Rabies is a Lyssavirus infection of mammals most commonly transmitted by the bite of an infected animal. Although rare in the United States thanks to decades of control efforts, it remains a significant worldwide public health problem. Historically, definitive diagnosis has been achieved via postmortem brain biopsy. However, several antemortem tests are now available, including nuchal skin biopsy for detection of the presence of rabies virus in cutaneous nerves. Since dermatologists are often called on to perform this biopsy, familiarity with this test and the rationale behind its use is useful despite the fact that rabies does not have skin manifestations.
Perez AL, Werchniak AE. Antemortem Diagnosis of Rabies via Nuchal Skin Biopsy. Arch Dermatol. 2007;143(5):659-675. doi:10.1001/archderm.143.5.663-a