1
|
Negrutiu M, Danescu S, Popa T, Focsan M, Vesa SC, Szasz F, Baican A. Imaging Approach in the Diagnostics and Evaluation of the Psoriasis Plaque: A Preliminary Study and Literature Review. Diagnostics (Basel) 2024; 14:969. [PMID: 38786267 PMCID: PMC11120603 DOI: 10.3390/diagnostics14100969] [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: 04/16/2024] [Revised: 05/03/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
(1) Background: the aim of the study was to demonstrate its usefulness in the field of imaging evaluation of plaque morphology in psoriasis vulgaris, with an emphasis on the use of confocal microscopy and other advanced skin-imaging techniques. (2) Methods: we conducted a prospective study over two years (July 2022-April 2024), on patients diagnosed with moderate or severe psoriasis vulgaris, treated in the dermatology department of our institution. We selected 30 patients, of whom 15 became eligible according to the inclusion and the exclusion criteria. A total of 60 psoriasis plaques were analyzed by dermatoscopy using a Delta 30 dermatoscope and Vidix 4.0 videodermoscope (VD), by cutaneous ultrasound (US) using a high-resolution 20 MHz linear probe, and by confocal microscopy, along with histopathological analysis. (3) Results: the study included fifteen patients with vulgar psoriasis, diagnosed histopathologically, of whom six were women and nine were men, with an average age of 55. Between two and six plaques per patient were selected and a total of sixty psoriasis plaques were analyzed by non-invasive imaging techniques. Twelve lesions were analyzed with ex vivo fluorescence confocal microscopy (FCM), compared to histology. US showed that the hyperechoic band and the lack of damage to the subcutaneous tissue were the most common criteria. The epidermis and dermis were found to be thicker in the area of psoriasis plaques compared to healthy skin. Dermatoscopy showed that the specific aspect of psoriasis plaques localized on the limbs and trunk was a lesion with an erythematous background, with dotted vessels with regular distribution on the surface and covered by white scales with diffuse distribution. The presence of bushy vessels with medium condensation was the most frequently identified pattern on VD. Good correlations were identified between the histological criteria and those obtained through confocal microscopy. (4) Conclusions: the assessment and monitoring of patients with psoriasis vulgaris can be conducted in a more complete and all-encompassing manner by incorporating dermatoscopy, ultrasonography, and confocal microscopy in clinical practice.
Collapse
Affiliation(s)
- Mircea Negrutiu
- Department of Dermatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (M.N.); (S.D.); (A.B.)
| | - Sorina Danescu
- Department of Dermatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (M.N.); (S.D.); (A.B.)
| | - Theodor Popa
- Department of Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Monica Focsan
- Nanobiophotonics and Laser Microspectroscopy Center, Interdisciplinary Research Institute on Bio-Nano-Sciences, Babes-Bolyai University, 400271 Cluj-Napoca, Romania;
| | - Stefan Cristian Vesa
- Department of Functional Sciences, Discipline of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Florin Szasz
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania
| | - Adrian Baican
- Department of Dermatology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (M.N.); (S.D.); (A.B.)
| |
Collapse
|
2
|
Orsini C, Trovato E, Cortonesi G, Pedrazzani M, Suppa M, Rubegni P, Tognetti L, Cinotti E. Line-field confocal optical coherence tomography: New insights for psoriasis treatment monitoring. J Eur Acad Dermatol Venereol 2024; 38:325-331. [PMID: 37823360 DOI: 10.1111/jdv.19568] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 08/31/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Line-field confocal optical coherence tomography (LC-OCT) is a new, valid means for a rapid and non-invasive in vivo examination of the epidermis and upper dermis, allowing digital interpretation and measurement of high-resolution images on a cellular level. Given these properties, it may represent a valid tool for monitoring psoriasis during treatment, allowing a new method to set a precise objective severity of the disease. OBJECTIVES We aimed to investigate the potentialities of LC-OCT in the non-invasive monitoring of microscopical changes associated with moderate-severe plaque psoriasis (PP) during the treatment with the most common biological drugs. MATERIALS AND METHODS We performed LC-OCT imaging of PP lesions from 17 patients before and after 8 weeks of treatment. The clinical severity of the single lesions was evaluated using a lesion score (LS), designed considering three parameters: erythema, desquamation and infiltration. LC-OCT images were segmented by artificial intelligence and evaluated based on three microscopic criteria: the thickness of the stratum corneum, the thickness of the living epidermis and the undulation of the dermo-epidermal junction. RESULTS Line-field confocal optical coherence tomography digital analysis allowed recognition and quantification of the three microscopic criteria, showing a reduction of all these during the follow-up. Furthermore, a high correlation between change in LS and the thickness of the stratum corneum and the thickness of the living epidermis was found. CONCLUSION Line-field confocal optical coherence tomography can non-invasively monitor the response of PP to different treatments. Morphometric changes occurring in the psoriatic lesion during the 8-week treatment period were identified by in vivo LC-OCT and measured by using artificial intelligence. Although future studies are required, based on these preliminary results, LC-OCT may represent a valid potential tool for precise monitoring of therapeutic response.
Collapse
Affiliation(s)
- C Orsini
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - E Trovato
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - G Cortonesi
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | | | - M Suppa
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - P Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - L Tognetti
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| | - E Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy
| |
Collapse
|
3
|
Verzì AE, Lacarrubba F, Dall'Oglio F, Puglisi D, Micali G. Density and diameter of dermal papillae from three different anatomical areas in normal skin using reflectance confocal microscopy. J Eur Acad Dermatol Venereol 2023; 37:e1248-e1250. [PMID: 37293691 DOI: 10.1111/jdv.19248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Affiliation(s)
| | | | | | - Davide Puglisi
- Dermatology Clinic, University of Catania, Catania, Italy
| | | |
Collapse
|
4
|
Zhang S, Wang X, Chen H, Cao H, Zhang H, Yang M, Zhu Y, Qin Q, Liu X, Wang J, Zhang G. Clinical efficacy and safety of two different hematoporphyrin monomethyl ether-mediated photodynamic therapy regimen in Chinese children with port-wine stain. Exp Dermatol 2023; 32:1371-1382. [PMID: 37157235 DOI: 10.1111/exd.14834] [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: 02/13/2023] [Revised: 03/27/2023] [Accepted: 04/30/2023] [Indexed: 05/10/2023]
Abstract
Hematoporphyrin monomethyl ether-photodynamic therapy (HMME-PDT) has achieved encouraging clinical outcomes in adult port-wine stain (PWS). Optimal treatment option for children with PWS was minimal. To compare whether the clinical effectiveness of HMME-PDT with the 5-min (fast) administration treatment regimen (FATR) was better than the 20-min (slow) administration treatment regimen (SATR) for PWS of children in vivo and in vitro. Thirty-four children with PWS were divided into two groups including FATR and SATR. The two groups received three times HMME-PDT, respectively. Treatment efficacy and safety were evaluated in vivo and in vitro. Erythema index (EI) was used to evaluate the clinical outcomes. Both FATR and SATR were effective and safe in children with PWS after HMME-PDT. There were significance differences between the two groups in reductions of EI after the second treatment (p < 0.001) and the third treatment (p < 0.001) with HMME-PDT. The serum HMME concentration reach the peak level at short time compare with SATR group. A significance increased superoxide levels were observed in FATR group compare to SATR groups in vitro (p < 0.05). Our study suggested that HMME-PDT was effective and safe for children with PWS, the therapy regimen with FATR was better in clinical efficacy than that of the SATR.
Collapse
Affiliation(s)
- Sheng Zhang
- Department of Dermatology and Venereology, Capital Institute of Pediatrics, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Xiuwei Wang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Translational Medicine Laboratory, Capital Institute of Pediatrics, Beijing, China
| | - Hongguang Chen
- Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Huina Cao
- Department of Dermatology and Venereology, Capital Institute of Pediatrics, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Hongli Zhang
- Department of Dermatology and Venereology, Capital Institute of Pediatrics, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Ming Yang
- Department of Dermatology and Venereology, Capital Institute of Pediatrics, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Yun Zhu
- Department of Dermatology and Venereology, Capital Institute of Pediatrics, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Qin Qin
- Department of Dermatology and Venereology, Capital Institute of Pediatrics, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Xiaoyan Liu
- Department of Dermatology and Venereology, Capital Institute of Pediatrics, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| | - Jianhua Wang
- Beijing Municipal Key Laboratory of Child Development and Nutriomics, Translational Medicine Laboratory, Capital Institute of Pediatrics, Beijing, China
| | - Gaolei Zhang
- Department of Dermatology and Venereology, Capital Institute of Pediatrics, Capital Institute of Pediatrics-Peking University Teaching Hospital, Beijing, China
| |
Collapse
|
5
|
Micali G, Verzì AE, Musumeci ML, Nardone B, Monfrecola G, Lacarrubba F. Noninvasive Evaluation of Diameter and Density of Dermal Papillae in Psoriatic and Healthy Skin Using Reflectance Confocal Microscopy: An Intrapatient Controlled Study and a Review. J Invest Dermatol 2023; 143:667-669.e2. [PMID: 36273623 DOI: 10.1016/j.jid.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | - Beatrice Nardone
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Giuseppe Monfrecola
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | | |
Collapse
|
6
|
Ocampo‐Garza SS, Villani A, Cinelli E, Camela E, Fabbrocini G, Megna M. Ixekizumab in scalp psoriasis: Clinical, dermoscopical, and
in vivo
reflectance confocal microscopy evaluation. Dermatol Ther 2022; 35:e15332. [PMID: 35068036 PMCID: PMC9285349 DOI: 10.1111/dth.15332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 01/03/2022] [Accepted: 01/19/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Sonia Sofia Ocampo‐Garza
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II
- Universidad Autónoma de Nuevo León, University Hospital "Dr. José Eleuterio González", Dermatology Department Monterrey Nuevo León Mexico
| | - Alessia Villani
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Eleonora Cinelli
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Elisa Camela
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Gabriella Fabbrocini
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II
| | - Matteo Megna
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II
| |
Collapse
|
7
|
Meibomian Glands or Not? Identification of In Vivo and Ex Vivo Confocal Microscopy Features and Histological Correlates in the Eyelid Margin. J Ophthalmol 2020; 2020:7516286. [PMID: 32676204 PMCID: PMC7345604 DOI: 10.1155/2020/7516286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/19/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose In vivo confocal laser scanning microscopy (CLSM) is an emerging diagnostic tool allowing fast and easy microscopic tissue examination. For the diagnostics of pathological eyelid margin lesions, the knowledge of the normal eyelid margin is essential. Methods We examined 18 eyelid margins of healthy humans using the in vivo CLSM device and 10 samples of healthy eyelid margins from donor sites with ex vivo CLSM and compared the findings to the corresponding histological sections of donor sites. Cross-section images of different depths and depths of different skin appendages were measured. Results The depth observed by in vivo CLSM is less than 150 μm into the eyelid. Images of the epidermis and superficial dermis skin, appendages including hair follicle, and sebaceous catheters can be captured associated with histopathology and ex vivo confocal microscopy. In correlation with histopathology, we identified different layers of the eyelid margin, different layers of the epidermis, and skin appendages by ex vivo confocal microscopy. Conclusions The study offers an overview of the in vivo confocal microscopy human eyelid margin characteristics in comparison to the standard histological examination and confirms that in vivo CLSM could not observe the meibomian gland acini structure.
Collapse
|
8
|
Grajdeanu IA, Statescu L, Vata D, Popescu IA, Porumb-Andrese E, Patrascu AI, Taranu T, Crisan M, Solovastru LG. Imaging techniques in the diagnosis and monitoring of psoriasis. Exp Ther Med 2019; 18:4974-4980. [PMID: 31819765 PMCID: PMC6895776 DOI: 10.3892/etm.2019.7957] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/09/2019] [Indexed: 12/23/2022] Open
Abstract
Plaque psoriasis is a chronic, immune-mediated disease, which has a multifactorial etiopathogenesis. Practical non-invasive techniques to monitor plaque psoriasis progression and treatment are necessary. Imaging techniques available for psoriasis assessment may vary in terms of resolution, depth of penetration and visual representation. This review summarizes the current developments in the field of psoriasis non-invasive imaging techniques, such as dermoscopy, conventional ultrasound and high frequency ultrasonography (HFUS), videocapillaroscopy (VC), reflectance confocal microscopy (RCM), optical microangiography (OMAG), laser Doppler imaging (LDI), multiphoton tomography (MPT) and optical coherence tomography (OCT). The aim was to collect and analyze data concerning types, indications, advantages and disadvantages of modern imaging techniques for in vivo psoriasis assessment. We focused on two main methods, videodermoscopy and HFUS, which can be included in daily dermatologists' practice and which may assist in establishing diagnosis, as well as monitoring response to topical and/or systemic therapy of psoriasis. Dermoscopy may be useful for a first evaluation and may offer an understanding of the type and distribution of blood vessels, as well as the color of the scale and the background of the lesion. Videodermoscopy allows magnification and offers a detailed evaluation of the vessel type. The utility of HFUS consists mainly in monitoring therapy response. These methods may be comparable with virtual histopathology.
Collapse
Affiliation(s)
- Ioana-Alina Grajdeanu
- Dermatology Department, Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Laura Statescu
- Dermatology Department, Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Dermatology Clinic, 'St. Spiridon' County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Dan Vata
- Dermatology Department, Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Dermatology Clinic, 'St. Spiridon' County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Ioana Adriana Popescu
- Dermatology Department, Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Dermatology Clinic, 'St. Spiridon' County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Elena Porumb-Andrese
- Dermatology Department, Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Dermatology Clinic, 'St. Spiridon' County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Adriana Ionela Patrascu
- Dermatology Department, Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Dermatology Clinic, 'St. Spiridon' County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Tatiana Taranu
- Dermatology Department, Faculty of Dental Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Dermatology Clinic, CF Iasi Hospital, 700506 Iasi, Romania
| | - Maria Crisan
- Dermatology Department, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania
| | - Laura Gheuca Solovastru
- Dermatology Department, Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Dermatology Clinic, 'St. Spiridon' County Emergency Clinical Hospital, 700111 Iasi, Romania
| |
Collapse
|
9
|
Peccerillo F, Odorici G, Ciardo S, Conti A, Pellacani G. Evaluation of generalized pustular psoriasis by reflectance confocal microscopy. Skin Res Technol 2019; 25:402-403. [DOI: 10.1111/srt.12655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 10/27/2018] [Accepted: 12/09/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Francesca Peccerillo
- Department of SurgicalMedical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine Modena Italy
- Dermatology UnitUniversity of Modena and Reggio Emilia Modena Italy
| | - Giulia Odorici
- Department of SurgicalMedical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine Modena Italy
- Dermatology UnitUniversity of Modena and Reggio Emilia Modena Italy
| | - Silvana Ciardo
- Department of SurgicalMedical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine Modena Italy
- Dermatology UnitUniversity of Modena and Reggio Emilia Modena Italy
| | - Andrea Conti
- Department of SurgicalMedical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine Modena Italy
- Dermatology UnitUniversity of Modena and Reggio Emilia Modena Italy
| | - Giovanni Pellacani
- Department of SurgicalMedical, Dental and Morphological Sciences with Interest Transplant, Oncological and Regenerative Medicine Modena Italy
- Dermatology UnitUniversity of Modena and Reggio Emilia Modena Italy
| |
Collapse
|
10
|
Ianoși SL, Forsea AM, Lupu M, Ilie MA, Zurac S, Boda D, Ianosi G, Neagoe D, Tutunaru C, Popa CM, Caruntu C. Role of modern imaging techniques for the in vivo diagnosis of lichen planus. Exp Ther Med 2018; 17:1052-1060. [PMID: 30679973 PMCID: PMC6327670 DOI: 10.3892/etm.2018.6974] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/21/2018] [Indexed: 12/21/2022] Open
Abstract
Lichen planus (LP) is a chronic inflammatory skin disease that can sometimes affect mucosal surfaces, with unknown pathogenesis, even though it appears to be an autoimmune disease. The diagnosis of lichen planus is usually based on histopathological examination of the lesions. Nowadays, the classical invasive diagnostic methods are replaced by modern non-invasive techniques. In this review, we present the main non-invasive imaging methods (dermoscopy, reflectance confocal microscopy, optical coherence tomography, ultrasound and diffuse reflection spectrophotometry) used in the diagnosis and therapeutic monitoring of lichen planus. Dermoscopy is a non-invasive method initially used for diagnosis of pigmented tumors but now is used also for inflammatory and infectious skin diseases. In lichen planus, the dermoscopy increases the accuracy of diagnosis, avoids skin biopsies commonly used and can be useful in the therapeutic monitoring by repeated investigation at different stages of treatment. Reflectance confocal microscopy (RCM) is a novel non-invasive imaging technique that is prevalently used for the diagnosis of skin tumors and inflammatory skin diseases. This technology has been mostly employed for bedside, real-time microscopic evaluation of psoriasis, lichen planus, contact dermatitis, revealing specific confocal features to support clinical diagnosis and assist with patient management. Optical coherence tomography (OCT) is an emergent imaging technique, developed over the last decade, based on the interaction of the infrared radiation (900–1,500 nm) and the living tissues. A limited information exists on the benefits of OCT technology for the in vivo diagnosis of LP but could be a useful auxiliary tool in the in vivo differential diagnosis, especially in clinical equivocal settings like mucosal lesions, and in monitoring the response to treatment. Our review shows the possibility of using modern imaging techniques for the in vivo diagnosis and also for evaluation of the treatment response.
Collapse
Affiliation(s)
- Simona Laura Ianoși
- Department of Dermatology, University of Medicine and Pharmacy of Craiova, Emergency County Hospital, 200349 Craiova, Romania
| | - Ana Maria Forsea
- Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Mihai Lupu
- Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Mihaela Adriana Ilie
- Department of Biochemistry, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Dermatology Research Laboratory, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Sabina Zurac
- Department of Pathology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Pathology, 'Colentina' University Hospital, 020125 Bucharest, Romania
| | - Daniel Boda
- Dermatology Research Laboratory, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Carol Medical Center, 010626 Bucharest, Romania
| | - Gabriel Ianosi
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Military Hospital, 200349 Craiova, Romania
| | - Daniela Neagoe
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, Emergency County Hospital, 200349 Craiova, Romania
| | - Cristina Tutunaru
- Department of Dermatology, University of Medicine and Pharmacy of Craiova, Emergency County Hospital, 200349 Craiova, Romania
| | - Cristina Maria Popa
- Department of Dermatology, University of Medicine and Pharmacy of Craiova, Emergency County Hospital, 200349 Craiova, Romania
| | - Constantin Caruntu
- Department of Physiology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Dermatology, 'Prof. N. Paulescu' National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
| |
Collapse
|
11
|
Levine A, Markowitz O. Introduction to reflectance confocal microscopy and its use in clinical practice. JAAD Case Rep 2018; 4:1014-1023. [PMID: 30456275 PMCID: PMC6232695 DOI: 10.1016/j.jdcr.2018.09.019] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Reflectance confocal microscopy (RCM) is a novel technology that provides noninvasive, in vivo imaging of the skin at nearly histologic resolution. In 2016, the US Centers for Medicare and Medicaid Services (CMS) established reimbursement codes for RCM image acquisition and for the reading and interpretation of images. The combination of RCM imaging with dermoscopy has improved the accuracy of skin cancer diagnosis while reducing the number of biopsies of benign skin lesions. With that, we are starting to see more dermatologists and dermatopathologists using RCM in clinical practice. This editorial is to serve as an introduction on RCM imaging with a focus on its usefulness in both the diagnosis and management of skin cancers. We end by briefly describing the characteristic RCM features of normal skin to serve as a building block for later cases that will explore both the benefits and drawbacks of incorporating RCM imaging for benign and malignant lesions.
Collapse
Affiliation(s)
| | - Orit Markowitz
- Correspondence to: Orit Markowitz, MD, FAAD, 5 East 98th Street, 5th floor, New York, NY 10029.
| |
Collapse
|
12
|
Batani A, Brănișteanu DE, Ilie MA, Boda D, Ianosi S, Ianosi G, Caruntu C. Assessment of dermal papillary and microvascular parameters in psoriasis vulgaris using in vivo reflectance confocal microscopy. Exp Ther Med 2017; 15:1241-1246. [PMID: 29434710 PMCID: PMC5774437 DOI: 10.3892/etm.2017.5542] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 09/06/2017] [Indexed: 11/05/2022] Open
Abstract
In vivo reflectance confocal microscopy (RCM) is a modern, non-invasive imaging technique, which allows for real-time examination of the upper layers of the skin at a resolution similar to that of classic microscopy. In addition, it has the advantage of real-time evaluation of blood flow and dynamic monitoring of cutaneous changes while preserving tissue integrity. The present study reported on the in vivo RCM technique as an objective method for the noninvasive assessment of psoriasis vulgaris that is potentially applicable in clinical studies and in monitoring the evolution of lesions under treatment. In psoriasis lesions, RCM virtual horizontal sections at the level of the dermo-epidermal junction featured numerous and prominent dermal papillae that were not surrounded by bright rings of basal cells. Micromorphological examination of the lesions using this technique revealed that mean values of the section area, the perimeter and the Feret's diameter of the dermal papillae were significantly higher in psoriatic lesions than in normal skin. An increased number of capillary vessels per lesional dermal papilla as compared to healthy skin was observed. Furthermore, micromorphological parameters of dermal capillaries were increased in psoriatic skin. These observations point to the utility of in vivo RCM as a promising technique for the non-invasive diagnosis of psoriasis vulgaris, for monitoring the evolution of lesions at a micromorphological level under various treatments and for gaining a better understanding of the pathophysiological processes that occur in the evolution of this disease.
Collapse
Affiliation(s)
- Alexandra Batani
- Dermatology Research Laboratory, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Daciana Elena Brănișteanu
- Department of Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Mihaela Adriana Ilie
- Dermatology Research Laboratory, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Daniel Boda
- Dermatology Research Laboratory, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Simona Ianosi
- Department of Dermatology, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Gabriel Ianosi
- Department of Surgery, Clinical Military Hospital, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Constantin Caruntu
- Physiology Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Dermatology, N. Paulescu National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
| |
Collapse
|
13
|
Agozzino M, Noal C, Lacarrubba F, Ardigò M. Monitoring treatment response in psoriasis: current perspectives on the clinical utility of reflectance confocal microscopy. PSORIASIS-TARGETS AND THERAPY 2017; 7:27-34. [PMID: 29387605 PMCID: PMC5774604 DOI: 10.2147/ptt.s107514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Reflectance confocal microscopy (RCM) evaluation of inflammatory skin diseases represents a relatively new technique that, during the past 5 years, has attracted increasing interest, with consequent progressive increment of publications in literature. The success of RCM is directly related to the high need for noninvasive techniques able to both reduce the number of skin biopsies and support clinical diagnosis and patient management. RCM helps to visualize microscopic descriptors of plaque psoriasis (PP) with good reproducibility between observers and a high grade of correspondence with histopathology. Several clinical tests are used for the therapeutic management of PP, but they are limited by subjective interpretation. Skin biopsy presents objective interpretation, but the procedure is invasive and not repeatable. RCM has been used not only for the evaluation of skin cancer or inflammatory skin diseases, but also for monitoring the efficacy of different treatments in PP. In this review, we present some examples of RCM applications in therapeutic psoriasis follow-up.
Collapse
Affiliation(s)
| | - Cecilia Noal
- Dermatology Unit, University of Trieste, Trieste
| | | | - Marco Ardigò
- Clinical Dermatology Department, San Gallicano Dermatological Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| |
Collapse
|
14
|
Agozzino M, Gonzalez S, Ardigò M. Reflectance Confocal Microscopy for Inflammatory Skin Diseases. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
15
|
Reflectance Confocal Microscopy for Inflammatory Skin Diseases. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:631-9. [DOI: 10.1016/j.ad.2016.01.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/10/2016] [Accepted: 01/28/2016] [Indexed: 11/23/2022] Open
|
16
|
Aldahan AS, Chen LL, Fertig RM, Holmes J, Shah VV, Mlacker S, Hsu VM, Nouri K, Tosti A. Vascular Features of Nail Psoriasis Using Dynamic Optical Coherence Tomography. Skin Appendage Disord 2016; 2:102-108. [PMID: 28232916 DOI: 10.1159/000449230] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 08/17/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Nail psoriasis is a painful and disfiguring nail disease that often leads to invasive biopsies. Dermoscopy of the hyponychium can be useful in the diagnosis showing twisted coiled vessels. Structural features of nail psoriasis have been described with optical coherence tomography (OCT). OBJECTIVES To investigate vascular features of nail psoriasis using dynamic OCT. METHODS This was an observational, prospective, controlled study in which psoriasis patients with psoriatic nail changes and healthy control patients underwent OCT imaging of the distal nail plate and proximal nail fold. Vertical and horizontal OCT images were analyzed to describe structural and vascular features and to quantify blood flow at depth. RESULTS Sixteen psoriatic nails and 16 control nails were included. Psoriatic nails had significantly increased blood flow in the proximal nail fold at depths of 0.72 mm (p = 0.035) and 0.76 mm (p = 0.027). Nail thickness was significantly greater in psoriatic nails compared to control nails (p = 0.0016). Compared to control nails, psoriatic nails had dilated, disorganized blood vessels superficially in the proximal nail fold. LIMITATIONS The main limitation of our study is the relatively small sample size. CONCLUSIONS OCT can identify structural and vascular features specific to nail psoriasis.
Collapse
Affiliation(s)
- Adam S Aldahan
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Fla., USA
| | - Lucy L Chen
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Fla., USA
| | - Raymond M Fertig
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Fla., USA
| | - Jon Holmes
- Michelson Diagnostics Ltd, Maidstone, UK
| | - Vidhi V Shah
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Fla., USA
| | - Stephanie Mlacker
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Fla., USA
| | - Vincent M Hsu
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Fla., USA
| | - Keyvan Nouri
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Fla., USA
| | - Antonella Tosti
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Fla., USA
| |
Collapse
|
17
|
Molecular probing of TNF: From identification of therapeutic target to guidance of therapy in inflammatory diseases. Cytokine 2016; 101:64-69. [PMID: 27633266 DOI: 10.1016/j.cyto.2016.08.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/22/2016] [Indexed: 12/21/2022]
Abstract
Therapy by blocking tumor necrosis factor (TNF) activity is highly efficacious and profoundly changed the paradigm of several inflammatory diseases. However, a significant proportion of patients with inflammatory diseases do not respond to TNF inhibitors (TNFi). Prediction of therapeutic response is required for TNFi therapy. Isotope labeled anti-TNF antibodies or TNF receptor have been investigated to localize TNF production at inflammatory tissue in animal models and in patients with inflammatory diseases. The in vivo detection of TNF has been associated with treatment response. Recently, fluorophore labeled anti-TNF antibody in combination with confocal laser endomicroscopy in patients with Crohn's disease yielded more accurate and quantitative in vivo detection of TNF in the diseased mucosa. More importantly, this method demonstrated high therapeutic predication value. Fluorophore labeled TNF binding aptamers in combination with modern imaging technology offers additional tools for in vivo TNF probing.
Collapse
|
18
|
Hoogedoorn L, Gerritsen MJP, Wolberink EAW, Peppelman M, van de Kerkhof PCM, van Erp PEJ. A four-phase strategy for the implementation of reflectance confocal microscopy in dermatology. J Eur Acad Dermatol Venereol 2016; 30:1308-14. [PMID: 27038136 DOI: 10.1111/jdv.13627] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/14/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Reflectance confocal microscopy (RCM) is gradually implemented in dermatology. Strategies for further implementation and practical 'hands on' guidelines are lacking. OBJECTIVE The primary outcome was to conduct a general strategy for further implementation of RCM. The secondary outcome was the diagnosis of psoriasis and differentiation of stable from unstable psoriatic plaques by means of the 'hands on' protocol, derived from the strategy. METHODS We used a four-phased model; an exploring phase, a systematic literature search, a clinical approach and, finally, an integration phase to develop a clinical guideline for RCM in psoriasis. Receiver operating characteristic curve statistics was applied to define the accuracy for the diagnosis of unstable psoriasis. RESULTS A general strategy for further implementation of RCM and practical approach was developed to examine psoriasis by RCM and to distinguish stable from unstable psoriasis. Unstable psoriasis was diagnosed by epidermal inflammatory cell counts with a sensitivity and specificity of 91.7% and 98.3%, respectively, and with an accuracy of 0.92 (area under the curve). In addition, a monitoring model was proposed. CONCLUSION This is the first study that shows a method for implementation of RCM in dermatology. The strategy and hands on protocol for psoriasis may serve as a model for other dermatological entities and additionally may lead to specialized ready-to-use RCM protocols for clinical dermatological practice.
Collapse
Affiliation(s)
- L Hoogedoorn
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M J P Gerritsen
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E A W Wolberink
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M Peppelman
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - P C M van de Kerkhof
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - P E J van Erp
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
19
|
Zor F, Karagoz H, Erdemir AT, Karslioglu Y, Acikel CH, Kapaj R, Guzey S, Gurel MS, Isik S, Siemionow M. Reflectance confocal microscopy as a useful diagnostic tool for monitoring of skin containing vascularized composite allograft rejection: A preliminary study on rats. Microsurgery 2015; 36:144-51. [DOI: 10.1002/micr.22419] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 03/26/2015] [Accepted: 03/30/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Fatih Zor
- Department of Plastic and Reconstructive Surgery; Gulhane Military Medical Academy; Ankara Turkey
| | - Huseyin Karagoz
- Gulhane Military Medical Academy, Haydarpasa Training Hospital; Department of Plastic and Reconstructive Surgery; Istanbul Turkey
- Department of Orthopaedic Surgery; University of Illinois, College of Medicine; Chicago IL
| | - Asli Turgut Erdemir
- Department of Dermatology; Istanbul Training and Research Hospital; Istanbul Turkey
| | | | - Cengiz Han Acikel
- Department of Biostatistics and FAVOR Laboratories; Gulhane Military Medical Academy; Ankara Turkey
| | - Rezarta Kapaj
- Department of Plastic and Reconstructive Surgery; Gulhane Military Medical Academy; Ankara Turkey
| | - Serbulent Guzey
- Department of Plastic and Reconstructive Surgery; Gulhane Military Medical Academy; Ankara Turkey
| | - Mehmet Salih Gurel
- Department of Dermatology; Istanbul Training and Research Hospital; Istanbul Turkey
| | - Selcuk Isik
- Department of Plastic and Reconstructive Surgery; Gulhane Military Medical Academy; Ankara Turkey
| | - Maria Siemionow
- Department of Orthopaedic Surgery; University of Illinois, College of Medicine; Chicago IL
| |
Collapse
|
20
|
Hoogedoorn L, Peppelman M, van de Kerkhof P, van Erp P, Gerritsen M. The value ofin vivoreflectance confocal microscopy in the diagnosis and monitoring of inflammatory and infectious skin diseases: a systematic review. Br J Dermatol 2015; 172:1222-48. [DOI: 10.1111/bjd.13499] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 11/27/2022]
Affiliation(s)
- L. Hoogedoorn
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| | - M. Peppelman
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| | - P.C.M. van de Kerkhof
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| | - P.E.J. van Erp
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| | - M.J.P. Gerritsen
- Department of Dermatology; Radboud University Medical Center; PO Box 9101 NL 6500 HB Nijmegen the Netherlands
| |
Collapse
|
21
|
Karagoz H, Gurel MS, Zor F. Non-invasive Monitoring of Skin-Containing Vascularized Composite Allotransplantation. Plast Reconstr Surg 2015. [DOI: 10.1007/978-1-4471-6335-0_42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
22
|
Kapsokalyvas D, Cicchi R, Bruscino N, Alfieri D, Prignano F, Massi D, Lotti T, Pavone FS. In-vivo imaging of psoriatic lesions with polarization multispectral dermoscopy and multiphoton microscopy. BIOMEDICAL OPTICS EXPRESS 2014; 5:2405-19. [PMID: 25071974 PMCID: PMC4102374 DOI: 10.1364/boe.5.002405] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/25/2014] [Accepted: 04/28/2014] [Indexed: 05/18/2023]
Abstract
Psoriasis is a skin autoimmune disease characterized by hyperkeratosis, hyperproliferation of the epidermis and dilatation of dermal papillary blood vessels. Healthy skin (5 volunteers) and psoriatic lesions (3 patients) were visualized in vivo, with high contrast and resolution, with a Polarization Multispectral Dermoscope and a Multiphoton Microscope. Psoriatic features were identified and quantified. The effective diameter of the superficial blood vessels was measured at 35.2 ± 7.2 μm and the elongated dermal papillae had an effective diameter of 64.2 ± 22.6 μm. The methodologies developed could be employed for quantitative diagnostic purposes and furthermore serve as a monitoring method of the effect of personalized treatments.
Collapse
Affiliation(s)
- Dimitrios Kapsokalyvas
- European Laboratory for Non-Linear Spectroscopy (LENS) University of Florence, Sesto-Fiorentino, 50019, Italy
| | - Riccardo Cicchi
- European Laboratory for Non-Linear Spectroscopy (LENS) University of Florence, Sesto-Fiorentino, 50019, Italy
- National Institute of Optics, National Research Council (INO-CNR), 50125, Florence, Italy
| | - Nicola Bruscino
- Division of Clinical, Preventive and Oncology Dermatology, Department of Critical Care Medicine and Surgery, University of Florence, 50129, Florence, Italy
| | | | - Francesca Prignano
- Division of Clinical, Preventive and Oncology Dermatology, Department of Critical Care Medicine and Surgery, University of Florence, 50129, Florence, Italy
| | - Daniela Massi
- Department of Surgery and Translational Medicine, University of Florence, 50134, Florence, Italy
| | - Torello Lotti
- Department of Dermatology and Venereology, University Guglielmo Marconi, 00193, Rome, Italy
| | - Francesco S. Pavone
- European Laboratory for Non-Linear Spectroscopy (LENS) University of Florence, Sesto-Fiorentino, 50019, Italy
- National Institute of Optics, National Research Council (INO-CNR), 50125, Florence, Italy
- Department of Physics, University of Florence, 50019, Sesto Fiorentino, Italy
| |
Collapse
|