When sampling a pustular lesion, small technique details can make a big difference in what your pathologist sees under the microscope, and ultimately, whether you get a clear diagnosis.
Here’s one of those key technique pearls:
Choose One Direction and Stick With It
When performing a punch biopsy on a lesion where pustules are present, especially when you suspect pemphigus foliaceus or another immune-mediated pustular disease:
Rotate your punch in one consistent direction (clockwise or counterclockwise).
What you shouldn’t do?
Don’t rotate back and forth.
Why It Matters
Swiveling the punch back and forth can dislodge or rupture the delicate pustule roof, destroying crucial histologic architecture.
When that happens, the diagnostic structures your pathologist needs, like intact pustules, are lost!
The result?
Ambiguous or inconclusive findings that make it harder to confirm a diagnosis.
A simple adjustment in your technique can dramatically improve diagnostic yield and ensure those fragile pustules make it intact to the microscope.
The Bottom Line
- Rotate your punch in one direction only
- Don’t swivel back and forth
- A small technique shift = a huge difference in what we can see histologically
Need a Second Set of Eyes?
If you’ve got a tricky pustular case or aren’t sure which site to sample, we’re happy to help.
Email clinical photos or questions to: info@InnovativeVetPath.com
Dr. Trainor can mark up biopsy sites and guide you before you sample so you can get the most diagnostic value possible.