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. 2024 Jun;4(6):e1073.
doi: 10.1002/cpz1.1073.

Performing Suction Blister Skin Biopsies

Elizabeth A MacDonald  1 , Erica L Katz  1 , Todd F Pearson  1 , John E Harris  1
Affiliations

Performing Suction Blister Skin Biopsies

Elizabeth A MacDonald et al. Curr Protoc. 2024 Jun.

Abstract

Traditional skin sampling methods include punch or shave biopsies to produce a solid tissue sample for analysis. These biopsy procedures are painful, require anesthesia, and leave permanent scars. This unit describes a suction blister skin biopsy method that can be used in place of traditional biopsy methodologies as a minimally invasive, non-scarring skin sampling technique. The induction of suction blisters uses an instrument with a chamber that applies negative pressure and gentle heat to the skin. Blister formation occurs within 1 hr, producing up to five blisters, each 10 mm in diameter per biopsy site. Blister fluid can be extracted and centrifuged to retrieve cells from the epidermis and upper dermis for flow cytometry, single-cell RNA sequencing, cell culture, and more without the need for digestion protocols. In addition, the blister fluid can be used to measure soluble proteins and metabolites. This unit describes the preparation of supplies and subjects, the suction blister biopsy procedure and blister formation, fluid extraction, and post-blistering care. © 2024 Wiley Periodicals LLC. Basic Protocol 1: Preparation of supplies and subject Basic Protocol 2: Suction blister biopsy procedure and formation Basic Protocol 3: Blister fluid extraction Basic Protocol 4: Post-blister care and clean up.

Keywords: biopsy; non‐scarring; skin; suction blister.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT:

John Harris is a consultant for AbbVie Inc, Aldena, Almirall, Alys Pharmaceuticals, Avoro, Bain Capital, DrenBio, Granular Therapeutics Inc, Incyte, Klirna, Matchpoint Therapeutics, NIRA Biosciences, TeVido BioDevices, Vimela Therapeutics, and Vividion. John Harris is an investigator for Barinthus Bio NA, Cour Pharma, Incyte, NexImmune, and TeVido BioDevices. John Harris is scientific founder of Aldena, Alys Pharmaceuticals, Klirna, NIRA Biosciences and Vimela Therapeutics. John Harris has equity in Aldena, Alys Pharmaceuticals, Incyte, NIRA Biosciences, Rheos Medicines, TeVido BioDevices, and Vimela Therapeutics.

The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1:
Figure 1:. Preparation of Supplies and Subject.
Reagents needed for blistering procedure (A). Electronic Diversities Negative Pressure Instrument Model NP-4 with one chamber (B). Chamber head securely attached onto subject’s arm with provided velcro (C). Abdominal suction blister sites with chamber head securely attached with paper tape, blister site immediately after removal of chamber heads, and 1 year post blistering (D).
Figure 2:
Figure 2:. Suction Blister Biopsy Procedure and Formation.
Visual time course of blister formation. 0 minutes of negative pressure (A). 10 minutes of negative pressure (B). 15 minutes of negative pressure, early signs of vesicle formation in the center and bottom right orifices. Yellow arrows point to vesicle formation (C). 20 minutes of negative pressure, blister vesicle formation and enlargement in 3 orifices, as indicated by yellow arrows (D). 35 minutes of negative pressure, vesicle formation observed in all 5 orifices (E). 45 minutes of negative pressure, top left blister beginning to leak, shown by yellow arrow, but other sites not yet fully expanded to 10 mm. Yellow bars indicate space between blister and plate (F). 55 minutes of negative pressure, top left blister continuing to leak, all other sites fully expanded (G). 5 fully formed blisters immediately after cup removal at 55 minutes (H).
Figure 3:
Figure 3:. Blister Fluid Extraction
Extraction of fully formed suction blister using 1-mL syringe with bevel face up (A). Blister site before and after extraction (B).
Figure 4:
Figure 4:. Post-blister Care and Clean Up.
Petroleum jelly and transparent film dressing covering two separate blister sites after fluid extraction.
Figure 5:
Figure 5:. Average blistering yields and outcomes.
Average time for blister formation for lesional vitiligo skin and unaffected skin. (A). Average volume of blister fluid collected from lesional vitiligo skin and unaffected nonlesional skin (B). Pie chart showing the percent of subjects willing to volunteer for a punch biopsy of those who consented for a suction blister biopsy (C).
Figure 6:
Figure 6:. Hyperpigmentation
Suction blister sites before the procedure, immediately after, and at different time points showing hyperpigmentation (A). Comparison between suction blister biopsy and a 4mm punch biopsy 1 year later (B).
See this image and copyright information in PMC

References

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