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Thread: Can anyone help decode my skin biopsy results?

  1. #1
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    Default Can anyone help decode my skin biopsy results?

    So, I have suffered from rosacea for 7 years that came on overnight when I moved into a new house at university. The last 2 years, the condition has regressed quite dramatically and have tried to control the issue with Vbeam with varying degrees of success. My symtoms are burning on the cheeks, nose, temples, ranging from moderate to severe, moderate redness at baseline and no pastules and pustules. I recently got a skin biopsy test done which has apparently now confirmed rosacea. However, the main reason I wanted to get tested was because I wanted to test the levels of demodex to see whether they may have been contributing or causing my rosacea. Frustratingly the results that came back confirmed demodex, but didn't test for levels, which was pointless in my eyes, as everyone has demodex and would test postive for Demodex.

    What is confusing to me is that I travelled to Cornwall for 4 days last week and my condition improved overnight. There was no change in my diet, weather, etc, but my skin drastically improved (redness and burning way down). I came back to London on Sunday and the last 3 days its gotten worse and worse by the day. How can this be with no change but environment. Could this potentially be linked to Demodex or not?

    I have attached my biopsy results if anyone might be able to decode them. The dermatologist I saw to follow up on these results didn't really offer up much in way of explaining the results to me.

    I read a scientific article which stated the following;

    PVI with lymphohistiocytic infiltrate
    This is the most confusing type of PVI. Conditions that are associated with a lymphohistiocytic inflammatory cell infiltrate include drug reactions, viral infections and post-viral reactions, HIV dermatoses, and leprosy24,25 (fig 6​6).). Ziel-Neelsen, acid fast bacilli, Gomori methenamine silver, PAS, and Fite stains should be performed on all inflammatory dermatoses with a prominent lymphohistiocytic infiltrate to exclude the presence of microorganisms.


    With that information, should I be looking at getting the stain tests done to see whether my rosacea could be caused by the presence of microorganisms?

    I am very confused by it all and at my wits end!

    Thanks,

    Screenshot 2019-10-23 at 17.07.23.jpg

  2. #2
    Senior Member Brady Barrows's Avatar
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    Seb91,
    This is what your screenshot shows:

    "Microscopy Specimen A Skin punch biopsy - Right Cheek
    The epidermis is unremarkable. There is a perifollicular chronic lymphohistiocytic inflammatory infiltrate with Demodex and the occasional plasma cell.
    These features are in keeping with the clinical suspicion of rosacea"

    A 'chronic lymphohistiocytic inflammatory infiltrate' is broken down here:

    chronic, Adjective. (of an illness) persisting for a long time or constantly recurring

    lymphohistiocytic, Adjective. Relating to both lymphocytes and histiocytes

    inflammatory, Adjective. relating to or causing inflammation of a part of the body

    infiltrate, noun, (medicine) an infiltrating substance or a number of infiltrating cells

    with Demodex (possibly) indicating only one mite

    occasional plasma cell, noun (physiology) a fully differentiated B cell that produces a single type of antibody

    Translation:
    You have an inflamed cheek (erythema) that the skin biopsy was taken from your cheek and there is nothing unusual found. 'Suspicion of Rosacea' is the recommended diagnosis according to your screen shot.

    One demodex is normal. While there are papers that indicate that demodex density is higher in rosacea patients, the numbers are much higher than having just one, usually five to twenty. In normal skin, one or two demodex is what is usually found. However a Russian study said that a skin scrape with light microscopy isn't as good as using the Confocal laser scanning in vivo microscopy which requires no skin scraping. If you read post no 2 which is my reply to Judworth's question, you will learn even more about demodex mite density counts and also that treating for demodex mites is probably a better tactic than taking tests for demodex density counts. You will either improve or you won't. If you do improve, you have demodectic rosacea. If you don't, you may still have another variant of rosacea that needs to be ruled out or one of the phenotypes of rosacea.
    Brady Barrows
    Blog - Join the RRDi



  3. #3
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    Quote Originally Posted by Seb91 View Post
    So, I have suffered from rosacea for 7 years that came on overnight when I moved into a new house at university. The last 2 years, the condition has regressed quite dramatically and have tried to control the issue with Vbeam with varying degrees of success. My symtoms are burning on the cheeks, nose, temples, ranging from moderate to severe, moderate redness at baseline and no pastules and pustules. I recently got a skin biopsy test done which has apparently now confirmed rosacea. However, the main reason I wanted to get tested was because I wanted to test the levels of demodex to see whether they may have been contributing or causing my rosacea. Frustratingly the results that came back confirmed demodex, but didn't test for levels, which was pointless in my eyes, as everyone has demodex and would test postive for Demodex.

    What is confusing to me is that I travelled to Cornwall for 4 days last week and my condition improved overnight. There was no change in my diet, weather, etc, but my skin drastically improved (redness and burning way down). I came back to London on Sunday and the last 3 days its gotten worse and worse by the day. How can this be with no change but environment. Could this potentially be linked to Demodex or not?

    I have attached my biopsy results if anyone might be able to decode them. The dermatologist I saw to follow up on these results didn't really offer up much in way of explaining the results to me.

    I read a scientific article which stated the following;

    PVI with lymphohistiocytic infiltrate
    This is the most confusing type of PVI. Conditions that are associated with a lymphohistiocytic inflammatory cell infiltrate include drug reactions, viral infections and post-viral reactions, HIV dermatoses, and leprosy24,25 (fig 6​6).). Ziel-Neelsen, acid fast bacilli, Gomori methenamine silver, PAS, and Fite stains should be performed on all inflammatory dermatoses with a prominent lymphohistiocytic infiltrate to exclude the presence of microorganisms.


    With that information, should I be looking at getting the stain tests done to see whether my rosacea could be caused by the presence of microorganisms?

    I am very confused by it all and at my wits end!

    Thanks,


    Screenshot 2019-10-23 at 17.07.23.jpg
    Wondering if you tried a demodex treatment as suggested by Brady? I used to experience similar periods of 3-4 days clear skin, then it would come raging back. I think it was due to the life cycle of the mites and possibly a change of environment/bedding/soap/water etc. Everthing is different when you travel and that could potentially have an impact on the demodex. If you haven’t tried ZZ cream yet Inwoukd definitely recommend it. You would probably know in a few days if it was helping.

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    Quote Originally Posted by redvelvet View Post
    Wondering if you tried a demodex treatment as suggested by Brady? I used to experience similar periods of 3-4 days clear skin, then it would come raging back. I think it was due to the life cycle of the mites and possibly a change of environment/bedding/soap/water etc. Everthing is different when you travel and that could potentially have an impact on the demodex. If you haven’t tried ZZ cream yet Inwoukd definitely recommend it. You would probably know in a few days if it was helping.
    thanks redvelvet.

    Where is the best place to get ZZ cream from the UK, or for UK delivery. I have followed a few threads and saw that there is also a cosmetic version and a regular version, which one would I be looking for?

    Thanks again,
    Seb

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    I just ordered it from demodex.co.uk hope thats the right one

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    Quote Originally Posted by Seb91 View Post
    thanks redvelvet.

    Where is the best place to get ZZ cream from the UK, or for UK delivery. I have followed a few threads and saw that there is also a cosmetic version and a regular version, which one would I be looking for?

    Thanks again,
    Seb

    Hi Seb,
    I don't know where to buy in the UK. I am in USA and ordered directly off the website. It took about a week to get to me. I ordered the original ointment, but there is also a cosmetic cream which I haven't tried yet. Apparently they both work equally, but the cosmetic one is less harsh. You should try a test on your wrist first and wait a day to make sure you are not allergic. Good luck!

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