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Hautbiopsie bei entzündlichen Hauterkrankungen im Kindesalter – wann ist sie sinnvoll?

Skin biopsy of inflammatory skin diseases in childhood—when is it reasonable?

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Zusammenfassung

Im Vergleich zum Erwachsenenalter werden entzündliche Hauterkrankungen bei Kindern wesentlich seltener biopsiert. Neben der Invasivität der Maßnahme, der notwendigen Lokalanästhesie, Infektionsgefahr und Narbenbildung wiegt auch das psychische Trauma der Operationssituation im Kindesalter schwerer. Wenn dennoch biopsiert wird, sind die Erwartungen an den histologischen Befund verständlicherweise hoch. Die Beurteilung einer kindlichen Hautbiopsie ist jedoch oft eine besondere Herausforderung für den Histopathologen: zum einen, weil häufig nur ein sehr kleiner Stanzzylinder oder oberflächliches Shave-Material entnommen wird, zum anderen, weil die derzeit verwendeten histologischen Diagnosekriterien zumeist an Biopsien von Erwachsenen entwickelt wurden. Aufgrund der noch in Entwicklung befindlichen Reifung des Immunsystems können Hautinfiltrate einer Erkrankung im Kindesalter anders aussehen als bei Erwachsenen. Die Kenntnisse darüber sind jedoch noch sehr begrenzt. Zudem sind bei Hauterkrankungen des Kindesalters die Erstmanifestationen zahlreicher seltener Genodermatosen differenzialdiagnostisch zu berücksichtigen, zu denen teilweise kaum Erfahrungen vorliegen. Im vorliegenden Beitrag werden, ausgehend vom klinischen Befund, mögliche Differenzialdiagnosen histopathologisch erläutert, um exemplarisch die Sinnhaftigkeit oder Notwendigkeit einer Hautbiopsie im Kindesalter zu demonstrieren. Aspekte der Kommunikation mit Eltern und Kind, Methoden der Lokalanästhesie sowie auch Biopsietechniken finden ergänzend Berücksichtigung.

Abstract

Compared with adulthood, inflammatory skin diseases are relatively rarely biopsied in children. Apart from the invasiveness of the procedure, the required local anesthesia, and the risks of infection and scarring, the psychological trauma of the operation has a higher impact in childhood. If a biopsy is performed, expectations towards the dermatopathology report are high. However, the evaluation of biopsies taken from children is challenging for the dermatopathologist: on the one hand, because the biopsies are often tiny or just superficial shaves and, on the other hand, because criteria for evaluation have mostly been developed from findings in adult biopsy specimens. In children, the immune system is still in the process of maturation and, therefore, infiltrates in the skin may look different from those seen in adults; however, knowledge about that is very limited to date. Moreover, numerous rare genodermatoses may manifest themselves first in childhood and need to be considered in the differential diagnosis while experience with them is often limited. Starting from the clinical presentation, this article presents histopathological features of possible differential diagnoses in order to demonstrate the value or necessity of a skin biopsy in a pediatric patient. In addition, communication with parents and child, methods of local anesthesia and biopsy techniques will be considered.

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Authors and Affiliations

  1. Klinik für Hautkrankheiten, Universitätsklinikum Münster, Von-Esmarch-Str. 58, 48149, Münster, Deutschland

    A. Böer-Auer

  2. Dermatologikum Hamburg, Stephansplatz 5, 20354, Hamburg, Deutschland

    A. Böer-Auer

  3. Campus Kiel, Dermatologie, Venerologie und Allergologie, Universitätsklinikum Schleswig-Holstein, Rosalind-Franklin-Str. 7, 24105, Kiel, Deutschland

    R. Fölster-Holst

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Correspondence to A. Böer-Auer.

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A. Böer-Auer und R. Fölster-Holst geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Böer-Auer, A., Fölster-Holst, R. Hautbiopsie bei entzündlichen Hauterkrankungen im Kindesalter – wann ist sie sinnvoll?. Hautarzt 69, 536–549 (2018). https://doi.org/10.1007/s00105-018-4205-7

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