Skin Biopsy

A biopsy of the skin is done to clear what is the condition of the skin such as psoriasis, to diagnose a disease such as skin cancer and to diagnose any bacterial or fungal skin infection. A skin biopsy is routinely done in a doctor's clinic as an outpatient procedure. You have to inform the doctor if you suffer any allergies to medications, especially any adverse reactions to local anesthetics or to iodine cleaning solutions. Keep the doctor informed if you are under any medication, are pregnant or suffer bleeding problems.

Skin biopsy procedures

If it is an excision biopsy, the entire suspect skin is cut out. Excision is normally done with a scalpel and the incision is closed up by stitches. If it is a punch biopsy, a sharp cutter is used to remove a small cylinder of skin. Stitches are made to close this type of biopsy wound as well. Such punch biopsies are quick, convenient and done for small wound. A pathologist can get a full thickness view of the skin. Sometimes more than one punch biopsy is necessary. The punch biopsy blade takes a small round core of tissue ranging from 2-6mm dia although 3-4mm is the usual size.

In a shave biopsy, the outermost part of a lesion is shaved off with a scalpel. Only if the top layer of the skin is suspected, a shave biopsy is adopted. A dermatologist will take a superficial slice of skin from the area of affected with a scalpel, dermablade or a razor blade. Although there are no stitches required, there will be a small scar that should heal in about a week's time. An aspiration is used to remove the skin that is fluid filled and not solid. The doctor inserts a small needle attached to a syringe into the lesion and the fluid is sucked out.

The biopsy site is cleaned with an iodine type solution with alcohol and with a sterile soap solution. A sterile towel is placed around the area once the skin is cleaned. A local anesthetic is injected into the skin to make it numb. You may feel a brief prick and stinging sensation as the medicine is injected. The doctor can perform the biopsy once the skin is numb. Now the tissue is removed and sent to the laboratory for analysis by a pathologist. If needed, the wound is stitched up.

A bandage is wound over the biopsy site. You may also be advised to wash the wound and apply antibacterial ointment and change the bandage daily. If you experience any pain in the biopsy site, consult the doctor about medication to relieve it.

• Unexpected bleeding may occur; especially if you are on any blood thinning medications such as aspirin. For instance, arterial puncture on the forehead or temple may take time to stop bleeding.
  
  
• There could be wound infections in about 1-5% of surgeries. There could be ulcerated or crusted skin wounds. Antibiotics may be used to clear this up.
  
  
• Infection is also common in diabetics, elderly patients and those on immunosuppressive medicines.
  
  
• If large scars, called keloids, there is an increased chance of forming a scar over the biopsy site.

Acrochordon

Acrochordon, also known as skin tag is an overgrowth of the skin hanging loose from the surrounding area and is connected by a stalk (peduncle). Acrochordons are normally benign growths; they are soft wrinkled protrusions and appear in flesh or light brown color. They are filled with collagen fibres and blood vessels with a thin layer of skin covering them.

They do not cause any pain and small growths may just fall off unknowingly. Slightly bigger acrochordons do not fall on their own and need to be removed using various methods. Though they can occur anywhere on the body, the areas like under arms, eyelids, upper chest, neck, and groin are more prone to develop skin tags as the skin here rubs against the clothing or with the adjoining skin. Acrochordon occurs in both men and women and the frequency of the condition increases as we age.

What causes Acrochordon?

Skin tags are caused by the constant rubbing between the skins of adjacent sites. Obesity is one of the very obvious causes that lead to acrochordon. These people tend to develop more skin tags simply because they have more skin folds on their body. Research also shows that this condition is inherited: people with close relatives having acrochordons have higher chances of developing this skin condition. Pregnant women also have a tendency to develop skin tags due to the hormonal changes taking place in their bodies. Diabetic patients are also prone to skin tags. Wart virus or human papilloma virus also cause skin tags.

Clinical examination is sufficient to diagnose the acrochordon. Yet in case of suspicion, doctor may advise skin biopsy. This procedure involves removal of small piece of skin to be examined in laboratory. This is done to rule out any malignancy of the growth.

Treatment of Acrochordon

Typically acrochordons do not require any treatment and they need not be removed. But the bearer may choose to get it removed either for cosmetic reasons or if the tags become bothersome. A word of caution here, if the skin tags are changing color or growing too quickly it is advisable to show it to your physician to rule out any further complications. Cryosurgery is used extensively, where the skin tag is removed by freezing it using the liquid nitrogen. Cauterization is one more method which involves burning of the skin tag using electrolysis (heat). Skin tags are also removed by surgical excision.

Hansen's Disease

Hansen's disease is an infectious skin disease that is chronic which affects the peripheral nerves, nasal mucosa, skin, eyes and upper respiratory tract. Hansen's disease, also known as Leprosy an infectious disease causes severe skin sores that can be disfiguring and may also cause nerve damage in the arms and legs. The disease is assumed to spread via nasal droplets or through broken skin or through secretions from the infected person's body that may contain the bacteria. Hansen's disease is not contagious and does not spread by merely coming in contact with the infected person.

Hansen's disease has been reported since ancient times and each culture across the world had a different understanding of the condition. Indians, Chinese and the Egyptians felt it was a contagious disease that was incurable. The outlook towards the disease has changed in the recent past. If the condition is diagnosed at an early stage and treated, it is curable. Though not completely eradicated, the disease has become rare and the number of cases of leprosy have reduced. Reported cases are from parts of Africa, Asia and very few cases in America.

Hansen's disease cause

A slow growing bacterium called Mycobacterium Leprae causes the condition. Leprosy is also called Hansen's disease named after the scientist who discovered the bacteria that caused the condition.

Hansen's disease symptoms

The skin and the peripheral nerves (nerves outside the brain and spinal cord) are largely affected by this condition. The nasal mucosa, eyes and upper respiratory tract also get affected. It takes about 3-5 years for symptoms to appear from when the person has come in contact with the bacteria.

• Disfiguring skin sores that are pale in color
  
• Lumps or bumps on skin
  
• Thick, stiff and dry skin
  
• Numbness in affected part of the skin
  
• Eye problems like reduced blinking and dryness
  
• Nosebleeds
  
• Ulcers on sole of feet
  
• Enlarged nerves
  

Hansen's Disease Types

Depending on the number of skin sores and its type, leprosy can be classified into the following types:

Lepromatus: A severe form of the disease that has extensive skin bumps and rashes. Kidneys, nose and male reproductive organs get affected. Muscle weakness and numbness is also felt. This type is more contagious.

Tuberculoid: This is a mild form of leprosy; people with this type have flat and pale colored patches on the skin. The pale colored patches on the skin may feel numb due to the nerve damage beneath the skin. This type of leprosy is less contagious.

Borderline: People suffering from this type of leprosy have symptoms of both lepromatus and tuberculoid.

Mid-borderline: Asymmetrically distributed reddish plaques can be seen. Swollen lymph nodes may also be seen; they either regress or progress to other forms of leprosy.

Indeterminate: A few hypo-pigmented macules may be seen; they either heal or progress to become other forms of leprosy.

Hansen's disease diagnosis

Diagnosis is based on the clinical symptoms such as localized skin lesions and sensory loss. Skin biopsy is done. A skin smear test may also be done. Without taking proper treatment, this disease can cause severe complications like:

• Glaucoma or blindness
  
• Infertility in men
  
• Kidney failure
  
• Disfiguration of the face
  
• Nerve damage
  
• Muscle weakness
  
• Damage to nasal mucosa

Hansen's disease treatment

It is a myth that leprosy cannot be treated. For the past two decades, over 16 million people with leprosy have been treated. WHO offers free treatment for people suffering from leprosy. Treatment of leprosy depends upon the type. Treatment includes:

Hansen's disease Facts

• Hansen's disease progresses slowly - however progressively to affect the skin and nervous system.
  
• Leprosy is not contagious and is not acquired by sitting next to the affected person.
  
• Early symptoms of the disease begin in the cooler areas of the body (eyes, earlobes, nose) and later go on to cause loss of sensation.
  
• Leprosy can get very damaging if left untreated; it can disfigure the face too.
  
• Some people are genetically vulnerable to this disease.
  
• There is no commercially available vaccine that can prevent leprosy.
  
• 500,000 to 700,000 new leprosy cases are reported every year worldwide. Most of the cases are found in the tropics and the sub-tropics like Indonesia, Brazil, India.
  
• The incubation period of the disease may vary from 6 months to 40 years.
  
• Apart from humans chimpanzees, mangabey monkeys and nine-banded armadillos may also transmit the infection.
  
• More than 95% of the human population has a natural immunity to the disease.
  
• When treated at the right time, most cases of Hansen's disease respond to the treatment and become non-infectious within a short span of time.