1
|
Fredman G, Fuchs CSK, Wenande E, Philipsen PA, Untracht GR, Andersen F, Bjerring P, Wiegell SR, Haedersdal M. Dynamic optical coherence tomography unveils subclinical, vascular differences across actinic keratosis grades I-III. Exp Dermatol 2024; 33:e15153. [PMID: 39138644 DOI: 10.1111/exd.15153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 06/18/2024] [Accepted: 07/22/2024] [Indexed: 08/15/2024]
Abstract
Actinic keratosis (AK) classification relies on clinical characteristics limited to the skin's surface. Incorporating sub-surface evaluation may improve the link between clinical classification and the underlying pathology. We aimed to apply dynamic optical coherence tomography (D-OCT) to characterize microvessels in AK I-III and photodamaged (PD) skin, thereby exploring its utility in enhancing clinical and dermatoscopic AK evaluation. This explorative study assessed AK I-III and PD on face or scalp. AK were graded according to the Olsen scheme before assessment with dermatoscopy and D-OCT. On D-OCT, vessel shapes, -pattern and -direction were qualitatively evaluated at predefined depths, while density and diameter were quantified. D-OCT's ability to differentiate between AK grades was compared with dermatoscopy. Forty-seven patients with AK I-III (n = 207) and PD (n = 87) were included. Qualitative D-OCT evaluation revealed vascular differences between AK grades and PD, particularly at a depth of 300 μm. The arrangement of vessel shapes around follicles differentiated AK II from PD (OR = 4.75, p < 0.001). Vessel patterns varied among AK grades and PD, showing structured patterns in AK I and PD, non-specific in AK II (OR = 2.16,p = 0.03) and mottled in AK III (OR = 29.94, p < 0.001). Vessel direction changed in AK II-III, with central vessel accentuation and radiating vessels appearing most frequently in AK III. Quantified vessel density was higher in AK I-II than PD (p ≤ 0.025), whereas diameter remained constant. D-OCT combined with dermatoscopy enabled precise differentiation of AK III versus AK I (AUC = 0.908) and II (AUC = 0.833). The qualitative and quantitative evaluation of vessels on D-OCT consistently showed increased vascularization and vessel disorganization in AK lesions of higher grades.
Collapse
Affiliation(s)
- Gabriella Fredman
- Department of Dermatology, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Emily Wenande
- Department of Dermatology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter A Philipsen
- Department of Dermatology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gavrielle R Untracht
- Department of Dermatology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Flemming Andersen
- Skin Center Mølholm, Private Hospital Mølholm, Vejle, Denmark
- Department of Dermatology, Aalborg University Hospital, Aalborg, Denmark
| | - Peter Bjerring
- Skin Center Mølholm, Private Hospital Mølholm, Vejle, Denmark
- Department of Dermatology, Aalborg University Hospital, Aalborg, Denmark
| | - Stine R Wiegell
- Department of Dermatology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Schuh S, Berger M, Schiele S, Rubeck A, Müller G, González JJV, Holmes J, Welzel J. Dynamic optical coherence tomography for imaging acute wound healing. Int Wound J 2024; 21:e70015. [PMID: 39165043 PMCID: PMC11336043 DOI: 10.1111/iwj.70015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 07/17/2024] [Accepted: 07/22/2024] [Indexed: 08/22/2024] Open
Abstract
The aim of this study was to investigate acute wound healing with dynamic optical coherence tomography (D-OCT). From 22 patients with 23 split skin graft donor sites, vessels at four wound edges, the wound bed, and adjacent and unaffected skin of the contralateral leg were measured by D-OCT at six time points from surgery to 4 weeks of healing. Changes in vessel orientation, density, diameter, morphology and pattern in horizontal, vertical and 3D images were analysed for wound healing and re-epithelialization. At 300 μm depth, there were significant differences of blobs and serpiginous vessels between normal and wounded skin. The wound had significantly more vertically oriented vessels, a higher degree of branching, vessel density and diameter compared with healthy skin. 3D images showed increased angiogenesis from healthy skin towards the wound centre, significantly higher vessel density at the wound than at normal skin and the highest at the interface. During wound healing blobs, coils and serpiginous vessels occurred significantly more frequently in lesional than healthy skin. Vessel density was greatest at the beginning, decreased and then increased by 4 weeks post-surgery. D-OCT helps to evaluate acute wound healing by visualizing and quantifying blood vessel growth in addition to re-epithelialization.
Collapse
Affiliation(s)
- Sandra Schuh
- Department of Dermatology and AllergologyUniversity Hospital AugsburgAugsburgGermany
| | - Maximilian Berger
- Department of Dermatology and AllergologyUniversity Hospital AugsburgAugsburgGermany
| | - Stefan Schiele
- Institute of MathematicsUniversity of AugsburgAugsburgGermany
| | - Anna Rubeck
- Institute of MathematicsUniversity of AugsburgAugsburgGermany
| | - Gernot Müller
- Institute of MathematicsUniversity of AugsburgAugsburgGermany
| | | | | | - Julia Welzel
- Department of Dermatology and AllergologyUniversity Hospital AugsburgAugsburgGermany
| |
Collapse
|
3
|
Fredman G, Wiegell SR, Haedersdal M, Untracht GR. Vascular feature identification in actinic keratosis grades I-III using dynamic optical coherence tomography with automated, quantitative analysis. Arch Dermatol Res 2024; 316:391. [PMID: 38878217 PMCID: PMC11180023 DOI: 10.1007/s00403-024-03022-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/08/2024] [Accepted: 04/26/2024] [Indexed: 06/19/2024]
Abstract
Clinical grading of actinic keratosis (AK) is based on skin surface features, while subclinical alterations are not taken into consideration. Dynamic optical coherence tomography (D-OCT) enables quantification of the skin´s vasculature, potentially helpful to improve the link between clinical and subclinical features. We aimed to compare microvascular characteristics across AK grades using D-OCT with automated vascular analysis. This explorative study examined AK and photodamaged skin (PD) on the face or scalp. AKs were clinically graded according to the Olsen Classification scheme before D-OCT assessment. Using an open-source software tool, the OCT angiographic analyzer (OCTAVA), we quantified vascular network features, including total and mean vessel length, mean vessel diameter, vessel area density (VAD), branchpoint density (BD), and mean tortuosity from enface maximum intensity projection images. Additionally, we performed subregional analyses on selected scans to overcome challenges associated with imaging through hyperkeratosis (each lesion group; n = 18). Our study included 45 patients with a total of 205 AKs; 93 grade I lesions, 65 grade II, 47 grade III and 89 areas with PD skin. We found that all AK grades were more extensively vascularized relative to PD, as shown by greater total vessel length and VAD (p ≤ 0.009). Moreover, AKs displayed a disorganized vascular network, with higher BD in AK I-II (p < 0.001), and mean tortuosity in AK II-III (p ≤ 0.001) than in PD. Vascularization also increased with AK grade, showing significantly greater total vessel length in AK III than AK I (p = 0.029). Microvascular quantification of AK unveiled subclinical, quantitative differences among AK grades I-III and PD skin. D-OCT-based microvascular assessment may serve as a supplement to clinical AK grading, potentially raising perspectives to improve management strategies.
Collapse
Affiliation(s)
- Gabriella Fredman
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, NV, 2400, Denmark.
| | - Stine R Wiegell
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, NV, 2400, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, NV, 2400, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
| | - Gavrielle R Untracht
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, NV, 2400, Denmark
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, 2800, Denmark
| |
Collapse
|
4
|
Vélez González JJ, Berger M, Schiele S, Rubeck A, Müller G, Welzel J, Schuh S. Dynamic optical coherence tomography of chronic venous ulcers. J Eur Acad Dermatol Venereol 2024; 38:223-231. [PMID: 37669869 DOI: 10.1111/jdv.19496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/11/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Chronic ulcers, especially venous leg ulcers, are a major burden on the healthcare system. To date there are only few non-invasive established procedures for evaluation of blood perfusion in wounds. Dynamic optical coherence tomography (D-OCT) provides images of the skin's superficial vascularisation. OBJECTIVES This study aims to investigate if and how the D-OCT measurement of chronic wounds can provide new information about the vascularisation during the healing process. METHODS We examined 16 venous ulcers over 16 weeks and evaluated the vessel morphology and density using D-OCT at the wound bed, borders, two centimetres adjacent to the wound und at non-ulcerated skin on the contralateral leg. RESULTS In D-OCT scans clumps were unique and the most common vessel type in the wound area of venous ulcers, whereas lines and serpiginous vessels were the most common in non-ulcerated skin. At the wound border mottle and cluster patterns occurred more frequently. Healthy skin showed a significant increase of mesh pattern. Vessel density significantly increased at the wound area compared to non-ulcerated skin. During the healing process the wound border showed the most vascular changes while only an increase in curves was observed in the wound centre. Non-healing wounds had fewer dots and blobs at the borders, fewer dots, coils, clumps, lines and serpiginous vessels at the centre and fewer dots in adjacent skin. Temperature analysis showed higher temperatures in non-ulcerated skin, followed by the wound margin and centre. Non-healing wounds showed the lowest temperatures in the wound centre. CONCLUSIONS These results highlight the non-invasive use of D-OCT for the examination and monitoring of wound healing in chronic venous ulcers. D-OCT imaging of blood vessels may offer the potential to detect disorders of wound healing at an early stage, differentiate ulcers of different genesis and to tailor more individualized, patient-oriented therapy.
Collapse
Affiliation(s)
| | - Maximilian Berger
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Stefan Schiele
- Institute of Mathematics, University of Augsburg, Augsburg, Germany
| | - Anna Rubeck
- Institute of Mathematics, University of Augsburg, Augsburg, Germany
| | - Gernot Müller
- Institute of Mathematics, University of Augsburg, Augsburg, Germany
| | - Julia Welzel
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| | - Sandra Schuh
- Department of Dermatology and Allergology, University Hospital Augsburg, Augsburg, Germany
| |
Collapse
|
5
|
Schuh S, Sattler EC, Rubeck A, Schiele S, De Carvalho N, Themstrup L, Ulrich M, Jemec GBE, Holmes J, Pellacani G, Welzel J. Dynamic Optical Coherence Tomography of Blood Vessels in Cutaneous Melanoma-Correlation with Histology, Immunohistochemistry and Dermoscopy. Cancers (Basel) 2023; 15:4222. [PMID: 37686502 PMCID: PMC10487152 DOI: 10.3390/cancers15174222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/28/2023] [Accepted: 08/15/2023] [Indexed: 09/10/2023] Open
Abstract
Dermoscopy adds important information to the assessment of cutaneous melanoma, but the risk of progression is predicted by histologic parameters and therefore requires surgery and histopathologic preparation. Neo-vascularization is crucial for tumor progression and worsens prognosis. The aim of this study was the in vivo evaluation of blood vessel patterns in melanoma with dynamic optical coherence tomography (D-OCT) and the correlation with dermoscopic and histologic malignancy parameters for the risk assessment of melanoma. In D-OCT vessel patterns, shape, distribution and presence/type of branching of 49 melanomas were evaluated in vivo at three depths and correlated with the same patterns in dermoscopy and with histologic parameters after excision. In D-OCT, blood vessel density and atypical shapes (coils and serpiginous vessels) increased with higher tumor stage. The histologic parameters ulceration and Hmb45- and Ki67-positivity increased, whereas regression, inflammation and PD-L1-positivity decreased with risk. CD31, VEGF and Podoplanin correlated with D-OCT vasculature findings. B-RAF mutation status had no influence. Due to pigment overlay and the summation effect, the vessel evaluation in dermoscopy and D-OCT did not correlate well. In summary, atypical vessel patterns in melanoma correlate with histologic parameters for risk for metastases. Tumor vasculature can be noninvasively assessed using D-OCT before surgery.
Collapse
Affiliation(s)
- Sandra Schuh
- Department of Dermatology, University Hospital Augsburg, 86179 Augsburg, Germany;
| | - Elke Christina Sattler
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University of Munich, 80337 Munich, Germany;
| | - Anna Rubeck
- Institute of Mathematics, University of Augsburg, 86159 Augsburg, Germany; (A.R.); (S.S.)
| | - Stefan Schiele
- Institute of Mathematics, University of Augsburg, 86159 Augsburg, Germany; (A.R.); (S.S.)
| | - Nathalie De Carvalho
- Department of Dermatology, University of Modena and Reggio Emilia, 41124 Modena, Italy; (N.D.C.); (G.P.)
| | - Lotte Themstrup
- Department of Dermatology, Roskilde Hospital, Health Science Faculty, University of Copenhagen, 4000 Roskilde, Denmark; (L.T.); (G.B.E.J.)
| | | | - Gregor B. E. Jemec
- Department of Dermatology, Roskilde Hospital, Health Science Faculty, University of Copenhagen, 4000 Roskilde, Denmark; (L.T.); (G.B.E.J.)
| | - Jon Holmes
- Michelson Diagnostics, Maidstone ME14 5FY, UK;
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, 41124 Modena, Italy; (N.D.C.); (G.P.)
| | - Julia Welzel
- Department of Dermatology, University Hospital Augsburg, 86179 Augsburg, Germany;
| |
Collapse
|
6
|
Yang JW, Fan GB, Tan F, Kong HM, Liu Q, Zou Y, Tan YM. The role and safety of UVA and UVB in UV-induced skin erythema. Front Med (Lausanne) 2023; 10:1163697. [PMID: 37441686 PMCID: PMC10335810 DOI: 10.3389/fmed.2023.1163697] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 06/05/2023] [Indexed: 07/15/2023] Open
Abstract
Background Different wavelengths of ultraviolet (UV) light cause skin damage through different mechanisms. Minimal erythema dose (MED) is usually used to clinically evaluate skin sensitivity to ultraviolet radiation by inducing skin erythema using ultraviolet B (UVB) or ultraviolet A (UVA) + UVB. Aims In this study, we detected changes in the blood flow at the MED erythema caused by UVB and UVA + UVB radiation through optical coherence tomography (OCT) to explain the role of different bands of ultraviolet rays in erythema induction. Methods Two MED irradiation areas on the subjects' back were irradiated with UVB alone or UVA + UVB (UVA: UVB = 8:1). The absolute energy of UVB remained the same in UVB and UVA+UVB. At 24 h after the irradiation, the changes in the blood flow in the MED area were detected using OCT. Results Compared with the blank control, the maximum blood flow depth, blood flow peak, and total blood flow of UVB-MED and UVA+UVB-MED were significantly increased. Notably, the maximum blood flow depth and blood flow peak of UVB-MED were higher than UVA+UVB-MED. There was no significant difference in total blood perfusion between UVA+UVB-MED and UVB-MED. Under the same UVB energy, the skin erythema caused by UVA + UVB was weaker than UVB alone. Conclusions The analysis of local blood flow by OCT showed that the peak and maximum depth of local blood flow caused by UVB alone were significantly higher than UVA + UVB.
Collapse
Affiliation(s)
- Jing-Wen Yang
- Department of Skin and Cosmetics Research, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
- Professional Technical Service Platform for Clinical Evaluation of Skin Health Related Products, Shanghai Science and Technology Commission, Shanghai, China
- MPA Key Laboratory for Monitoring and Evaluation of Cosmetics, Shanghai, China
| | - Guo-Biao Fan
- Department China Regulatory Affairs, LVMH Perfume and Cosmetic (Shanghai) Limited Company, Shanghai, China
| | - Fei Tan
- Department of Skin and Cosmetics Research, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hai-Mei Kong
- Department of Skin and Cosmetics Research, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
- Professional Technical Service Platform for Clinical Evaluation of Skin Health Related Products, Shanghai Science and Technology Commission, Shanghai, China
- MPA Key Laboratory for Monitoring and Evaluation of Cosmetics, Shanghai, China
| | - Qing Liu
- Department China Regulatory Affairs, LVMH Perfume and Cosmetic (Shanghai) Limited Company, Shanghai, China
| | - Ying Zou
- Department of Skin and Cosmetics Research, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
- Professional Technical Service Platform for Clinical Evaluation of Skin Health Related Products, Shanghai Science and Technology Commission, Shanghai, China
- MPA Key Laboratory for Monitoring and Evaluation of Cosmetics, Shanghai, China
| | - Yi-Mei Tan
- Department of Skin and Cosmetics Research, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China
- Professional Technical Service Platform for Clinical Evaluation of Skin Health Related Products, Shanghai Science and Technology Commission, Shanghai, China
- MPA Key Laboratory for Monitoring and Evaluation of Cosmetics, Shanghai, China
- Human Phenome Institute, Fudan University, Shanghai, China
| |
Collapse
|
7
|
Holm KBE, Nielsen LJ, Lock-Andersen J, Behrendt N, Svensson MS, Themstrup L, Jemec GBE. Optical coherence tomography for presurgical delineation of basal cell carcinomas on the face-A comparison with histopathology. J Cutan Pathol 2023; 50:441-449. [PMID: 36794511 DOI: 10.1111/cup.14412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND To minimize the risk of incomplete excision of basal cell carcinomas (BCC) the macroscopic tumor margins should be adequately defined. Optical coherence tomography (OCT) is a non-invasive imaging tool that can provide structural and vascular information about skin cancer lesions. The study objective was to compare the presurgical delineation of facial BCC by clinical examination, histopathology, and OCT imaging in tumors undergoing full excision. METHODS Ten patients with BCC lesions on the face were examined clinically, with OCT and histopathology at 3-mm intervals, from the clinical lesion border and beyond the resection line. The OCT scans were evaluated blinded and a delineation estimate of each BCC lesion was made. The results were compared to the clinical and histopathologic results. RESULTS OCT evaluations and histopathology were in agreement in 86.6% of the collected data points. In three cases the OCT scans estimated a reduction of the tumor size compared to the clinical tumor border set by the surgeon. CONCLUSION The results of this study support the notion that OCT can have a role in the clinical daily practice by aiding clinicians in delineating BCC lesions before surgery.
Collapse
Affiliation(s)
- K B E Holm
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - L J Nielsen
- Department of Plastic and Breast Surgery, Zealand University Hospital, Roskilde, Denmark
| | - J Lock-Andersen
- Department of Plastic and Breast Surgery, Zealand University Hospital, Roskilde, Denmark
| | - N Behrendt
- Department of Pathology, Zealand University Hospital, Roskilde, Denmark
| | - M S Svensson
- Department of Pathology, Zealand University Hospital, Roskilde, Denmark
| | - L Themstrup
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
8
|
Dynamic Optical Coherence Tomography: A Non-Invasive Imaging Tool for the Distinction of Nevi and Melanomas. Cancers (Basel) 2022; 15:cancers15010020. [PMID: 36612016 PMCID: PMC9817967 DOI: 10.3390/cancers15010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/08/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Along with the rising melanoma incidence in recent decades and bad prognoses resulting from late diagnoses, distinguishing between benign and malignant melanocytic lesions has become essential. Unclear cases may require the aid of non-invasive imaging to reduce unnecessary biopsies. This multicentric, case-control study evaluated the potential of dynamic optical coherence tomography (D-OCT) to identify distinguishing microvascular features in nevi. A total of 167 nevi, including dysplastic ones, on 130 participants of all ages and sexes were examined by D-OCT and dermoscopy with a histological reference. Three blinded analyzers evaluated the lesions. Then, we compared the features to those in 159 melanomas of a prior D-OCT study and determined if a differential diagnosis was possible. We identified specific microvascular features in nevi and a differential diagnosis of melanomas and nevi was achieved with excellent predictive values. We conclude that D-OCT overcomes OCT´s inability to distinguish melanocytic lesions based on its focus on microvascularization. To determine if an addition to the gold standard of a clinical-dermoscopic examination improves the diagnosis of unclear lesions, further studies, including a larger sample of dysplastic nevi and artificial intelligence, should be conducted.
Collapse
|
9
|
Ha-Wissel L, Yasak H, Huber R, Zillikens D, Ludwig RJ, Thaçi D, Hundt JE. Case report: Optical coherence tomography for monitoring biologic therapy in psoriasis and atopic dermatitis. Front Med (Lausanne) 2022; 9:995883. [PMID: 36237538 PMCID: PMC9551172 DOI: 10.3389/fmed.2022.995883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Biologic therapies are increasingly used to treat chronic inflammatory skin diseases such as psoriasis and atopic dermatitis. In clinical practice, scores based on evaluation of objective and subjective symptoms are used to assess disease severity, leading to evaluation of treatment goals with clinical decisions on treatment initiation, switch to another treatment modality or to discontinue current treatment. However, this visual-based scoring is relatively subjective and inaccurate due to inter- and intraobserver reliability. Optical coherence tomography (OCT) is a fast, high-resolution, in vivo imaging modality that enables the visualization of skin structure and vasculature. We evaluated the use of OCT for quantification and monitoring of skin inflammation to improve objective assessment of disease activity in patients with psoriasis and atopic dermatitis. We assessed the following imaging parameters including epidermal thickness, vascular density, plexus depth, vessel diameter, and vessel count. A total of four patients with psoriasis or atopic dermatitis were treated with biologic agents according to current treatment guidelines. OCT was used to monitor their individual treatment response in a target lesion representing disease activity for 52 weeks. Psoriatic and eczema lesions exhibited higher epidermal thickness, increased vascular density, and higher vessel count compared to uninvolved skin. An upward shift of the superficial vascular plexus accompanied by smaller vessel diameters was seen in psoriasis in contrast to atopic dermatitis, where larger vessels were observed. A response to biologic therapy was characterized by normalization of the imaging parameters in the target lesions in comparison to uninvolved skin during the observation period of 52 weeks. Optical coherence tomography potentially serves as an instrument to monitor biologic therapy in inflammatory skin diseases. Imaging parameters may enable objective quantification of inflammation in psoriasis or atopic dermatitis in selected representative skin areas. OCT may reveal persistent subclinical inflammation in atopic dermatitis beyond clinical remission.
Collapse
Affiliation(s)
- Linh Ha-Wissel
- Department of Dermatology, Allergology and Venereology, University Hospital Schleswig-Holstein Lübeck (UKSH), Lübeck, Germany
- Institute for Inflammatory Medicine, University of Lübeck, Lübeck, Germany
- *Correspondence: Linh Ha-Wissel,
| | - Handan Yasak
- Institute for Inflammatory Medicine, University of Lübeck, Lübeck, Germany
| | - Robert Huber
- Institute of Biomedical Optics, University of Lübeck, Lübeck, Germany
| | - Detlef Zillikens
- Department of Dermatology, Allergology and Venereology, University Hospital Schleswig-Holstein Lübeck (UKSH), Lübeck, Germany
| | - Ralf J. Ludwig
- Department of Dermatology, Allergology and Venereology, University Hospital Schleswig-Holstein Lübeck (UKSH), Lübeck, Germany
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| | - Diamant Thaçi
- Institute for Inflammatory Medicine, University of Lübeck, Lübeck, Germany
| | - Jennifer E. Hundt
- Lübeck Institute of Experimental Dermatology (LIED), University of Lübeck, Lübeck, Germany
| |
Collapse
|
10
|
Dong LB, Wei YZ, Lan GP, Chen JT, Xu JJ, Qin J, An L, Tan HS, Huang YP. High resolution imaging and quantification of the nailfold microvasculature using optical coherence tomography angiography (OCTA) and capillaroscopy: a preliminary study in healthy subjects. Quant Imaging Med Surg 2022; 12:1844-1858. [PMID: 35284284 PMCID: PMC8899956 DOI: 10.21037/qims-21-672] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/11/2021] [Indexed: 11/19/2023]
Abstract
BACKGROUND A wide range of diseases, such as systemic sclerosis, can be diagnosed by imaging the nailfold microcirculation, which is conventionally performed using capillaroscopy. This study applied optical coherence tomography angiography (OCTA) as a novel high resolution imaging method for the qualitative and quantitative assessment of the nailfold microvasculature, and compared OCTA imaging with capillaroscopy. METHODS For qualitative assessment, high resolution OCTA imaging was used to achieve images that contained a wide field of view of the nailfold microvasculature through mosaic scanning. OCTA imaging was also used to observe the characteristic changes in the microvasculature under external compression of the upper arm. For quantitative evaluation, the capillary density and the capillary diameter of the nailfold microvasculature were assessed with both OCTA and capillaroscopy by repeated measurements over 2 days in 13 normal subjects. The results were analyzed using the intraclass correlation coefficient (ICC). RESULTS OCTA imaging showed the typical nailfold microvasculature pattern, part of which was not directly seen with the capillaroscopy. OCTA imaging revealed significant changes in the nailfold microvasculature when a large external pressure was applied via arm compression, but no significant changes were observed using capillaroscopy. The capillary density measured by OCTA and capillaroscopy was 6.8±1.5 and 7.0±1.2 loops/mm, respectively, which was not significantly different (P=0.51). However, the capillary diameter measured by OCTA was significantly larger than that measured using capillaroscopy (19.1±2.5 vs. 13.3±2.3 µm, P<0.001). The capillary diameter measurements using OCTA and capillaroscopy were highly reproducible (ICC =0.926 and 0.973, respectively). While the capillary diameter measured with OCTA was significantly larger, it was rather consistent with the diameter measured using capillaroscopy (ICC =0.705). CONCLUSIONS This study demonstrated that OCTA is a potentially viable and reproducible tool for the imaging and quantification of the capillaries in the nailfold microvasculature. The results of this study provide a solid basis for future applications of OCTA in qualitative and quantitative assessment of nailfold microcirculation in vivo.
Collapse
Affiliation(s)
- Li-Bin Dong
- School of Mechatronic Engineering and Automation, Foshan University, Foshan, China
| | - Ying-Zhao Wei
- School of Mechatronic Engineering and Automation, Foshan University, Foshan, China
| | - Gong-Pu Lan
- School of Physics and Optoelectronic Engineering, Foshan University, Foshan, China
- Guangdong-Hong Kong-Macao Joint Laboratory for Intelligent Micro-Nano Optoelectronic Technology, Foshan University, Foshan, China
- Innovation and Entrepreneurship Teams Project of Guangdong Pearl River Talents Program, Guangdong Weiren Meditech Co., Ltd., Foshan, China
| | - Jia-Tao Chen
- School of Mechatronic Engineering and Automation, Foshan University, Foshan, China
| | - Jing-Jiang Xu
- School of Physics and Optoelectronic Engineering, Foshan University, Foshan, China
- Guangdong-Hong Kong-Macao Joint Laboratory for Intelligent Micro-Nano Optoelectronic Technology, Foshan University, Foshan, China
- Innovation and Entrepreneurship Teams Project of Guangdong Pearl River Talents Program, Guangdong Weiren Meditech Co., Ltd., Foshan, China
| | - Jia Qin
- School of Physics and Optoelectronic Engineering, Foshan University, Foshan, China
- Guangdong-Hong Kong-Macao Joint Laboratory for Intelligent Micro-Nano Optoelectronic Technology, Foshan University, Foshan, China
- Innovation and Entrepreneurship Teams Project of Guangdong Pearl River Talents Program, Guangdong Weiren Meditech Co., Ltd., Foshan, China
| | - Lin An
- School of Physics and Optoelectronic Engineering, Foshan University, Foshan, China
- Guangdong-Hong Kong-Macao Joint Laboratory for Intelligent Micro-Nano Optoelectronic Technology, Foshan University, Foshan, China
- Innovation and Entrepreneurship Teams Project of Guangdong Pearl River Talents Program, Guangdong Weiren Meditech Co., Ltd., Foshan, China
| | - Hai-Shu Tan
- School of Physics and Optoelectronic Engineering, Foshan University, Foshan, China
- Guangdong-Hong Kong-Macao Joint Laboratory for Intelligent Micro-Nano Optoelectronic Technology, Foshan University, Foshan, China
| | - Yan-Ping Huang
- School of Physics and Optoelectronic Engineering, Foshan University, Foshan, China
- Guangdong-Hong Kong-Macao Joint Laboratory for Intelligent Micro-Nano Optoelectronic Technology, Foshan University, Foshan, China
- Innovation and Entrepreneurship Teams Project of Guangdong Pearl River Talents Program, Guangdong Weiren Meditech Co., Ltd., Foshan, China
| |
Collapse
|
11
|
Ruini C, Daxenberger F, Gust C, Schuh S, French LE, Welzel J, Sattler EC. [Advances in optical coherence tomography]. Hautarzt 2021; 72:1048-1057. [PMID: 34698874 DOI: 10.1007/s00105-021-04905-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Abstract
Optical coherence tomography (OCT) has been able to establish itself in recent years not only in academic-scientific, but also in everyday dermatological practice. Its focus lies on epithelial tumors of the skin, which can be diagnosed intuitively and within a few seconds. Thus, basal cell carcinomas, actinic keratoses, and different stages of field cancerization can be diagnosed and monitored for response to therapy or possible recurrence. This often helps to avoid invasive sample extraction. Recently, the field of OCT and its latest advancement, dynamic OCT (D-OCT), has been expanded to include non-oncologic dermatological diseases. This encompasses inflammatory dermatoses and the analysis of physiological skin parameters such as hydration. Thanks to automated vascular imaging and the measurement of objective parameters such as epidermal thickness, blood flow at depth, optical attenuation coefficient, and skin roughness, more and more characteristics of the skin can be studied in a noninvasive and standardized way. New potential areas of application are eczema, contact allergic dermatitis, psoriasis, rosacea, telangiectasia, acute and chronic wounds, melasma and nevus flammeus but also melanocytic lesions.
Collapse
Affiliation(s)
- Cristel Ruini
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, Frauenlobstr. 9-11, 80337, München, Deutschland. .,Doctorate School (PhD) in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italien.
| | - Fabia Daxenberger
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, Frauenlobstr. 9-11, 80337, München, Deutschland
| | - Charlotte Gust
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, Frauenlobstr. 9-11, 80337, München, Deutschland
| | - Sandra Schuh
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Lars E French
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, Frauenlobstr. 9-11, 80337, München, Deutschland.,Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, USA
| | - Julia Welzel
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Elke C Sattler
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, Frauenlobstr. 9-11, 80337, München, Deutschland
| |
Collapse
|
12
|
Abignano G, Green L, Eng S, Emery P, Del Galdo F. Nailfold Microvascular Imaging by Dynamic Optical Coherence Tomography in Systemic Sclerosis: A Case-Controlled Pilot Study. J Invest Dermatol 2021; 142:1050-1057. [PMID: 34571001 DOI: 10.1016/j.jid.2021.08.436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/21/2021] [Accepted: 08/08/2021] [Indexed: 11/29/2022]
Abstract
In systemic sclerosis, outcome measures of skin microvasculopathy are needed for both clinical trials and practice. The aim of this study was to determine whether dynamic-optical coherence tomography (D-OCT) is able to provide information on microvasculopathy compared with the current gold standard, nailfold videocapillaroscopy (NVC), in patients with systemic sclerosis. This case-controlled study included (i) 40 patients with systemic sclerosis, classified by NVC pattern in four age- and sex-matched groups (normal/nonspecific, early, active, late); (ii) a fifth group of 10 age- and sex-matched healthy controls. All participants underwent NVC and D-OCT. D-OCT images were compared with the corresponding NVC images. Reliability was assessed. D-OCT images visualized the corresponding NVC patterns. D-OCT microvascular flow density was different across the five NVC pattern groups (P = 0.0114) with a significant trend test (P = 0.0006). Microvascular flow density correlated with the NVC semiquantitative score (r = -0.7, P < 0.0001), number of abnormal shapes/mm (r = ‒0.3, P = 0.0264), and number of capillaries/mm (r = 0.6, P < 0.0001). Reliability was excellent (intraclass correlation coefficient > 0.9). In conclusion, in patients with systemic sclerosis, D-OCT provided qualitative and quantitative information on nailfold microvasculopathy, showing a correlation between microvascular flow density and NVC scores. The development of D-OCT as a standardized imaging technique could provide a quantitative outcome measure in clinical trials and practice.
Collapse
Affiliation(s)
- Giuseppina Abignano
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds, United Kingdom; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom; Rheumatology Institute of Lucania (IReL) and Rheumatology Department of Lucania, San Carlo Regional Hospital, Potenza, Italy.
| | - Lorraine Green
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds, United Kingdom; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Sookhoe Eng
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds, United Kingdom; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds, United Kingdom; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Francesco Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds, United Kingdom; NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| |
Collapse
|
13
|
Ruini C, Schuh S, Gust C, Kendziora B, Frommherz L, French LE, Hartmann D, Welzel J, Sattler EC. Line-field confocal optical coherence tomography for the in vivo real-time diagnosis of different stages of keratinocyte skin cancer: a preliminary study. J Eur Acad Dermatol Venereol 2021; 35:2388-2397. [PMID: 34415646 DOI: 10.1111/jdv.17603] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The treatment of keratinocyte cancers (KC) strictly depends on their differentiation and invasiveness. Non-invasive diagnostic techniques can support the diagnosis in real time, avoiding unnecessary biopsies. This study aimed to preliminarily define main imaging criteria and histological correlations of actinic keratosis (AK), Bowen's disease (BD) and squamous cell carcinoma (SCC) using the novel device line-field confocal optical coherence tomography (LC-OCT). METHODS Dermoscopy and LC-OCT images of 73 histopathologically confirmed lesions (46 AKs, 11 BD and 16 SCCs) were included in the study. Exemplary lesions (10 AKs, 5 BD and 5 SCCs) were additionally investigated with optical coherence tomography and reflectance confocal microscopy. RESULTS Most common LC-OCT findings of KC in the descriptive statistics were hyperkeratosis/parakeratosis, disruption of stratum corneum, broadened epidermis, basal and suprabasal keratinocyte atypia, dilated vessels/neoangiogenesis and elastosis/collagen alterations. In the univariate multinomial logistic regression, a preserved DEJ was less common in SCC compared with AK and BD, BD displayed marked keratinocyte atypia involving all epidermal layers (bowenoid pattern), while SCC showed ulceration, increased epidermal thickness, keratin plugs, acantholysis, not visible/interrupted DEJ and epidermal bright particles. LC-OCT increased the diagnostic confidence by 24.7% compared with dermoscopy alone. CONCLUSIONS Our study describes for the first time specific LC-OCT features of different stages of KC and their histopathological correlates, focusing on keratinocyte morphology and architecture of the epidermis and DEJ. LC-OCT may open new scenarios in the bedside diagnosis, treatment planning and follow-up of KC.
Collapse
Affiliation(s)
- C Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany.,PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - S Schuh
- Department of Dermatology and Allergy, University Hospital, Augsburg, Germany
| | - C Gust
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - B Kendziora
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - L Frommherz
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - L E French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany.,Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - D Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - J Welzel
- Department of Dermatology and Allergy, University Hospital, Augsburg, Germany
| | - E C Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| |
Collapse
|
14
|
Fuchs CSK, Ortner VK, Hansen FS, Philipsen PA, Haedersdal M. Subclinical effects of adapalene-benzoyl peroxide: a prospective in vivo imaging study on acne micromorphology and transfollicular delivery. J Eur Acad Dermatol Venereol 2021; 35:1377-1385. [PMID: 33508886 DOI: 10.1111/jdv.17140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/14/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Adapalene-benzoyl peroxide (A-BPO) is a first-line topical treatment for acne vulgaris. In vivo reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) detect micromorphological changes over time and visualize transfollicular delivery. OBJECTIVES To visualize temporal, subclinical effects of A-BPO on acne micromorphology using RCM and OCT, and evaluate their impact on transfollicular delivery of microparticulate carrier systems. METHODS Fifteen patients with mild to moderate acne received a 6-week course of A-BPO. Micromorphological changes were evaluated at time 0, 3 and 6 weeks with RCM (n = 1190 images) and OCT (n = 210 scans). Transfollicular delivery of microparticles was assessed at baseline and week 6. RESULTS In vivo imaging visualized steady normalization of skin micromorphology in response to A-BPO over 6 weeks, including decreased hyperkeratinization of follicular borders (RCM median decrease -71.2%, P < 0.05), reduced intrafollicular keratinous content (RCM median decrease -47.7%, P < 0.05) and increased epidermal thickness (OCT median increase of 25.25%, P < 0.05). Imaging visualized microparticles in the follicular unit. Despite a visible reduction in keratin and sebum, transfollicular microparticle delivery appeared unaffected. CONCLUSIONS Reflectance confocal microscopy and OCT detect A-BPO-induced changes in micromorphology and visualize transfollicular microparticle delivery. Keratolysis and sebolysis did not have a measurable effect on transfollicular delivery of microparticles.
Collapse
Affiliation(s)
- C S K Fuchs
- Department of Dermatology, University of Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - V K Ortner
- Department of Dermatology, University of Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - F S Hansen
- Department of Dermatology, University of Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - P A Philipsen
- Department of Dermatology, University of Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - M Haedersdal
- Department of Dermatology, University of Copenhagen, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| |
Collapse
|
15
|
Welzel J, Schuh S, De Carvalho N, Themstrup L, Ulrich M, Jemec GBE, Holmes J, Pellacani G. Dynamic optical coherence tomography shows characteristic alterations of blood vessels in malignant melanoma. J Eur Acad Dermatol Venereol 2021; 35:1087-1093. [PMID: 33300200 DOI: 10.1111/jdv.17080] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 10/13/2020] [Accepted: 10/21/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Dynamic optical coherence tomography (D-OCT) allows in vivo visualization of blood vessels in the skin and in malignant tumours. Vessel patterns in malignant melanoma may be associated with tumour stage. OBJECTIVE The aim of this study was to describe blood vessel patterns in melanomas and to correlate them with stage. METHODS One hundred fifty-nine malignant melanomas were assessed in a multicentre study. Every tumour was imaged using D-OCT prior to surgery and histologic evaluation. The tumour data such as thickness and ulceration as well as the staging at primary diagnosis and a follow-up of at least 40 months resulted in a stage classification. The vessel patterns were assessed according to predefined categories, compared with healthy adjacent skin, and correlated to stage. RESULTS Melanomas contained more blood vessels in different patterns compared with healthy adjacent skin. In particular, irregular vascular shapes such as blobs, coils, curves and serpiginous vessels were more common in melanomas. In addition, these patterns were significantly more often found in high-risk and metastatic melanomas than in low-risk lesions. CONCLUSION In melanomas, the density of the blood vessels is increased, and irregular vascular patterns are more frequent. At higher stages, especially in metastatic melanomas, these atypical vessels are significantly more common.
Collapse
Affiliation(s)
- J Welzel
- Department of Dermatology, University Hospital Augsburg, Augsburg, Germany
| | - S Schuh
- Department of Dermatology, University Hospital Augsburg, Augsburg, Germany
| | - N De Carvalho
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - L Themstrup
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - M Ulrich
- CMB Collegium Medicum Berlin, Berlin, Germany
| | - G B E Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - J Holmes
- Michelson Diagnostics, Maidstone, UK
| | - G Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
16
|
Pomerantz H, Christman MP, Bloom BS, Lederhandler M, Feng H, Holmes J, Geronemus RG. Dynamic Optical Coherence Tomography of Cutaneous Blood Vessels in Melasma and Vessel Response to Oral Tranexamic Acid. Lasers Surg Med 2020; 53:861-864. [PMID: 33161588 DOI: 10.1002/lsm.23345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/13/2020] [Accepted: 10/16/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Melasma may be related to aberrant blood vessels, but there has been no report on the utility of dynamic optical coherence tomography (D-OCT) in studying vessel characteristics in melasma. We studied the characteristics of cutaneous blood vessels in melasma and the effects of oral tranexamic acid (TXA) with D-OCT. STUDY DESIGN/MATERIALS AND METHODS Six patients with moderate to severe melasma had a D-OCT scanning of the areas on the face affected by melasma and not affected by it. Three of them had scans within 3 months after starting oral TXA and at a follow-up visit. Blood flow at different depths of the skin and vessel diameter were compared between the melasma and normal skin. For those taking oral TXA, we compared the percent change of blood flow and diameter between the melasma and normal skin. RESULTS Dermal blood flow and vessel diameter were greater in the melasma skin than in the normal skin. Oral TXA reduced dermal blood flow in both the melasma and normal skin, but the reduction was more dramatic in the lesional melasma skin. CONCLUSIONS D-OCT findings that (i) dermal blood vessels in melasma are increased in size and flow and (ii) oral TXA reduced the vessel size and flow, providing evidence supporting the relationship between melasma and cutaneous blood vessels. D-OCT may be utilized in measuring response to treatments targeting melasma. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
Collapse
Affiliation(s)
| | | | - Bradley S Bloom
- Laser & Skin Surgery Center of New York, New York, New York.,The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Margo Lederhandler
- Laser & Skin Surgery Center of New York, New York, New York.,The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | | | - Roy G Geronemus
- Laser & Skin Surgery Center of New York, New York, New York.,The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York
| |
Collapse
|
17
|
Ruini C, Rahimi F, Fiocco Z, French LE, Hartmann D, Oppel E, Sattler E. Optical coherence tomography for patch test grading: A prospective study on its use for noninvasive diagnosis of allergic contact dermatitis. Contact Dermatitis 2020; 84:183-191. [PMID: 33012002 DOI: 10.1111/cod.13714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 09/27/2020] [Accepted: 10/01/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The diagnosis of allergic contact dermatitis should be confirmed by skin patch tests. Distinguishing between irritant and allergic reactions is sometimes difficult. OBJECTIVES To analyse the in vivo morphological changes in patch test reactions compared to healthy skin, and to detect subclinical changes in doubtful reactions using optical coherence tomography (OCT). To develop an OCT-based algorithm to support patch-test grading. METHODS One hundred twenty-nine skin patch-test areas were scanned with OCT to evaluate the following features: architectural and vascular morphology, epidermal thickness, optical attenuation coefficient (AC), and blood flow at 0.1, 0.2, and 0.35 mm depth. RESULTS Most common OCT features of acute contact allergic reactions in patch tests were spongiosis with microvesicles (94.8%), macrovesicles (60.3%), and coalescing vesicles (46.6%), the latter useful in differentiating acute allergic from irritant dermatitis (P-value < .05). Objective quantitative parameters correlated well with the severity grade: epidermal thickness due to spongiosis, AC (P-value < .05) and blood flow at 0.2 and 0.35 mm (P-value < .01). CONCLUSIONS OCT as a noninvasive diagnostic tool, established for skin cancer diagnosis, is useful for evaluating contact allergic patch-test reactions. Not only morphological but also objective features such as blood flow and AC correlate with the reaction severity. Further studies are needed to explore the differences in irritant and allergic contact dermatitis.
Collapse
Affiliation(s)
- Cristel Ruini
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University, Munich, Germany.,Department of Dermatology and PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Farnaz Rahimi
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Zeno Fiocco
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Lars E French
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University, Munich, Germany.,Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Daniela Hartmann
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Eva Oppel
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Elke Sattler
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University, Munich, Germany
| |
Collapse
|
18
|
Yélamos O, Alejo B, Ertekin SS, Villa-Crespo L, Zamora-Barquero S, Martinez N, Domínguez M, Iglesias P, Herrero A, Malvehy J, Puig S. Non-invasive clinical and microscopic evaluation of the response to treatment with clobetasol cream vs. calcipotriol/betamethasone dipropionate foam in mild to moderate plaque psoriasis: an investigator-initiated, phase IV, unicentric, open, randomized clinical trial. J Eur Acad Dermatol Venereol 2020; 35:143-149. [PMID: 32365242 PMCID: PMC7818495 DOI: 10.1111/jdv.16559] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/10/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Treatment response for psoriasis is typically evaluated using clinical scores. However, patients can relapse after clinical clearance, suggesting persistent inflammation. Dermoscopy, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) can non-invasively improve treatment response assessment. OBJECTIVES To compare the clinical and non-invasive microscopic features in a psoriatic target lesion treated with clobetasol cream or calcipotriol/betamethasone dipropionate foam (Cal/BD foam). METHODS Prospective, unicentric, open, randomized clinical trial comparing clinical data [total clinical score (TCS)] and microscopic data (dermoscopy, RCM and OCT) in psoriasis patients treated with clobetasol or Cal/BD foam. RESULTS We included 36 adult patients (22 men). At week 4, more patients treated with Cal/BD foam achieved TCS ≤1 than with clobetasol (63.2% vs. 18.8%, P = 0.016). Treatment satisfaction was higher with Cal/BD foam (P < 0.03). Microscopically, Cal/BD foam induced more reduction in epidermal thickness at week 4 (P < 0.049). Dilated horizontal blood vessels were more common with clobetasol than with Cal/BD foam at week 8 (69.2% vs. 31.2%, P = 0.159). If epidermal hyperplasia was noted at baseline, the response was poorer with clobetasol (P = 0.029). LIMITATIONS Small sample size, open study, imaging sampling bias. CONCLUSION Cal/BD foam is more effective than clobetasol, has better patient satisfaction and induces greater reduction in the hyperkeratosis/acanthosis, regardless of baseline epidermal hyperplasia.
Collapse
Affiliation(s)
- O Yélamos
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.,Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain.,Department of Dermatology, Centro Médico Teknon - Quirónsalud, Barcelona, Spain
| | - B Alejo
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - S S Ertekin
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - L Villa-Crespo
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - S Zamora-Barquero
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - N Martinez
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - M Domínguez
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - P Iglesias
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - A Herrero
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - J Malvehy
- CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
| | - S Puig
- CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
19
|
Taudorf EH, Olsen J, Lindsø Andersen P, Bouazzi D, Jemec GBE. Dynamic Optical Coherence Tomography Imaging of Telangiectasia Prior to Intense Pulsed Light Treatment-An Opportunity to Target Treatment? Lasers Surg Med 2020; 53:212-218. [PMID: 32533557 DOI: 10.1002/lsm.23280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/25/2020] [Accepted: 05/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate whether optical coherence tomography (OCT) could be utilized to characterize blood flow and vessel dimensions of facial telangiectasias before and during consecutive intense pulsed light (IPL) treatment. STUDY DESIGN/MATERIALS AND METHODS Dynamic OCT (D-OCT) was used to image telangiectasia immediately before and after, 1-3 days after, and 1 month after IPL treatment. Measurements included vessel width and depth, blood flow, and attenuation. Vessel dimensions at baseline were verified by a blinded observer. Clinical improvement was detected as good, moderate, or none, and adverse effects were registered at 1-month follow-up. RESULTS In total, 14 patients with facial telangiectasia were included. At baseline, vessel width was median 0.25 mm (interquartile range [IQR]: 0.19-0.34 mm) with an intra-class coefficient (ICC) of 0.89 (95% confidence interval [CI]: 0.70; 0.97). Vessel depth was 0.30 mm (IQR: 0.25-0.33 mm; ICC: 0.40 [CI: -0.07; 0.75]). Vessel depth increased significantly from baseline to 1-month follow-up (P = 0.008), whereas no significant changes in vessel width, blood flow, or attenuation were detected. Clinical efficacy seemed related to the relation between vessel dimensions and applied energy settings. CONCLUSIONS The D-OCT imaging technique demonstrated that facial telangiectasias were found deeper within the skin after one IPL treatment. By characterizing the vessel dimensions and blood flow of telangiectasia, D-OCT may improve efficacy and safety of IPL. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
Collapse
Affiliation(s)
- Elisabeth H Taudorf
- Department of Dermatology, Health Sciences Faculty, Zealand University Hospital, University of Copenhagen, Sygehusvej 5, Roskilde, 4000, Denmark
| | - Jonas Olsen
- Department of Dermatology, Health Sciences Faculty, Zealand University Hospital, University of Copenhagen, Sygehusvej 5, Roskilde, 4000, Denmark
| | - Pernille Lindsø Andersen
- Department of Dermatology, Health Sciences Faculty, Zealand University Hospital, University of Copenhagen, Sygehusvej 5, Roskilde, 4000, Denmark
| | - Dorra Bouazzi
- Department of Dermatology, Health Sciences Faculty, Zealand University Hospital, University of Copenhagen, Sygehusvej 5, Roskilde, 4000, Denmark
| | - Gregor B E Jemec
- Department of Dermatology, Health Sciences Faculty, Zealand University Hospital, University of Copenhagen, Sygehusvej 5, Roskilde, 4000, Denmark
| |
Collapse
|
20
|
Manfredini M, Liberati S, Ciardo S, Bonzano L, Guanti M, Chester J, Kaleci S, Pellacani G. Microscopic and functional changes observed with dynamic optical coherence tomography for severe refractory atopic dermatitis treated with dupilumab. Skin Res Technol 2020; 26:779-787. [DOI: 10.1111/srt.12868] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/02/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Marco Manfredini
- Dermatology Unit Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine University of Modena & Reggio Emilia Modena Italy
| | - Serena Liberati
- Allergology Unit Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine University of Modena & Reggio Emilia Modena Italy
| | - Silvana Ciardo
- Dermatology Unit Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine University of Modena & Reggio Emilia Modena Italy
| | - Laura Bonzano
- Allergology Unit Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine University of Modena & Reggio Emilia Modena Italy
| | - Mario Guanti
- Allergology Unit Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine University of Modena & Reggio Emilia Modena Italy
| | - Johanna Chester
- Dermatology Unit Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine University of Modena & Reggio Emilia Modena Italy
| | - Shaniko Kaleci
- Dermatology Unit Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine University of Modena & Reggio Emilia Modena Italy
| | - Giovanni Pellacani
- Dermatology Unit Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant, Oncological & Regenerative Medicine University of Modena & Reggio Emilia Modena Italy
| |
Collapse
|
21
|
Rajabi-Estarabadi A, Vasquez-Herrera NE, Martinez-Velasco MA, Tsatalis J, Verne SH, Nouri K, Tosti A. Optical coherence tomography in diagnosis of inflammatory scalp disorders. J Eur Acad Dermatol Venereol 2020; 34:2147-2151. [PMID: 32078188 DOI: 10.1111/jdv.16304] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 01/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The common inflammatory scalp disorders share similar clinical manifestations, and patient work up require invasive, undesirable diagnostic procedures like biopsy to ensure correct diagnosis. Optical coherence tomography (OCT) is a non-invasive high-resolution imaging modality that has found a valuable tool to assist in the diagnose and evaluation of different skin diseases. OBJECTIVES To describe the structural and vascular dynamic OCT (D-OCT) findings of inflammatory scalp disorders including scalp psoriasis, seborrhoeic dermatitis and contact dermatitis and to compare trichoscopy and OCT features. METHODS Subjects with diagnosis of seborrhoeic dermatitis, psoriasis or contact dermatitis were enrolled in this study. OCT scans were taken on involved scalp, and the same scalp regions were evaluated by trichoscopy and compared with healthy scalp. RESULTS A total of fourteen subjects (two healthy controls, four seborrhoeic dermatitis, five psoriasis and three contact dermatitis) participated. D-OCT imaging of vascular pattern in healthy scalp and the inflammatory scalp disorders were described. D-OCT images could enhance the clinician's ability to distinguish psoriasis from seborrhoeic dermatitis by objectively detect and assess red loop density. In scalp contact dermatitis, the vessels of the deep plexus were more dilated and fewer in number than those found in seborrhoeic dermatitis. CONCLUSION Dynamic OCT provides information that more clearly elucidates changes at the level of the superficial and deep plexuses without invasively interfering with superficial structures. In the context of inflammatory scalp disorders, this is useful to discern disorders with overlapping symptoms and minimize the use of invasive biopsies to diagnose.
Collapse
Affiliation(s)
- A Rajabi-Estarabadi
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - M A Martinez-Velasco
- Oncodermatology and Trichology Clinic, National University of Mexico, Mexico City, Mexico
| | - J Tsatalis
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - S H Verne
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - K Nouri
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - A Tosti
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| |
Collapse
|
22
|
Jiang WC, Zhang H, Xu Y, Jiang C, Xu Y, Liu W, Tan Y. Cutaneous vessel features of sensitive skin and its underlying functions. Skin Res Technol 2019; 26:431-437. [PMID: 31793701 PMCID: PMC7317501 DOI: 10.1111/srt.12819] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/09/2019] [Indexed: 11/29/2022]
Abstract
Background Following the sufficient studies of the effects of skin barrier impairment and heightened neural reaction on sensitive skin (SS), many scholars have paid great attention to the roles of superficial microvasculature in SS. Methods By questionnaire survey, lactic acid sting test, and capsaicin test, eligible subjects were classified as normal skin, only lactic acid sting test positive (LASTP), only capsaicin test positive (CATP), and both positive (both LASTP and CATP). D‐OCT was used to photograph images for evaluating the cutaneous vessels features each group. Results Totally 137 subjects completed the study. Compared with LASTN group, the vascular vessels were closer to epidermis in LASTP group. Mesh and branching vessels were more popular in SS than normal skin. High blood vessel density was more prevalent in SS, while low density frequently presented in normal skin. The vascular depth had a closely negative correlation with face flushing and SSS, and vascular shapes had a good positive correlation with face flushing and SSB. Conclusions Our study indicates that there is a significant difference in vascular depth, shape, and density between SS and normal skin which is valuable to explore SS pathologic mechanism and to further investigate cutaneous microvasculature functions in SS.
Collapse
Affiliation(s)
- Wen-Cai Jiang
- Skin and Cosmetic Research Department, Shanghai Dermatology Hospital, Shanghai, China.,School of Life Science, Fudan University, Shanghai, China
| | - Hui Zhang
- Nursing Department, Yangpu Hospital, Tongji University, Shanghai, China
| | - Yafei Xu
- Skin and Cosmetic Research Department, Shanghai Dermatology Hospital, Shanghai, China
| | - Changqing Jiang
- Skin and Cosmetic Research Department, Shanghai Dermatology Hospital, Shanghai, China
| | - Yingying Xu
- Skin and Cosmetic Research Department, Shanghai Dermatology Hospital, Shanghai, China
| | - Wei Liu
- Department of Dermatology, the General Hospital of Air Force, Haidian, China
| | - Yimei Tan
- Skin and Cosmetic Research Department, Shanghai Dermatology Hospital, Shanghai, China.,School of Life Science, Fudan University, Shanghai, China
| |
Collapse
|
23
|
Guida S, Ciardo S, De Pace B, De Carvalho N, Peccerillo F, Manfredini M, Farnetani F, Chester J, Kaleci S, Manganelli M, Guida G, Pellacani G. The influence of MC1R on dermal morphological features of photo-exposed skin in women revealed by reflectance confocal microscopy and optical coherence tomography. Exp Dermatol 2019; 28:1321-1327. [PMID: 31520496 DOI: 10.1111/exd.14037] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/01/2019] [Accepted: 09/06/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The melanocortin 1 receptor (MC1R) gene is one of the major determinants of skin pigmentation. It is a highly polymorphic gene and some of its polymorphisms have been related to specific skin phenotypes, increased risk of skin cancers and skin photoageing. Currently, its contribution to changes in dermal features in photo-exposed skin is unknown. OBJECTIVE The main objective of this study is to evaluate the potential correlation between MC1R status and specific healthy photo-exposed skin characteristics. MATERIALS AND METHODS Skin facial features were estimated by evaluation with standard digital photography with automated features count, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) in 100 healthy women. Skin of the forearms was used as a control. RESULTS The study found an association between RHC MC1R polymorphisms and dermal features in photo-exposed areas being represented by increased vessel density and pixel density in OCT (P = .025 and P = .001, respectively) and increased coarse collagen in RCM (P = .034), as compared to non-RHC subjects. To our knowledge this is previously unreported. Additionally, previously reported correlations between light hair colour and pigmented spots with MC1R RHC polymorphisms have been confirmed. CONCLUSIONS Our results suggest the role of RHC MC1R variants in dermal variations of facial skin, as compared to non-RHC variants. To our knowledge this is previously unreported.
Collapse
Affiliation(s)
- Stefania Guida
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Science with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Silvana Ciardo
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Science with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara De Pace
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Science with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Nathalie De Carvalho
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Science with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Peccerillo
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Science with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Manfredini
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Science with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Farnetani
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Science with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Johanna Chester
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Science with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Shaniko Kaleci
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Science with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Michele Manganelli
- Molecular Biology Section, Department of Basic Medical Sciences Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Gabriella Guida
- Molecular Biology Section, Department of Basic Medical Sciences Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Giovanni Pellacani
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Science with Interest Transplant, Oncological and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
24
|
Garbarino F, Migliorati S, Farnetani F, De Pace B, Ciardo S, Manfredini M, Reggiani Bonetti L, Kaleci S, Chester J, Pellacani G. Nodular skin lesions: correlation of reflectance confocal microscopy and optical coherence tomography features. J Eur Acad Dermatol Venereol 2019; 34:101-111. [DOI: 10.1111/jdv.15953] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/13/2019] [Indexed: 12/24/2022]
Affiliation(s)
| | | | - F. Farnetani
- Dermatology Unit University of Modena and Reggio Emilia Modena Italy
| | - B. De Pace
- Dermatology Unit University of Modena and Reggio Emilia Modena Italy
| | - S. Ciardo
- Dermatology Unit University of Modena and Reggio Emilia Modena Italy
| | - M. Manfredini
- Dermatology Unit University of Modena and Reggio Emilia Modena Italy
| | | | - S. Kaleci
- Dermatology Unit University of Modena and Reggio Emilia Modena Italy
| | - J. Chester
- Dermatology Unit University of Modena and Reggio Emilia Modena Italy
| | - G. Pellacani
- Dermatology Unit University of Modena and Reggio Emilia Modena Italy
| |
Collapse
|
25
|
Chaseling GK, Crandall CG, Gagnon D. Skin blood flow measurements during heat stress: technical and analytical considerations. Am J Physiol Regul Integr Comp Physiol 2019; 318:R57-R69. [PMID: 31596109 DOI: 10.1152/ajpregu.00177.2019] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
During heat stress, the skin vasculature can greatly increase conductance secondary to vasodilation. The subsequent increase in skin blood flow allows for convective heat transfer from the core to the skin and between the skin surface and the surrounding environment. Measurement of skin blood flow, therefore, provides valuable information regarding heat exchange between the body and the environment. In addition, assessment of skin blood flow can be used to study vascular control mechanisms. Most often, skin blood flow is measured by venous occlusion plethysmography, Doppler ultrasound, laser-Doppler flowmetry, and, more recently, optical coherence tomography. However, important delimitations to each of these methods, which may be dependent on the research question, must be considered when responses from these approaches are interpreted. In this brief review, we discuss these methods of skin blood flow measurement and highlight potential sources of error and limitations. We also provide recommendations to guide the interpretation of skin blood flow data.
Collapse
Affiliation(s)
- Georgia K Chaseling
- Cardiovascular Prevention and Rehabilitation Centre, Montreal Heart Institute, Montréal, Québec, Canada.,Département de Pharmacologie et Physiologie, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Craig G Crandall
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and University of Texas Southwestern Medical Center, Dallas, Texas
| | - Daniel Gagnon
- Cardiovascular Prevention and Rehabilitation Centre, Montreal Heart Institute, Montréal, Québec, Canada.,Département de Pharmacologie et Physiologie, Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| |
Collapse
|
26
|
Optical coherence tomography of onychomycosis: proposed terminology and a suggestion of practical usage. Arch Dermatol Res 2019; 312:51-58. [PMID: 31595307 DOI: 10.1007/s00403-019-01989-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/09/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
Abstract
Onychomycosis is the most common cause of nail changes accounting for about half of all nail diseases. It is important to diagnose the fungal pathogen to prescribe adequate treatment, but as genus- and species-specific diagnostic tests can be time consuming and expensive, it is crucial to obtain representative tissue during nail scrapings. Optical coherence tomography (OCT) is a non-invasive imaging tool enabling real-time imaging of skin and tissue. Pilot studies using OCT have described morphological characteristics of onychomycosis, though diagnostic criteria of onychomycosis and other nail diseases are lacking. The aim of this study is to investigate the applicability of OCT to detect and localize fungal elements in nails with clinical signs of onychomycosis. OCT scans and nail scrapings were performed on all participants and only confirmed cases of onychomycosis were included in the data analysis. All scans were analyzed, and a set of morphological criteria based on known literature and deviations from healthy nail morphology were suggested. The suggested morphological features were: hyperreflective lines divided into sharply and diffusely demarcated; hyperreflective dots divided into singular and clustered patterns; irregular surface, divided into mild, moderate and severe degree; dark bands and disturbed architecture. The suggested OCT morphology is a refinement of previous studies, and though OCT cannot replace genus- or species-specific identification, it could be a useful assistance tool to increase diagnostic sensitivity of nail scrapings and laboratory tests as well as for monitoring treatment response.
Collapse
|
27
|
|
28
|
Liu M, Drexler W. Optical coherence tomography angiography and photoacoustic imaging in dermatology. Photochem Photobiol Sci 2019; 18:945-962. [PMID: 30735220 DOI: 10.1039/c8pp00471d] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Optical coherence tomography angiography (OCTA) is a relatively novel functional extension of the widely accepted ophthalmic imaging tool named optical coherence tomography (OCT). Since OCTA's debut in ophthalmology, researchers have also been trying to expand its translational application in dermatology. The ability of OCTA to resolve microvasculature has shown promising results in imaging skin diseases. Meanwhile, photoacoustic imaging (PAI), which uses laser pulse induced ultrasound waves as the signal, has been studied to differentiate human skin layers and to help in skin disease diagnosis. This perspective article gives a short review of OCTA and PAI in the field of photodermatology. After an introduction to the principles of OCTA and PAI, we describe the most updated results of skin disease imaging using these two optical imaging modalities. We also place emphasis on dual modality imaging combining OCTA and photoacoustic tomography (PAT) for dermatological applications. In the end, the challenges and prospects of these two imaging modalities in dermatology are discussed.
Collapse
Affiliation(s)
- Mengyang Liu
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, 1090 Vienna, Austria.
| | | |
Collapse
|
29
|
Manfredini M, Bettoli V, Sacripanti G, Farnetani F, Bigi L, Puviani M, Corazza M, Pellacani G. The evolution of healthy skin to acne lesions: a longitudinal,
in vivo
evaluation with reflectance confocal microscopy and optical coherence tomography. J Eur Acad Dermatol Venereol 2019; 33:1768-1774. [DOI: 10.1111/jdv.15641] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 04/03/2019] [Indexed: 11/26/2022]
Affiliation(s)
- M. Manfredini
- Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant Oncological & Regenerative Medicine Dermatology Unit University of Modena & Reggio Emilia Modena Italy
- Department of Medical Sciences Section of Dermatology University of Ferrara Ferrara Italy
- Dermatology Unit Nuovo Ospedale Civile di Sassuolo Sassuolo Italy
| | - V. Bettoli
- Department of Medical Sciences Section of Dermatology University of Ferrara Ferrara Italy
| | - G. Sacripanti
- Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant Oncological & Regenerative Medicine Dermatology Unit University of Modena & Reggio Emilia Modena Italy
| | - F. Farnetani
- Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant Oncological & Regenerative Medicine Dermatology Unit University of Modena & Reggio Emilia Modena Italy
| | - L. Bigi
- Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant Oncological & Regenerative Medicine Dermatology Unit University of Modena & Reggio Emilia Modena Italy
| | - M. Puviani
- Dermatology Unit Nuovo Ospedale Civile di Sassuolo Sassuolo Italy
| | - M. Corazza
- Department of Medical Sciences Section of Dermatology University of Ferrara Ferrara Italy
| | - G. Pellacani
- Department of Surgical, Medical, Dental & Morphological Sciences with Interest Transplant Oncological & Regenerative Medicine Dermatology Unit University of Modena & Reggio Emilia Modena Italy
| |
Collapse
|
30
|
De Mey JGR, Bloksgaard M, Aalkjær C. Physiological Consequences of Coronary Arteriolar Dysfunction and Its Influence on Cardiovascular Disease: Diagnostic and Additional Therapeutic Consequences. Physiology (Bethesda) 2019; 34:82-83. [PMID: 30724126 DOI: 10.1152/physiol.00053.2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jo G R De Mey
- University of Southern Denmark , Odense , Denmark.,Aarhus University, Aarhus , Denmark
| | | | | |
Collapse
|
31
|
Hansen FS, Wenande E, Haedersdal M, Fuchs CSK. Microneedle fractional radiofrequency-induced micropores evaluated by in vivo reflectance confocal microscopy, optical coherence tomography, and histology. Skin Res Technol 2019; 25:482-488. [PMID: 30659657 DOI: 10.1111/srt.12676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/08/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Microneedle fractional radiofrequency (MNRF) is a minimally invasive technique that delivers radiofrequency (RF) energy into the skin via microneedles. Reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) enable the characterization of device-tissue interactions in in vivo skin. The aim of this study is to describe MNRF-induced micropores using RCM and OCT imaging. MATERIALS AND METHODS Five healthy participants were treated with a 7 × 7 array of 1500 μm microneedles on two adjacent areas of the right hip. One area received MNRF using high RF energy while the other underwent MNRF at low RF energy. Micropore morphology was evaluated qualitatively and quantitatively with RCM and OCT. To relate imaging with histology, one participant underwent punch biopsy in both areas. RESULTS Reflectance confocal microscopy visualized shape, content, and thermal-induced coagulation zone (CZ) of MNRF micropores. At high RF energy, micropores showed concentric shape, contained hyperreflective granules, and coagulated tissue from epidermis to dermo-epidermal junction (diameter 63-85 μm). Micropores at low RF energy, presented with a stellate shape, no content and CZs that were visible only in epidermis (CZ thickness 9 μm, IQR 8-21 μm). Evaluating OCT, high RF energy showed deeper (150 μm), more easily identifiable micropores compared to low RF energy micropores (70 μm). Histology showed tissue coagulation to a depth of 1500 μm at high RF energy, while at low RF energy, disruption was only visible in epidermis. CONCLUSION Microneedle fractional radiofrequency micropores show distinct characteristics in both RCM and OCT, depending on RF energy. These in vivo imaging modalities are complementary and allow combined, qualitative, and quantitative evaluation.
Collapse
Affiliation(s)
- Frederikke S Hansen
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Emily Wenande
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christine S K Fuchs
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
32
|
Holmes J, Schuh S, Bowling FL, Mani R, Welzel J. Dynamic Optical Coherence Tomography Is a New Technique for Imaging Skin Around Lower Extremity Wounds. INT J LOW EXTR WOUND 2019; 18:65-74. [DOI: 10.1177/1534734618821015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Chronic wounds such as venous leg ulcers invariably heal slowly and recur. In the case of venous leg ulcers, poor healing of chronic wounds is variously attributed to ambulatory hypertension, impaired perfusion and diffusion, presence of chronic inflammation at wound sites, lipodermatosclerosis, and senescence. The aim of this study was to investigate whether a new technique, optical coherence tomography (OCT), which permits imaging of blood capillaries in the peri-wound skin, can provide new insights into the pathology. OCT and its recent variant, dynamic OCT, permit rapid noninvasive depth-resolved imaging of the capillaries in the superficial dermis via a handheld probe, showing the morphology and density of vessels down to 20 µm in diameter. We used dynamic OCT to investigate 15 chronic wounds and assess characteristics of the vessels at the 4 poles around the wounds, the wound bed, adjacent dermatosclerosis, and unaffected skin. The results of the study show that both vessel morphology and density in the wound edges are dramatically different from that in healthy skin, showing clusters of glomuleri-like vessels (knot-like forms or clumps) and an absence of linear branching vessels, and also greater blood perfusion. Such vessel shapes are reported to be associated with tissue growth. The OCT imaging procedure was rapid and well tolerated by patients and provided new information not available from other devices. Thus, OCT appears to have great promise as a tool for the evaluation and study of chronic ulcers.
Collapse
Affiliation(s)
- Jon Holmes
- Michelson Diagnostics Ltd, Maidstone, Kent, UK
| | | | | | - Raj Mani
- University of Southampton, Southampton, UK
- Chiang Mai University, Chiang Mai, Thailand
- Shanghai Jiao Tong University, Shanghai, China
| | | |
Collapse
|
33
|
De Carvalho N, Welzel J, Schuh S, Themstrup L, Ulrich M, Jemec GBE, Holmes J, Kaleci S, Chester J, Bigi L, Ciardo S, Pellacani G. The vascular morphology of melanoma is related to Breslow index: An in vivo study with dynamic optical coherence tomography. Exp Dermatol 2018; 27:1280-1286. [DOI: 10.1111/exd.13783] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 09/04/2018] [Accepted: 09/10/2018] [Indexed: 01/04/2023]
Affiliation(s)
| | - Julia Welzel
- Department of Dermatology; General Hospital Augsburg; Augsburg Germany
| | - Sandra Schuh
- Department of Dermatology; General Hospital Augsburg; Augsburg Germany
| | - Lotte Themstrup
- Department of Dermatology; Zealand University Hospital; Roskilde Denmark
- Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
| | | | - Gregor B. E. Jemec
- Department of Dermatology; Zealand University Hospital; Roskilde Denmark
- Health Sciences Faculty; University of Copenhagen; Copenhagen Denmark
| | | | - Shaniko Kaleci
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - Johanna Chester
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - Laura Bigi
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - Silvana Ciardo
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| | - Giovanni Pellacani
- Department of Dermatology; University of Modena and Reggio Emilia; Modena Italy
| |
Collapse
|
34
|
Lindsø Andersen P, Olsen J, Friis KBE, Themstrup L, Grandahl K, Mortensen OS, Jemec GBE. Vascular morphology in normal skin studied with dynamic optical coherence tomography. Exp Dermatol 2018; 27:966-972. [PMID: 29733465 DOI: 10.1111/exd.13680] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2018] [Indexed: 01/08/2023]
Abstract
Dynamic optical coherence tomography (D-OCT) is a non-invasive imaging technique, suitable for the study of structural and dynamic features of cutaneous microvasculature. Studies with D-OCT have primarily focused on non-melanoma skin cancer (NMSC), and a reference description of healthy skin is lacking. The aim of the study was to describe the prevalence of standard microvascular features in normal skin. A total of 280 participants without skin disease were D-OCT-scanned on four body locations: three sun-exposed areas and one unexposed: forehead, back of the neck, back of the hand and medial side of the upper arm. Frequencies of standard vascular features were reported, and relations to anatomical location and demographic data were investigated. "Dots," "lines" and "curves" were the most frequent shapes at 150 μm, 300 μm and 500 μm. "Mottle" was the predominant pattern at 150 μm and 300 μm. "Mesh" was found from 300 μm and primarily found at 500 μm. Regional differences in vascular characteristics were primarily found comparing the medial side of the arm with the other body locations. In normal skin, the most frequent shapes were "dots," "lines" and "curves," and "mottle" was present more superficially than "mesh." In conclusion, regional anatomical differences should be taken into account when evaluating D-OCT images.
Collapse
Affiliation(s)
- Pernille Lindsø Andersen
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Olsen
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Kersti Brosbøl Engelund Friis
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Lotte Themstrup
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Grandahl
- Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark.,Department of Occupational Medicine, Copenhagen University Hospital, Holbaek, Denmark
| | - Ole Steen Mortensen
- Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark.,Department of Occupational Medicine, Copenhagen University Hospital, Holbaek, Denmark.,Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gregor Borut Ernst Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark.,Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
35
|
Fuchs CSK, Andersen AJB, Ardigo M, Philipsen PA, Haedersdal M, Mogensen M. Acne vulgaris severity graded by in vivo reflectance confocal microscopy and optical coherence tomography. Lasers Surg Med 2018; 51:104-113. [DOI: 10.1002/lsm.23008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Christine S. K. Fuchs
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Amanda J. B. Andersen
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Marco Ardigo
- Clinical Dermatology; IFO-San Gallicano Dermatological Institute-IRCCS; Rome Italy
| | - Peter A. Philipsen
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Merete Haedersdal
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Mette Mogensen
- Department of Dermatology; Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| |
Collapse
|
36
|
Waibel JS, Holmes J, Rudnick A, Woods D, Kelly KM. Angiographic optical coherence tomography imaging of hemangiomas and port wine birthmarks. Lasers Surg Med 2018; 50:718-726. [PMID: 29566276 DOI: 10.1002/lsm.22816] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES A current therapeutic challenge of vascular lesions is that they do not always respond effectively to laser treatment. Information on targeted vessels could potentially be used to guide laser treatments. Optical coherence tomography (OCT) is a useful tool for the non-invasive imaging of tissues, including skin hemangiomas and port wine birthmarks. Dynamic OCT is able to rapidly characterize cutaneous blood vessels. The primary goal of this study was to demonstrate the ability of bedside OCT to image (i) overall vessel pattern; (ii) individual vessel morphology, diameter and depth; and (iii) total vessel density as a function of depth in infantile hemangiomas and port wine birthmarks (PWB). MATERIALS AND METHODS This IRB approved, observational clinical trial was performed among healthy volunteers ages 3 months-73 years old. All patients presented for laser treatment of either infantile hemangiomas or PWB with skin types ranging from Fitzpatrick I-V. OCT imaging of 49 hemangioma and PWB scans were performed pre- and post-treatment. The diameter and depth of the blood vessels making up the vascular lesions were measured. In addition, normal skin was scanned for comparison. Five datasets for infantile hemangiomas and five for PWB that were without motion artifacts were analyzed. RESULTS Scanned lesions exhibited variable and highly heterogeneous blood vessel patterns with vessel diameters ranging from 20 to 160 μm, suggesting that the laser treatment with single pulse durations may not be optimal. The largest blood vessel diameter observed (160 μm) may not be adequately treated by commonly used pulsed dye laser pulse durations. CONCLUSION OCT allowed rapid, non-invasive characterization of the diameter and depth of blood vessels in individual vascular lesions. Imaged lesions consisted of a heterogeneous population of vessel sizes, morphologies, and depth. Future studies could utilize this information to assist development of individualized treatment protocols in an effort to improve vascular birthmark removal. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Jill S Waibel
- Miami Dermatology and Laser Institute, 7800 S.W 87th Ave Suite B200, Miami, Florida 33173
| | - Jon Holmes
- Michelson Diagnostics Ltd., Eclipse House, Eclipse Park, Sittingbourne Road, Maidstone, Kent, United Kingdom
| | - Ashley Rudnick
- Miami Dermatology and Laser Institute, 7800 S.W 87th Ave Suite B200, Miami, Florida 33173
| | - Daniel Woods
- Michelson Diagnostics Ltd., Eclipse House, Eclipse Park, Sittingbourne Road, Maidstone, Kent, United Kingdom
| | | |
Collapse
|