OpenHealth Q&A

Seeking Clarity on My Biopsy Results

**Patient Background** - **Gender:** Female - **Age:** 33 years - **Height:** 5'5" - **Smoking Status:** Non-smoker **Primary Concern:** Experiencing itchy welts that transition into hyperpigmented areas, followed by flare-ups in the same regions. Originally occurring monthly, these episodes have increased to every two weeks over the past year. Currently, the patient is not using any medications besides antihistamines and Xolair. Daily regimen includes 2 Allegra, 2 Zyrtec, and 1 Pepcid, with Xolair administered monthly. Previous treatments involving steroids and topical creams have failed to eliminate the symptoms completely. The patient’s primary worry involves mycosis fungoides. Although the doctor reassured her not to be concerned about this, she wonders if the biopsy results definitively rule out this diagnosis. There has been a lack of communication from her dermatologist post-biopsy, who suggested she consult with an allergist. However, the allergist has indicated that the symptoms are not allergy-related. The patient expresses feelings of fear and frustration regarding her persistent condition, especially as she previously considered hormonal factors while breastfeeding, which she stopped four months ago. Previously, she had a negative ANA test a year prior. While her CBC labs returned normal results, her anxieties about mycosis fungoides remain. She seeks advice on how to alleviate her symptoms, feeling disheartened because topical treatments and antihistamines have proven ineffective. Currently, she has one lesion on her chest and about five on her back. Notably, these issues began to surface a month after contracting COVID-19 last year, and she questions whether this could be a contributing factor. **Biopsy Findings:** Location: Right chest inframammary region Diagnosis: Superficial and deep perivascular dermatitis characterized by scattered dyskeratotic keratinocytes and post-inflammatory pigmentary changes. **Commentary:** A differential diagnosis could include a drug reaction or a viral exanthem, but the absence of eosinophils makes the former less likely. There is also suspicion of a connective tissue disorder, although there are no signs of vasculitis. Clinical correlation is advised. A PAS stain was negative for fungal hyphae. These observations are based on both initial and deeper tissue sections reviewed by one or more pathologists during an intradepartmental consultation. **Clinical History and Data:** A punch biopsy was conducted to assess urticaria and to rule out skin hypersensitivity or urticarial vasculitis. The sample, labeled with the patient’s information and the specific biopsy site, measures 2 x 2 x 3 mm and was preserved in 10% neutral buffered formalin. All specimen portions have been submitted for analysis. **Microscopic Analysis:** Findings reveal a predominance of perivascular and periadnexal inflammatory cell infiltration, featuring lymphocytes, plasma cells, and histiocytes. Scattered necrotic keratinocytes are identified at the dermoepidermal junction, accompanied by melanophages within the superficial dermis.

Answers (1)

9/14/2025, 7:31:02 PM

OpenHealth AI

It sounds like you are experiencing frustrating and concerning skin symptoms, and your worries about the biopsy results are completely understandable. Let’s summarize the key points and outline next steps to help you manage your symptoms and concerns.

Main Points:

1. Your biopsy indicated superficial and deep perivascular dermatitis rather than mycosis fungoides, which may help alleviate some of your anxiety.
2. The findings suggest possible inflammatory skin conditions, but there’s no clear indication of a specific allergy or connective tissue disease.

Explanation:

Based on your biopsy results, you do not have evidence of mycosis fungoides, which is a form of lymphoma that affects the skin. Instead, the diagnosis of dermatitis indicates a skin inflammation that may be related to a number of factors, possibly including past viral infections such as COVID-19. The absence of eosinophils suggests that it's less likely to be an allergic reaction.

Persistent dermatitis can sometimes be challenging to treat, especially when traditional methods have failed. Your symptoms, including itchy welts and hyperpigmentation, can often be a result of chronic inflammation and may require a tailored approach to management.

Next Steps:

1. Symptom Tracking: Keep a detailed diary of your outbreaks, noting when they occur, their duration, any associated triggers (like stress, food, or environmental changes), and any changes in skincare products or medications. This information can be very helpful for your healthcare team.

2. Review Medications: Discuss your current regimen with your dermatologist, particularly the antihistamines and the response to Xolair. Given that topical treatments haven’t helped, ask about other options such as:

   • Topical corticosteroids that might be more potent for flare-ups.
   • Calcineurin inhibitors like tacrolimus or pimecrolimus, which can help reduce inflammation without the side effects of steroids.

3. Lifestyle Modifications: Incorporate gentle, non-irritating skincare products, and consider hypoallergenic options if you haven't already. Additionally, take steps to maintain skin moisture and reduce irritation, such as:

   • Using fragrance-free moisturizers after bathing.
   • Avoiding hot showers which can exacerbate skin irritation.

4. Follow-Up Plan: Since communication has been a challenge, set a follow-up appointment with your dermatologist. Make it clear that you're seeking clarity on how to manage your symptoms effectively. If they recommend an allergist, express your concern about the previous assessment and seek confirmation on other potential causes.

5. Support Systems: Consider seeking support from a mental health professional or joining a support group for individuals with chronic skin conditions. Addressing your feelings of fear and frustration is important in managing your overall well-being.

Your journey can feel overwhelming, but addressing your symptoms with a systematic approach can help you regain control. If you have further questions or need clarification on specific treatments, feel free to ask.