Punch Biopsy Pathology Findings Normal?

[CindiNelson]

I've had several punch biopsies over the last few years...for facial skin lesions that wouldn't heal and continued to "ooze".  I did recently request copies of the pathology reports just to have them for my records.  

But I was surprised to see a number of findings on all the reports:  
hyperkeratoris and keratin filled follicles
lymphocytic infiltrate or inflammatory cell infiltrate
dermal fibrosis or epidermal hyperplasia
acanthosis
parakeratin


My dermatologist did't mention any of these findings to me when he would remove the stitches and I'm just wondering if these indicate anything that I should be investigating as the origin of the skin lesions.  The skin lesions were also very itchy.

[Alan Rockoff, MD]

No, these findings are just incidental and nonspecific and don't indicate much of anything.  Any lab report needs to be interpreted in light of the clinical picture, and you can't expect to do that yourself.  The one who needs to help you is your dermatologist.  It's very uncommon to have to biopsy the face even once, much less several times.  Facial sores that continue to ooze are also quite uncommon, unless you help them ooze by squeezing or picking at them.  If you do that, I suggest you stop for at least 6 weeks--100% no touching--and then see a skin doctor.  If you see a different one for a second opinion, bring the pathology reports with you.

Best.

Dr. Rockoff

[CindiNelson]

I'm not sure what you mean "in light of the clinical picture". No questions were asked or other examination.

But you're saying these findings would not have anything to do with autoimmune skin disease?  I do have Hashimoto's/hypothyroidism that appears to have been untreated for some time. I thought hyperkeratosis was a hypothyroidism symptom....and with the skin showing an inflammatory infiltrate process, I know this is exactly what Hashi's does to one's thyroid gland.  

[CindiNelson]

i should have also mentioned I have small spot vitiligo...some on my face, but also on my arms, chest, upper back.  

[CindiNelson]

I did some research today and from the description I found, it sounds like the oozing could have just been cutaenous mucinosis...from the untreated hypothyroidism?
Sounds like Shar-Pei dogs have the same problem..blisters that can break open.

p.s you mentioned picking skin in your reply...that wasn't an issue...it was just an areas of skin in the nasal folds that opened and oozed and wouldn't heal.  and then one later in the nasal bridge area.  I think this is where mucin accumulates in hypothyroidism.  

[CindiNelson]

Ok, looks like the $19 doesn't get you any follow-up, so let me come clean.  i knew the answer and was just very curious if another dermatologist would miss the diagnosis.  evidently, endocrine skin changes aren't even on the radar for some dermatologists and I hope to change that since I endured over a decade of skin problems due to undiagnosed Hashimoto's/hypothyroidism.

The truth is, I had about a dozen facial biopsies.  All were in the nasal fold area and glabella.  And although it is correct that those findings are non-specific, those (and several others that were on the pathology reports) are exactly what the medical literature says will be found in hypothyroidism...those non-specific findings that i listed.  So I guess when you see it once, it's understandable to miss it...but a dozen times?  i think not.

so the clues are...and this is straight from medical abstracts/articles:  
There is the development of fibrous tissue and that tissue is often suggestive of an irritative or inflammatory process.
Hyperkeratoris of the epidermis is associated with excessive keratin formation within the hair follicles.
Granuloma annular, papular mucinosis, etc...all can be associated with hypothryoidism.

specifically, if one wants to know more...google thyroid dermopathy, infiltrative dermopathy, autoimmune and skin, hypothyroidism and skin, myxedematous infiltrate, cutaneous mucinosis.

I've done so much research on this and it was frustrating to see that there are abundant medical abstracts on how the dermatologist is often the one who first sees the signs of an autoimmune disease in the patient...because the skin often gives the first signal.  

and regarding the skin picking comment that imo seems to turn it back onto the patient's fault...it is interesting that in hypothyrodism in birds and dogs...they will pull out feathers and fur.  I wouldn't think it to be a far reach to skin picking in an human who had hypothyroidism as I can remember my skin being so itchy.  In fact, my biopsies were in the areas where mucin does accumulate in hypo (cheeks, nose, around eyes) and I wonder whether i may have unwittingly scratched these areas which were myxedematous...and it just started oozing.  However, I did read that with Shar-Peis who have an overabundance of mucin in their skin, the cutaneous mucinois blisters can just burst...and so that is also is a possibility.

Anyway, i wanted to make sure this information was available to anyone who is intersted....as I have suffered greatly because my own autoimmune skin disorder/hypothyroidsim was not detected by my dermatologist.