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• W2595604077 abstract "To the Editor: Michel medium (MM) is the preferred medium for transportation of skin biopsy specimens for direct immunofluorescence (DIF). However, it has a limited shelf life and may not always be available to the dermatologist. In this study, we evaluated the utility of honey as a transport medium for skin biopsy samples meant for DIF. Thirty-six DIF-positive skin biopsy samples were randomly allocated into 3 groups (A, B, and C; 12 biopsy specimens per group). The blocks were immersed in phosphate-buffered saline to remove the optimum cutting temperature (OCT) compound. The biopsy specimens were then placed in contact lens holding boxes and about 3 mL of honey was poured on top of the samples. They were stored at room temperature (27°-34°C) until further use. Samples in batch A were taken out after 5 days (D5), while those in batches B and C were processed after 10 (D10) and 20 days (D20), respectively. Biopsy specimens were washed in phosphate-buffered saline in a rotator at 4°C in a refrigerator for 15 hours and DIF was then carried out. Disease-wise distribution of samples and the results of DIF study are shown in Table I. Tissue-bound immune complexes were preserved for ≤20 days in all biopsy specimens stored in honey except in 1 case of dermatitis herpetiformis, which turned out to be negative at D10. Intensity of staining was comparable with the first DIF test in all except 1 case of pemphigus vulgaris, which showed reduced intensity of staining with immunoglobulin G at D20 (Fig 1).Table IDisease-wise distribution of skin biopsy specimens and direct immunofluorescence resultsNo. of days51020Immunofluorescence findingsPV555ICS with IgG/C3PF1——ICS with IgG/C3PE——1ICS with IgG/C3 & Granular BMZ with C3BP131Linear BMZ band with IgG/C3LAD221Linear BMZ band with IgAMMP—11Linear BMZ band with IgG/C3DH—11Granular IgA in dermal papillaeHSP3—2Granular blood vessel wall staining with IgA, C3 &FBTotal121212BMZ, Basement membrane zone; BP, bullous pemphigoid; DH, dermatitis herpetiformis; DIF, direct immunofluorescence; FB, fibrinogen; HSP, Henoch-Schönlein purpura; ICS, intercellular staining; IMF, immunofluorescence; LAD, linear immunoglobulin A dermatosis; MMP, mucous membrane pemphigoid; PE, pemphigus erythematosus; PF, pemphigus foliaceus; PV, pemphigus vulgaris. Open table in a new tab BMZ, Basement membrane zone; BP, bullous pemphigoid; DH, dermatitis herpetiformis; DIF, direct immunofluorescence; FB, fibrinogen; HSP, Henoch-Schönlein purpura; ICS, intercellular staining; IMF, immunofluorescence; LAD, linear immunoglobulin A dermatosis; MMP, mucous membrane pemphigoid; PE, pemphigus erythematosus; PF, pemphigus foliaceus; PV, pemphigus vulgaris. Honey has been known for its preservative properties since medieval times; it does so by preventing autolysis and putrefaction.1Singh A. Hunasgi S. Koneru A. Vanishree M. Ramalu S. Manvikar V. Comparison of honey with ethanol as an oral cytological fixative: a pilot study.J Cytol. 2015; 32: 113-117Crossref PubMed Scopus (7) Google Scholar It was used to preserve skin grafts in burns patients who required multiple skin grafting.2Gupta M. Preservation of split skin grafts in honey: a preliminary study.Indian J Surg. 1977; 39: 591-598Google Scholar, 3Subrahmanyam M. Storage of skin grafts in honey.Lancet. 1993; 341: 63-64Abstract PubMed Scopus (40) Google Scholar In the present study, we found that honey can be used as an alternate transport medium for skin biopsy specimens for DIF. We used commercially available honey (purchased from the nearby department store) in this study to ensure the easy availability of this transport medium to any physician seeking to send samples for DIF test. It is important to keep the biopsy specimen in a moist condition before DIF. In case a biopsy specimen is placed in a container with honey, penetration of honey into the deeper tissues may be inadequate because it is more viscous. This might lead to deterioration of the immune complexes over a period of time. To avoid this, we recommend placing the biopsy specimen into the container first and then pouring honey over it so that the biopsy specimen retains moisture and the immunoreactants are preserved. Not being able to use fresh biopsy specimens immersed in honey was a limitation of the study. This required taking an additional biopsy specimen from the patient, which would add to patient discomfort; hence the additional biopsy procedure was avoided. Simultaneous comparison of MM versus honey was not done in the present study, and hence the superiority of any particular medium cannot be inferred." @default.
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• W2595604077 date "2017-04-01" @default.
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• W2595604077 title "Direct immunofluorescence microscopy of skin biopsy samples preserved in honey" @default.
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• W2595604077 doi "https://doi.org/10.1016/j.jaad.2016.11.006" @default.
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