Practical Review and Recent Developments in Pediatric Dermatopathology

In vivo evaluation of skin of children with LC-OCT: An objective assessment

BACKGROUND

Several non-invasive skin imaging methods have been developed in recent years. Line-field confocal optical coherence tomography (LC-OCT) is one of them, leading to the best compromise in terms of resolution and penetration depth. Skin biopsies are an essential technique in paediatric dermatology, but they are a major stressful event for the child and their parents. Current LC-OCT studies have not been dedicated to a paediatric population. If, however, LC-OCT proves to be helpful in children, it may help guide and decrease a certain number of skin biopsies.

OBJECTIVES

(1) To evaluate the feasibility of using LC-OCT in paediatric patients, and (2) to assess the maturation of skin structures in children over time with this method.

METHODS

In vivo LC-OCT images were collected on six specific body regions (forehead, forearm, chest, back, dorsum of the hand and palmar surface) and in six age groups (between the ages of 0 and 16 years).

RESULTS

In all body areas and age groups assessed, 9 of 10 images were rated as good-to-excellent, the only exception were the images acquired on the palmar surface. LC-OCT allowed visualizing very well the skin structures up to a penetration of 500 μm. We observed that the body regions located on the upper extremities of the body (forearm, dorsum of the hand and palmar surface) showed both a maturation on their structure and differences in thickness with respect to the other regions evaluated.

CONCLUSIONS

LC-OCT can easily be used for non-invasive imaging of children's skin and allows to document progressive skin changes in the different age groups. It may be a useful asset for imaging and diagnosing superficial skin disorders and as such reducing the number of invasive procedures while increasing the speed of diagnosis in the paediatric population.

A Six-Year Retrospective Analysis of Skin Biopsies in the Pediatric and Adolescent Population Performed at a Tertiary Health Care Center in India

Background

Hesitancy to perform skin biopsies in children or adolescents may lead to delayed diagnosis or misdiagnosis and relatively, few studies analyzing pediatric skin biopsies exist.

Aim and Objectives

This study aims to analyze the spectrum of skin diseases biopsied and demographic data of pediatric patients underwent skin biopsies at a tertiary health care center in India.

Materials and Methods

Biopsy records over six years were analyzed, noting demographic data, disease duration, clinical differential diagnoses (CDD), final diagnosis after histopathology, disease categorization, and agreement between clinical and final diagnosis. The mean, range, and statistical significance of differences between proportions were calculated.

Results

A total of 1308 biopsy records were analyzed. A male preponderance was noted (males - 55.1%; n = 721, females - 44.9%; n = 587). Most biopsies were performed in adolescents (12-18 years; 55.2%) followed by school-age children (5-12 years; 31.4%). Preponderant disease groups biopsied comprised papulosquamous (17.7%; n = 231) and infectious diseases (14.1%; n = 184). Leprosy was the most common infectious disease (37.5%; n = 69) with most patients belonging to borderline tuberculoid spectrum. The overall diagnostic agreement was 74.7%. No correlation of final diagnosis was noted with the number of CDD offered. In more than a fifth of cases, biopsy averted misdiagnosis.

Conclusions

This study highlights the importance of skin biopsies in pediatric patients and the relatively high clinico-histopathologic agreement. Leprosy and papulosquamous diseases were preponderant in the pediatric dermatopathology caseload.