, Carac or Fluoroplex), imiquimod (aka Aldara or Zyclara) or diclofenac can also be used. Other treatments include curettage, photodynamic therapy, chemical peels, or laser therapy. Your doctor will choose a treatment based on what your AK looks like, where it is, or how many you have. Now, if you have AKs, that’s probably a pretty good sign that you’ve gotten some sun in the past and you should be getting regular skin checks.

Xeomin joins Botox and Dysport in fighting wrinkles

The FDA recently approved Xeomin for use in temporary improvement against glabellar wrinkles (glabella = the area between your eyebrows and above your nose; wrinkles in this area are your frown lines). Similar to Botox and Dysport, Xeomin contains the botulinum toxin. Unlike Botox and Dysport, the toxin itself is naked and not associated with proteins. What this practically means in terms of aesthetic outcome is still unclear. So, the jury’s still out on how Xeomin will fare in comparison to Botox and Dysport. Xeomin will likely widely be available in the spring of 2012. It will be interesting to try it out and see what the key differences are between to botulinum toxins — or maybe they are more similar than dissimilar! Xeomin is manufactured by Merz Aesthetics while Botox is manufactured by Allergan and Dysport by Medicis.

Seborrheic keratoses – aka “Barnacles”

Seborrheic keratoses (SKs) account for many referrals to the dermatologist. What are seborrheic keratoses? If you’ve seen a dermatologist before, they may have been referred to as barnacles, wisdom spots, SKs, seb kers, or some other creative terms. Bottom line is, they are benign spots. Chances are mom or dad had them too and passed on some of the genes that dictate their growth to you. There are many flavors (or perhaps more appropriately, looks) to seborrheic keratoses. They typically look like stuck-on warty pigmented growths on the skin but they can also be smooth, barely raised, pink or non-pigmented. In general, they don’t cause problems so if your SK doesn’t bother you, don’t bother it! Unfortunately, sometimes they do get in the way — e.g. of your necklace, bra strap, waistband, eyeglasses, brush/comb, etc. Or maybe you’re just bothered by the way they look. (You can’t tell your SK where to grow and it might just crop up in a very visible area like the face.) In this case, talk to your dermatologist. There are various options for removal. Cryotherapy (the liquid nitrogen cold spray), curettage, and shaving are just some methods for removal. There are benefits and drawbacks to each so let a doctor take care of removal. You don’t want to exchange an SK for a scar. And you probably want a method that can keep your SK away for as long as possible. Some people also use a loofah sponge when showering or bathing to help even out the wartiness/roughness of the SK.

Just keep in mind, since seborrheic keratoses often are pigmented, it can be hard for the non-trained eye to distinguish a potential skin cancer from a seborrheic keratosis. So when in doubt, see a dermatologist for evaluation!