title: Use of the frozen section 'jelly-roll' technique to aid in the diagnosis of bullous congenital ichthyosiform erythroderma (epidermolytic hyperkeratosis).
abstract: Frozen section is a valuable tool that is often underutilized in the setting of in-patient dermatology. Traditionally, frozen section has been used in dermatology to diagnose toxic epidermal necrolysis, with some additional utility in staphylococcal scalded skin syndrome in the new born period. We report a newborn female with ruptured bullae on the face, chest, back and extremities with a clinical differential diagnosis that included staphylococcal scalded skin, bullous congenital ichthyosiform erythroderma/epidermolytic hyperkeratosis and epidermolysis bullosa. A thin detached skin sample ('jelly-roll') taken from a ruptured bulla on the abdomen was prepared for frozen section analysis. Characteristic findings of epidermolytic hyperkeratosis were seen which included hyperkeratosis with granular layer degeneration, vacuolization and eosinophilic globules. The 'jelly-roll' technique can be used for quick diagnosis with minimal trauma to the patient. Epidermolytic hyperkeratosis was subsequently confirmed by a biopsy fixed in formalin and by genetic testing. A novel missense mutation in KRT1 (I479N) was identified. Herein, we discuss the use of the frozen section 'jelly roll' technique for rapid diagnosis in a case of bullous congenital ichthyosis erythroderma/epidermolytic hyperkeratosis.
authors.affiliation: Department of Dermatology, Wilford Hall Ambulatory Surgical Center, Lackland AFB, TX, USA.
authors.forename: Blake
authors.initials: B
authors.lastname: Galler
authors.affiliation: Department of Dermatology, Wilford Hall Ambulatory Surgical Center, Lackland AFB, TX, USA.
authors.forename: Casey
authors.initials: C
authors.lastname: Bowen
authors.affiliation: Micrographic Surgery and Dermatologic Oncology, Vanderbilt University, Nashville, TN, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Arnold
authors.affiliation: Department of Dermatology, Wilford Hall Ambulatory Surgical Center, Lackland AFB, TX, USA.
authors.forename: Todd
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Department of Dermatology, Wilford Hall Ambulatory Surgical Center, Lackland AFB, TX, USA.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Dalton
mesh_terms: D005260:Female; D006801:Humans; D017488:Hyperkeratosis, Epidermolytic / Q000235:genetics / Q000378:metabolism / Q000473:pathology; D007231:Infant, Newborn; D053556:Keratin-1 / Q000235:genetics / Q000378:metabolism; D020125:Mutation, Missense; D012867:Skin / Q000378:metabolism / Q000473:pathology; D013206:Staphylococcal Scalded Skin Syndrome / Q000235:genetics / Q000378:metabolism / Q000473:pathology
chemical_list: C491616:KRT1 protein, human; D053556:Keratin-1
keywords: bullous congenital ichthyosiform erythroderma; epidermolytic hyperkeratosis; frozen section; in-patient dermatology; ‘jelly-roll’