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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Epidermolysis bullosa &#40;EB&#41; comprises a group of genetic diseases characterized by extremely fragile skin&#46; It is caused by mutations in genes coding for proteins in the epidermis&#44; basement membrane&#44; and&#47;or dermis&#46; The estimated worldwide incidence of EB ranges from 3&#46;8 and 20&#46;1 cases per million persons&#46; While a genetic work-up is essential when attempting to confirm the diagnosis and the subtype of EB&#44; the histology study is very useful during the initial approach to the patient&#44; since&#44; in addition to guiding the diagnosis&#44; it makes it possible to rule out other&#44; much more frequent diseases&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In order to perform an appropriate skin biopsy in a patient with suspected EB&#44; several considerations must be taken into account &#40;<a class="elsevierStyleCrossRef" href="#sec0040">supplementary material&#44; video</a>&#41;&#46; It is important to be aware of such considerations&#44; since the diagnostic usefulness of the sample will depend on them&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1&#44;2</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Description of the Technique</span><p id="par0015" class="elsevierStylePara elsevierViewall">First&#44; we must select a nonacral and blister-free area of skin&#46; The area must be rubbed with a pencil eraser by rotating it 180 degrees on its axis from side to side&#46; This should be done for at least 5&#8211;10 cycles until erythema appears&#44; without producing clinically visible erosions or blisters&#46; After about 30<span class="elsevierStyleHsp" style=""></span>minutes&#44; samples can be taken following the usual approach in skin biopsy&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">If possible&#44; 3 skin samples should be obtained&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The first biopsy should be with a punch &#40;4<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; attempting to ensure that half of the sample contains erythematous skin after friction and the other half contains normal skin&#46; The sample should be sent in formol for assessment with hematoxylin&#8211;eosin&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The second sample &#8211; for the immunofluorescence study &#8211; can be obtained using a punch measuring 3&#8211;4<span class="elsevierStyleHsp" style=""></span>mm&#46; It should be sent in saline solution and frozen or in Michel transport medium&#46; This sample should be sent as soon as possible to a reference center with experience in the diagnosis of EB&#44; since standard panels do not contain all the antibodies necessary to diagnose this disease&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Lastly&#44; a third&#44; very small sample can be obtained with a punch measuring 2<span class="elsevierStyleHsp" style=""></span>mm and sent in glutaraldehyde for electron microscopy&#46; This study makes it possible to determine the level at which the blister forms&#44; as well as the presence or absence of structural proteins&#46; Electron microscopy is more relevant when the genetic work-up and&#47;or immunofluorescence do not yield conclusive results&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0040" class="elsevierStylePara elsevierViewall">Patients with suspected EB&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Complications</span><p id="par0045" class="elsevierStylePara elsevierViewall">Excess rubbing with the eraser could generate a blister that would lead to a false positive&#46; We should only rub until erythema appears&#44; without damaging the skin where the biopsy specimen is taken from&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="par0050" class="elsevierStylePara elsevierViewall">EB comprises an uncommon group of diseases&#46; Histology is a useful early diagnostic tool when assessing affected patients&#46; It is important to use the correct approach in order to obtain samples that will prove useful to the pathologist during the diagnostic process&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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Videos of Surgical Procedures in Dermatology
Skin Biopsy in a Patient With Suspected Epidermolysis Bullosa
Biopsia de piel en un paciente con sospecha de epidermólisis ampollosa
A. Giacamana,
Corresponding author
anizagiacaman@gmail.com

Corresponding author.
, E. Gregg Azcárateb, C. Saus Sarriasc, A. Martín-Santiagoa
a Departamento de Dermatología, Hospital Universitario Son Espases, Palma de Mallorca, Spain
b Departamento de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, Spain
c Departamento de Anatomía Patológica, Hospital Universitario Son Espases, Palma de Mallorca, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Epidermolysis bullosa &#40;EB&#41; comprises a group of genetic diseases characterized by extremely fragile skin&#46; It is caused by mutations in genes coding for proteins in the epidermis&#44; basement membrane&#44; and&#47;or dermis&#46; The estimated worldwide incidence of EB ranges from 3&#46;8 and 20&#46;1 cases per million persons&#46; While a genetic work-up is essential when attempting to confirm the diagnosis and the subtype of EB&#44; the histology study is very useful during the initial approach to the patient&#44; since&#44; in addition to guiding the diagnosis&#44; it makes it possible to rule out other&#44; much more frequent diseases&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In order to perform an appropriate skin biopsy in a patient with suspected EB&#44; several considerations must be taken into account &#40;<a class="elsevierStyleCrossRef" href="#sec0040">supplementary material&#44; video</a>&#41;&#46; It is important to be aware of such considerations&#44; since the diagnostic usefulness of the sample will depend on them&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1&#44;2</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Description of the Technique</span><p id="par0015" class="elsevierStylePara elsevierViewall">First&#44; we must select a nonacral and blister-free area of skin&#46; The area must be rubbed with a pencil eraser by rotating it 180 degrees on its axis from side to side&#46; This should be done for at least 5&#8211;10 cycles until erythema appears&#44; without producing clinically visible erosions or blisters&#46; After about 30<span class="elsevierStyleHsp" style=""></span>minutes&#44; samples can be taken following the usual approach in skin biopsy&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">If possible&#44; 3 skin samples should be obtained&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The first biopsy should be with a punch &#40;4<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; attempting to ensure that half of the sample contains erythematous skin after friction and the other half contains normal skin&#46; The sample should be sent in formol for assessment with hematoxylin&#8211;eosin&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The second sample &#8211; for the immunofluorescence study &#8211; can be obtained using a punch measuring 3&#8211;4<span class="elsevierStyleHsp" style=""></span>mm&#46; It should be sent in saline solution and frozen or in Michel transport medium&#46; This sample should be sent as soon as possible to a reference center with experience in the diagnosis of EB&#44; since standard panels do not contain all the antibodies necessary to diagnose this disease&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Lastly&#44; a third&#44; very small sample can be obtained with a punch measuring 2<span class="elsevierStyleHsp" style=""></span>mm and sent in glutaraldehyde for electron microscopy&#46; This study makes it possible to determine the level at which the blister forms&#44; as well as the presence or absence of structural proteins&#46; Electron microscopy is more relevant when the genetic work-up and&#47;or immunofluorescence do not yield conclusive results&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">1</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0040" class="elsevierStylePara elsevierViewall">Patients with suspected EB&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Complications</span><p id="par0045" class="elsevierStylePara elsevierViewall">Excess rubbing with the eraser could generate a blister that would lead to a false positive&#46; We should only rub until erythema appears&#44; without damaging the skin where the biopsy specimen is taken from&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="par0050" class="elsevierStylePara elsevierViewall">EB comprises an uncommon group of diseases&#46; Histology is a useful early diagnostic tool when assessing affected patients&#46; It is important to use the correct approach in order to obtain samples that will prove useful to the pathologist during the diagnostic process&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflicts of Interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;W&#46; Lucky"
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                            2 => "S&#46; Rowe"
                            3 => "K&#46;S&#46; Marathe"
                            4 => "E&#46; Gorell"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Hern&#225;ndez-Mart&#237;n"
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        "texto" => "<p id="par0060" class="elsevierStylePara elsevierViewall">We are grateful to the audiovisual team at Hospital Universitario Son Espases and to the patients with epidermolysis bullosa and their families&#46;</p>"
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ISSN: 00017310
Original language: English
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