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  • Will skin biopsy help with diagnoses?

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    Old 07-19-2011, 03:18 PM   #1
    gingertea
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    Will skin biopsy help with diagnoses?

    I have had a rash on my back for over a year and it's spreading. Yesterday my dermatologist took a biopsy and I am waiting for the results. Over the years I have had some tests and positive results by my PCP for various symptoms, and now I am wondering if it all adds up to Lupus.

    Positive results have been anemia, osteoarthritis, low B-12, low Vitamin D,
    Pac's, carpal tunnel and many various rashes...though not a butterfly rash, and digestive issues (diagnosed as h pylori). The symptoms I told my PCP I had were; joint aches, headaches, indigestion, tingling and numbness in my hands, heart palpitations and periods of just feeling crummy. I don't remember ever hearing Lupus mentioned. Does it show on a regular CBC, or do you need a special test? Is a skin biopsy a good way to diagnose? I feel like such a hypochondriac...even though I've had positive dx for so many complaints. They just can't relate the tests results into something concrete.
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    Old 07-19-2011, 06:10 PM   #2
    VeeJ
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    Re: Will skin biopsy help with diagnoses?

    Ginger, hi & welcome! I had similar symptoms, plus GI & urinary problems, migraines, weight & hair loss, etc. So, no, you're not a hypochondriac! I'm just a dumb patient, of course, so please read this with a grain of salt!

    While standard bloodwork can reveal anomalies like anemia, B-12, and Vit D, more specialized bloodwork is typically done to look for autoantibodies. The threshhold blood test is ANA, but it has pitfalls, e.g., values can rise/fall as flares appear/recede. Because it's positive in a variety of conditions, it alone cannot diagnose lupus. While most people with SYSTEMIC lupus have positive ANA, in a small subtype called Ro-lupus, ANA stays negative. The test is hard to perform, so different labs can get different results. And in *skin-only* lupus, ANA stays negative, as do the more specific subtype tests.

    Those more specific subtype blood tests look for specific autoantibodies, such as anti-ds-DNA, anti-Sm, anti-Ro, anti-La, antihistone, antiphospholipid, anti-RNP, etc. (There are a bunch.) Because of that weird ANA exception for Ro-lupus, it's sometimes critical that the dr. run ANA & all the subtype tests *simultaneously*.

    Deep-punch biopsy coupled with immunofluorescent stain tests is another path to dx. Under the microscope, the skin cells show certain characteristics. Then the stain tests can fluoresce in linear bands seen virtually only in lupus, so they can prove VERY definitive. That said, the stain tests can't determine the specific lupus rash (malar vs. discoid vs. the two kinds of SCLE, ETC.); the dr. figures out the specific lupus rash type by its appearance, behavior, etc.

    Speaking of rashes... what does your rash look like & feel like? Does it scar or depigment? Do you see any connection to UV (sun or tanning bed)?

    I turned out to be in that tiny Ro-lupus group, negative for ANA but positive for anti-Ro. I had years of targetlike nonscarring rashes on upper arms & back that, after deep punch + immunofluorescent stain tests, were diagnosed as SCLE annular form. So my biopsy results dovetailed with blood results, in that the two SCLE rashes are heavily correlated to anti-Ro. I've taken Plaquenil for years & must avoid sun. Both have helped a lot.

    Have you read the sticky posts (permanent info posts) at the top of the thread list? They're a good intro to reading more. I hope this helps some. Post again soon, OK? Wishing you luck & sending my best wishes, Vee

     
    Old 07-20-2011, 08:49 AM   #3
    gingertea
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    Re: Will skin biopsy help with diagnoses?

    Hi Vee, Thanks for the info! As far as I know I have never had a blood test for Lupus.
    My PCP was able to 'fix' all the vitamin deficiencies. Osteoarthritis was found with an x-ray. She said to stop working so hard. Any rashes she prescribed some cream and told me not to scratch. Told me one spot on my arm was nothing (just keratosis). (In her defense, the doctor's office lost my chart with 15 years of info in it and she had to start from scratch.) I went to the dermatologist on my own because the spot my PCP was nothing started getting bigger. Sure enough, it was basal cell carcinoma. She took it off immediately and sent it to lab that confirmed it. Because of the condition of my skin she had me schedule regular appointments. More skin cancer showed up and I had surgery to remove it. It just so happened when I went back for a followup on the surgery, my rash was in full bloom. She looked at it, and biopsied it on the spot. She also took a good look at my arms, hands and fingernails. At every other appointment she has been very up front and told me she suspected skin cancer. This time she didn't even mention skin cancer, so I'm assuming it's not. Besides she didn't even use her "cancer cell finder". She said she would call with the results if she got them before I had to go back and have stitches removed.

    Back to the rash...it started like a bug bite at the base of my neck. It stayed that way
    for a few months, then started to spread down my back and eventually to the skin and scalp behind one ear, my stomach and my hip. It's like a blanket of small bumps. If I scratch, it really welts up. I stay out of the sun as much as possible. If I go out I keep my skin covered. Even so, on sunny days I feel the rash 'crawling'. It was dumb luck that the rash was so bad at my dermatologist appointment that she could get an active biopsy. I brought the tube of medication my PCP gave me for the rash. She said it was worthless and not to use it. She prescribed Clobetasol mixed into a thick cream and Zyrtec. I may be way off thinking Lupus, but at this point anything that helps the rash, swollen numb hands and joints will be appreciated! I'll let you know what I hear from the biopsy.

    Thanks again,

    Your fellow (dumb and hopeless) hypochrondiac!
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    Old 07-20-2011, 09:37 AM   #4
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    Re: Will skin biopsy help with diagnoses?

    Ginger, the "sticky post" with the 11 classification criteria shows how systemic lupus (SLE) is diagnosed. You'll note only several are blood results. To be diagnosed with the systemic form of lupus, you generally must meet 4 or more of the 11. This can happen over time, meaning not necessarily simultaneously. Envision checking each off in indelible ink.

    There are other types of lupus subject to different diagnostic criteria. For example, people with cutaneous lupus meet fewer than 4 from the SLE list; they may have such things as fatigue & pain, in addition to lupus-specific rashes. Finally, drug-induced lupus (DILE) and neo-natal lupus also have different criteria.

    It's really not hopeless! I hope this isn't lupus; but if it is, many patients improve with treatment and regular follow-ups. So hang tough, OK? With hopes you get answers soon, so you can feel better---whatever this is. Bye, Vee

    Last edited by VeeJ; 07-20-2011 at 09:39 AM. Reason: spelling

     
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