Skin biopsy

Elston, Dirk M.; Stratman, Erik J.; Miller, Stanley J.

doi:10.1016/j.jaad.2015.06.033

Cited by 122 publications

(37 citation statements)

References 78 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…5 To differentiate GBFDE from SJS, the biopsy specimen should be of an acute lesion, <24 hours old, because older bullae can display epidermal necrosis observed in SJS. 6 The previous biopsies from our patient were all performed several days after contrast administration and were therefore more consistent with the histopathology of SJS. Our case denotes the importance of early biopsy in bullous eruptions for accurate diagnosis.…”

Section: Discussionmentioning

confidence: 55%

Contrast-induced generalized bullous fixed drug eruption resembling Stevens-Johnson syndrome

Gavin

Sharp

Walker

et al. 2019

Baylor University Medical Center Proceedings

View full text Add to dashboard Cite

A 59-year-old woman with end-stage renal disease presented for suspected Stevens-Johnson syndrome that was ultimately diagnosed as generalized bullous fixed drug eruption (GBFDE) secondary to the administration of iodinated nonpolar radiocontrast. The patient had three previous episodes of a generalized bullous eruption after a thrombectomy, fistulogram, and an arteriovenous fistula revision, all requiring radiocontrast administration. Biopsies taken after previous eruptions demonstrated full-thickness epidermal necrosis, and she was diagnosed with Stevens-Johnson syndrome thought to be due to allopurinol. However, against medical advice she continued taking allopurinol and remained asymptomatic until the current presentation. Based on the clinical appearance and time frame of the eruptions, the patient was diagnosed with GBFDE due to radiocontrast. GBFDE, a rare variant of a fixed drug eruption, can be misdiagnosed as Stevens-Johnson syndrome due to their overlapping features of drug-induced whole-body blisters and variable degrees of epidermal necrosis.

show abstract

Section: Discussionmentioning

confidence: 55%

Contrast-induced generalized bullous fixed drug eruption resembling Stevens-Johnson syndrome

Gavin

Sharp

Walker

et al. 2019

Baylor University Medical Center Proceedings

View full text Add to dashboard Cite

show abstract

“…SJS, Stevens-Johnson syndrome; TEN, toxic epidermal necrolysis; ICD-10, International Classification of Diseases, 10th Edition. a Inpatient treatment of SJS/TEN is recommended [2]. b Establishing a diagnosis of SJS/TEN requires skin biopsy to determine massive epidermal degeneration [22]. c Steroid therapy (≥0.5 mg/kg/day of prednisolone), intravenous immunoglobulin therapy (IVIg), or plasma exchange therapy are recommended for SJS/TEN patients in Japan [23–25].…”

Section: Methodsmentioning

confidence: 99%

“… b Establishing a diagnosis of SJS/TEN requires skin biopsy to determine massive epidermal degeneration [22]. …”

Section: Methodsmentioning

confidence: 99%

Development of an electronic medical record-based algorithm to identify patients with Stevens-Johnson syndrome and toxic epidermal necrolysis in Japan

et al. 2019

View full text Add to dashboard Cite

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), severe drug reactions, are often misdiagnosed due to their rarity and lack of information on differential diagnosis. The objective of the study was to develop an electronic medical record (EMR)-based algorithm to identify patients with SJS/TEN for future application in database studies. From the EMRs of a university hospital, two dermatologists identified all 13 patients with SJS/TEN seen at the Department of Dermatology as the case group. Another 1472 patients who visited the Department of Dermatology were identified using the ICD-10 codes for diseases requiring differentiation from SJS/TEN. One hundred of these patients were then randomly sampled as controls. Based on clinical guidelines for SJS/TEN and the experience of the dermatologists, we tested 128 algorithms based on the use of ICD-10 codes, clinical courses for SJS/TEN, medical encounters for mucocutaneous lesions from SJS/TEN, and items to exclude paraneoplastic pemphigus. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratio (DOR) of each algorithm were calculated, and the optimal algorithm was defined as that with high PPV and maximal sensitivity and specificity. One algorithm, consisting of a combination of clinical course for SJS/TEN, medical encounters for mucocutaneous lesions from SJS/TEN, and items to exclude paraneoplastic pemphigus, but not ICD-10 codes, showed a sensitivity of 76.9%, specificity of 99.0%, PPV of 40.5%, NPV of 99.8%, and DOR of 330.00. We developed a potentially optimized algorithm for identifying SJS/TEN based on clinical practice records. The almost perfect specificity of this algorithm will prevent bias in estimating relative risks of SJS/TEN in database studies. Considering the small sample size, this algorithm should be further tested in different settings.

show abstract

“…Tips for increasing the accuracy of these tests were included (eg, screening tests for hypereosinophilic syndrome should be conducted off of systemic steroids and multiple serological and tissue tests may be needed to diagnose urticarial phase bullous pemphigoid, where direct immunofluorescence may be less sensitive than in bullous phase disease). 6 …”

Section: Methodsmentioning

confidence: 99%

A diagnostic checklist for generalized dermatitis

Nedorost¹

2018

CCID

View full text Add to dashboard Cite

PurposeGeneralized dermatitis (defined as histological spongiotic dermatitis affecting more than three anatomical areas of the skin surface) has many potential causes that mimic atopic dermatitis and contact dermatitis. If a treatable cause is missed, the patient may be treated with chronic immunosuppressive therapy that carries more risk than specific treatment for a disease mimicking dermatitis. Checklists have been shown to improve patient safety, primarily in procedural contexts. This work assessed the utility of a diagnostic checklist for subacute and chronic generalized dermatitis in patients who had not improved after at least 1 month of avoidance of contact allergens identified by comprehensive patch testing, if indicated.Patients and methodsDesigned as a quality improvement project using Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines, a diagnostic checklist was used by the principal investigator for 1 year in a tertiary referral dermatitis clinic for patients without a confirmed cause for the dermatitis after two to three visits with the investigator. All patients had had diagnostic patch testing if indicated. Almost all had undergone skin biopsy by their referring provider. Fifteen patients met the criteria for inclusion in this study. Outcome measures included provider and patient perception of efficiency and/or confusion caused by the checklist. Length of time from the initiation of use of the checklist to final diagnosis was recorded. Additional diagnoses considered that were not included in the initial checklist were added to the checklist during the course of the study.ResultsThe checklist was useful in improving diagnostic efficiency (prompting consideration of diagnoses not otherwise considered upon initiation of the visit that resulted in a final plan of care) in these complex cases of recalcitrant dermatitis. Open utilization of the checklist by the investigator during the clinical encounter was well accepted by patients and families.ConclusionChecklists can be useful for complex cognitive diagnostic work.IRB approval statusUniversity Hospitals Cleveland Medical Center Institutional Review Board # 11-15-34.

show abstract

Skin biopsy

Cited by 122 publications

References 78 publications

Contrast-induced generalized bullous fixed drug eruption resembling Stevens-Johnson syndrome

Contrast-induced generalized bullous fixed drug eruption resembling Stevens-Johnson syndrome

Development of an electronic medical record-based algorithm to identify patients with Stevens-Johnson syndrome and toxic epidermal necrolysis in Japan

A diagnostic checklist for generalized dermatitis

Contact Info

Product

Resources

About