The use of chalazion clamps to create adequate sustained pressure for slit skin smear

CLINICAL CHALLENGE Demonstration of lepra bacilli on skin slit and scrape smears stained by the Ziehl-Neelsen method is an important diagnostic aid for leprosy, especially in resource-poor settings. The technique involves pinching the fold of skindusually of the earlobedtightly between the thumb and index finger until it blanches, making a 5-mm long and 2-mm deep cut, scraping the base of the cut after turning the blade by 908 to collect (bloodless) fluid, and making a smear followed by staining. Often, the physician’s ability to maintain sufficient mechanical pressure to cause blanching is inadequate and may result in a bloody smear causing discomfort to the patient because of multiple slits.