Case report: Optical coherence tomography for monitoring biologic therapy in psoriasis and atopic dermatitis

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.

Lesional skin of seborrheic dermatitis patients is characterized by skin barrier dysfunction and correlating alterations in the stratum corneum ceramide composition

“…Furthermore, a rougher lesional skin surface corresponds to the scaly phenotype of the disease 1 . Increased blood flow and epidermal thickness have been observed by OCT in the involved skin of psoriasis and atopic dermatitis patients compared to uninvolved skin and healthy controls 33,34 . Stand‐alone, but also combined, standardized photography and OCT qualify as valuable non‐invasive tools which enable sensitive and selective endpoints for disease monitoring and detection of treatment responses in clinical trials 35 …”

Transvaginal natural orifice endoscopic surgery for ovarian cystectomy: a more suitable surgical approach for the day-care procedure

“…Information on all patients was collected from hospital databases, including patient age, body mass index (BMI), the maximum diameter of the cyst, previous pregnancy and abdominal surgery, surgical location, the total time to surgery (i.e., from cutaneous incision to closure), blood loss quantified by subjective visual quantification ( 27 , 28 ), simultaneously conducting other surgeries, intraoperative complications (i.e., bladder, bowel, and vascular injury), conversion to another surgical procedure, perioperative decrease in serum hemoglobin, postoperative exhaust time, postoperative fever (i.e., any oral temperature≥ occurrence of 38.0°C ≥24 h postoperatively), hospital stay, and postoperative complications. All patients underwent an outpatient review 1 month postoperative to assess postoperative recovery and clinical data.…”

Inflammation and Psoriasis: A Comprehensive Review

“…Moreover, there was a positive significant correlation between ET in lesional skin and PASI clinical score. After 52 weeks, full normalization of the vessel count and a decreased vascular density due to a reduction of vessel diameter were observed [88]. In another study, 23 patients were treated with topical corticosteroids, cyclosporine, or phototherapy and evaluated at baseline and 1 and 2 months after treatment.…”