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Clinical impression (submitting clinician): A) DDX: Dermatitis Unspecified vs. Prurigo Nodularis. Morphology: patches, macules, and papules. Procedure: Biopsy by Punch Method.
B) Same differential — second punch biopsy taken specifically for direct immunofluorescence (DIF), sent out to Cockerell Dermatopathology.
Diagnosis
A) RIGHT LATERAL ANTECUBITAL SKIN:
PRURIGO NODULARIS / LICHEN SIMPLEX CHRONICUS (L28.1)
Comment: The findings mostly reflect excoriation. Excoriated spongiotic dermatitis is a possibility.
PAS stain does not reveal fungal organisms. Deeper level sections have been reviewed.
B) RIGHT LATERAL ANTECUBITAL SKIN:
PLEASE SEE OUTSIDE REPORT CS25-39105 FROM COCKERELL DERMATOPATHOLOGY
(D48.5)
Comment: The direct immunofluorescence examination of the tissue for IgG, IgA, IgM, C3, and fibrinogen was
negative.
Quoted verbatim from the signed report.
Findings at a Glance
Site
Right lateral antecubital
4 × 2 mm punch biopsy
Fungal Stain (PAS)
Negative
No fungal organisms
Direct Immunofluorescence
Negative
IgG, IgA, IgM, C3, fibrinogen
Diagnosis
Non-specific
Attributed to excoriation
Microscopic Description and Gross Examination
MICROSCOPIC DESCRIPTION
A) Microscopic examination of the tissue had been performed and is reflected within the line diagnosis/comment section of the report.
B) Specimen received for DIF processing.
GROSS
A) Received in formalin and labeled with patient name and site location, specimen consists of a 4X2 mm tan, skin punch biopsy, which is entirely submitted in a single cassette.
B) DIF
Patient Details
BISHOP, TYLER W
DOB: 05/26/1987 | Age: 37 | Sex: Male
Account: 1582236
Submitting Clinician
Allison Smith, PA-C
Carlsbad
6010 Hidden Valley Rd Suite 120
Carlsbad, CA 92011-4219
Electronically signed 04/08/2025 02:57 PM PDT
Specimen Details
Accession: W25-10532
Collected: 04/02/2025
Received: 04/03/2025
Reported: 04/07/2025
DIF referred out: Cockerell Dermatopathology, report CS25-39105
Performing Lab: West Dermatology Pathology Lab — J. Robert West, M.D., Inc, 1041 E Yorba Linda Blvd, Ste. 304, Placentia, CA 92870
Director: Payam Abrishami, M.D. | CLIA #: 05D1099673 | Phone: (714) 924-7240
Reading pathologist: Amy Yang, M.D. — Certified in Dermatopathology by the American Boards of Pathology and Dermatology