Excelence in Dermatology Japan

皮膚生検

いつ行うか?

  • 異常であるように見える病変または予測に反した挙動をする病変をすべてサンプリングする。
  • 患畜が経験的治療に反応しなかった場合に皮膚生検を検討する。
  • 患畜が全身性の症状を示す場合に皮膚生検を検討する。
  • 結節または非治癒性の潰瘍は腫瘍性病変である可能性があるため、生検を行う。
  • 考えられる治療法が危険または高額である場合、病理組織検査により診断を確定する。
  • 他の診断を除外するために実施する。

何を見つけるか?

  • 臨床診断を確定する。
  • 疑わしい臨床診断を除外する。

何が必要か?

  • 皮膚生検用パンチ(4 mmまたは6 mm)、母指鉗子、虹彩鋏、くさび状生検を行う場合はメス刃、針ホルダー、縫合資材、10%ホルマリン

どのように行うか?

  • 局所麻酔。必要に応じて鎮静および疼痛管理を行う。
  • 皮膚に処理はしない。
  • 必要に応じて、皮膚を覆っている被毛をそっと刈り取る。
  • 1~2%リドカインまたはブピバカイン
  • 炭酸水素ナトリウム(1:9)による刺痛の緩和
     重炭酸塩0.1 mLをリドカイン0.9 mLに添加
  • 1,000倍希釈したエピネフリンをシリンジのハブに入れる。
     1部位につき0.75~1 cc、25ゲージ針を用いる。
  • 2%リドカインの推奨安全用量
    犬:1~1.5 mL/4 kg
    猫:0.5~0.75 mL/4 kg
    容量を多くする必要がある場合、生理食塩水で2倍希釈する。
  • 注射が効いてくるまで最長10分間待つ。

ヒント

  • 診断可能な領域を選択する確度をあげるために、検体は数個採取する。
  • 皮膚専門医が疾患の原因を判断するのに役立つ可能性があるため、診断だけでなく完全な顕微鏡所見の記述を依頼する。
  • 皮膚科に関心のある病理医に検体を送る。そのような病理医は、顕微鏡検査でみられる変化を特定の病因学的診断とマッチングできる可能性が高いためである。
  • 病理医に鑑別診断の一覧を提供し、特徴、臨床パターン、認められる病変、これまでの治療歴を説明する。

abscess

A discrete swelling containing purulent material, typically in the subcutis

Photo of abscess

Perianal abscess in a dog

alopecia

Absence of hair from areas where it is normally present; may be due to folliculitis, abnormal follicle cycling, or self-trauma

Photo of alopecia

Extensive alopecia secondary to cutaneous epitheliotropic lymphoma

alopecia (“moth-eaten”)

well-circumscribed, circular, patchy to coalescing alopecia, often associated with folliculitis

Photo of alopecia (“moth-eaten”)

“Moth-eaten” alopecia secondary to superficial bacterial folliculitis

angioedema

Regional subcutaneous edema

Photo of angioedema

Angioedema due to cutaneous drug eruption

annular

Ring-like arrangement of lesions

Photo of annular

Annular lesions in a dog with erythema multiforme

atrophy

Thinning of the skin or other tissues

Photo of atrophy

Cutaneous atrophy due to glucocorticoids

bulla

Fluid-filled elevation of epidermis, >1cm

Photo of bulla

Bullae in a dog with bullous pemphigoid

hemorrhagic bullae

Blood-filled elevation of epidermis, >1cm

Photo of hemorrhagic bullae

Interdigital hemorrhagic bulla in a dog with deep pyoderma and furunculosis

comedo

dilated hair follicle filled with keratin, sebum

Photo of comedo

Comedones on the ventral abdomen of a dog with hypercortisolism

crust

Dried exudate and keratinous debris on skin surface

Photo of crust

Multifocal crusts due to pemphigus foliaceus

cyst

Nodule that is epithelial-lined and contains fluid or solid material.

Photo of cyst

Epidermal inclusion cyst

depigmentation

Extensive loss of pigment

Photo of depigmentation

Depigmentation of planum nasale in dog with vitiligo.

ecchymoses

Patches due to hemorrhage >1cm

Photo of ecchymoses

Ecchymoses of a dog’s leg due to vasculitis

epidermal collarettes

Circular scale or crust with erythema, associated with folliculitis or ruptured pustules or vesicles

Photo of epidermal collarettes

Epidermal collarettes in a dog with Staphylococcus superficial bacterial folliculitis

erosion

Defect in epidermis that does not penetrate basement membrane. Histopathology may be needed to differentiate from ulcer.

Photo of erosion

Erosions in a dog with vasculitis

erythema

Red appearance of skin due to inflammation, capillary congestion

Photo of erythema

Erythema in a dog with cutaneous drug eruption

eschar

Thick crust often related to necrosis, trauma, or thermal/chemical burn

Photo of eschar

Eschar from physical trauma

excoriation

Erosions and/or ulcerations due to self-trauma

Photo of excoriation

Excoriations in a cat with atopic dermatitis

fissure

Excessive stratum corneum, confirmed via histopathology. This term is often used to describe the nasal planum and footpads.

Photo of fissure

Fissures of the footpads in a dog with superficial necrolytic dermatitis

fistula

Ulcer on skin surface that originates from and is contiguous with tracts extending into deeper, typically subcutaneous tissues

Photo of fistula

Perianal fistulas in a dog

follicular casts

Accumulation of scale adherent to hair shaft

Photo of follicular casts

Follicular casts surrounding hairs from a dog with hypothyroidism

hyperkeratosis

Excessive stratum corneum, confirmed via histopathology. This term is often used to describe the nasal planum and footpads.

Photo of hyperkeratosis

Idiopathic hyperkeratosis of the nasal planum (left) and footpads (right)

hyperpigmentation

Increased melanin in skin, often secondary to inflammation

Photo of hyperpigmentation

Inflammatory lesions (left) resulting in post-inflammatory hyperpigmentation (right)

hypopigmentation

Partial pigment loss

Photo of hypopigmentation

Idiopathic hypopigmentation of planum nasale

hypotrichosis

Lack of hair due to genetic factors or defects in embryogenesis.

Photo of hypotrichosis

Congenital hypotrichosis in chocolate Labrador puppies.

leukoderma

Lack of cutaneous pigment

Photo of leukoderma

Macular leukoderma in a dog

leukotrichia

Loss of hair pigment

Photo of leukotrichia

Progressive leukotrichia in patient with vitiligo.

lichenification

Thickening of the epidermis, often due to chronic inflammation resulting in exaggerated texture

Photo of lichenification

Lichenification of skin in a dog with chronic atopic dermatitis and Malassezia dermatitis

macule

Flat lesion associated with color change <1cm

Photo of macule

Pigmented macule (left) Erythematous macule (right)

melanosis

Increased melanin in skin, may be secondary to inflammation.

Photo of melanosis

Post inflammatory hyperpigmentation of this dog’s thigh

miliary

Multifocal, papular, crusting dermatitis; a descriptive term, not a diagnosis

Photo of miliary

Miliary dermatitis in a flea allergic cat

morbiliform

A erythematous, macular, papular rash; the erythematous macules are typically 2-10 mm in diameter with coalescence to form larger lesions in some areas

Photo of morbiliform

Morbiliform eruptions in a dog with a cutaneous drug reaction

nodule

A solid elevation >1cm

Photo of nodule

Nodules on nose of dog with cutaneous histiocytosis.

onychodystrophy

Abnormal nail morphology due to nail bed infection, inflammation, or trauma; may include: Onychogryphosis, Onychomadesis, Onychorrhexis, Onychoschizia

Photo of onychodystrophy

Onychodystrophy in dog with chronic allergies

onychogryphosis

Abnormal claw curvature; secondary to nail bed inflammation or trauma

Photo of onychogryphosis

Onychogryphosis in a dog with symmetric lupoid onychodystrophy

onychomadesis

Claw sloughing due to nail bed inflammation or trauma

Photo of onychomadesis

Onychomadesis in a dog with symmetric lupoid onychodystrophy

onychorrhexis

Claw fragmentation due to nail bed inflammation or trauma

Photo of onychorrhexis

Onychorrhexis in a dog with symmetric lupoid onychodystrophy

onychoschizia

Claw splitting due to nail bed inflammation or trauma

Photo of onychoschizia

Onychoschizia in a dog with symmetric lupoid onychodystrophy

papule

Solid elevation in skin ≤1cm

Photo of papule

Papules on a dog with superficial bacterial folliculitis

papules

Solid elevation in skin ≤1cm

Photo of papules

Papules on a dog with superficial bacterial folliculitis

paronychia

Inflammation of the nail fold

Photo of paronychia

Paronychia in a dog with symmetric lupoid onychodystrophy

patch

Flat lesion associated with color change >1cm

Photo of patch

Hypopigmented patch (left), erythematous patch (right)

petechiae

Small erythematous or violaceous lesions due to dermal bleeding

Photo of petechiae

Petechiae in a dog with cutaneous vasculitis

phlebectasia

Venous dilation; most commonly associated with hypercortisolism

Photo of phlebectasia

Phlebectasia and cutaneous atrophy due to hypercortisolism in a dog

plaques

Flat-topped elevation >1cm formed of coalescing papules or dermal infiltration

Photo of plaques

Plaques in a cat with cutaneous lymphoma

pustule

Raised epidermal infiltration of pus

Photo of pustule

Pustules on the abdomen of a dog with superficial staphylococcal pyoderma.

reticulated

Net-like arrangement of lesions

Photo of reticulated

Reticulated leukotrichia on the back of a horse

scale

Accumulation of loose fragments of stratum corneum

Photo of scale

Loose, large scales due to ichthyosis in a Golden Retriever

scar

Fibrous tissue replacing damaged cutaneous and/or subcutaneous tissues

Photo of scar

Scarring (right) following the healing of an ulcer (left) in a dog with sterile nodular dermatitis

serpiginous

Undulating, serpentine (snake-like) arrangement of lesions

Photo of serpiginous

Serpiginous urticarial lesions on a horse

telangiectasia

Permanent enlargement of vessels resulting in a red or violet lesion (rare)

Photo of telangiectasia

Telangiectasia in a dog with angiomatosis

ulcer

A defect in epidermis that penetrates the basement membrane. Histopathology may be needed to differentiate from an erosion.

Photo of ulcer

Ulcerations of the skin of a dog with vasculitis.

urticaria

Wheals (steep-walled, circumscribed elevation in the skin due to edema ) due to hypersensitivity reaction

Photo of urticaria

Urticaria in a horse

vesicle

Fluid-filled elevation of epidermis, <1cm

Photo of vesicle

Vesicles and bullae on ear pinna due to bullous pemphigoid

wheal

Steep-walled, circumscribed elevation in the skin due to edema

Photo of wheal

Wheals associated with intradermal allergy testing in a horse