Concordance among in vivo reflectance confocal microscopy, trichoscopy, and histopathology in the evaluation of scalp discoid lupus

Abstract

Background: Reflectance confocal microscopy (RCM) has been used for the evaluation of several inflammatory skin conditions, including skin discoid lupus erythematosus (DLE), and has been correlated with conventional histopathology (HP). However, RCM is not being widely used in trichology. Few reports and just preliminary data suggest the use of RCM as a complementary tool in alopecias. Objectives: To correlate the major RCM features of scalp DLE with trichoscopy and HP findings of biopsy specimens obtained from the same lesions. Methods: This is an observational, analytical, and cross-sectional study involving 12 patients with a clinically established diagnosis of scalp DLE. Patients underwent global clinical photograph, trichoscopy, and RCM examination in the same site followed by two 4-mm punch biopsy specimens for HP analysis. Inter-methods agreement among RCM imaging, trichoscopy, and horizontal histopathology sections (HHS) were calculated using Cohen Kappa (k) statistics. Results: Statistical analysis of the agreement between RCM and HP features disclosed an overall agreement similar to skin DLE. Seven of the eleven features evaluated had agreement superior to 75%. We also evaluated RCM features associated with three of their corresponding trichoscopic findings for further investigation of their agreement with HP. Statistical analysis showed an enhancement with agreement of 86% when the non-invasive techniques are used together. Conclusion: Consistent correlation between RCM and HP observed in our study supports the reliability of RCM in the diagnosis of scalp DLE. RCM may be considered a promising tool for scalp DLE microscopic evaluation and presents similar RCM features to DLE in other body sites. By associating clinical, trichoscopic and RCM evaluation, dermatologists will have a non-invasive arsenal for the assessment of hair and scalp disorders, benefiting patients.

Reflectance Confocal Microscopy, Optical Coherence Tomography, and Multiphoton Microscopy in Inflammatory Skin Disease Diagnosis

“…Six reports examined RCM use in discoid lupus erythematosus (DLE) [22‐25,67,68]. RCM findings showed inflammatory refractive cells and inflammation in the dermal‐epidermal junction (DEJ), and had 91.7% agreement with histology [22,24].…”

“…Six reports examined RCM use in discoid lupus erythematosus (DLE) [22‐25,67,68]. RCM findings showed inflammatory refractive cells and inflammation in the dermal‐epidermal junction (DEJ), and had 91.7% agreement with histology [22,24]. When observer‐blinded RCM was performed to assess for features of chronic DLE and subacute cutaneous lupus erythematosus (SCLE), a sensitivity of 62.96% and a specificity of 94.53% was achieved [68].…”

“… Hyperkeratosis and epidermotropic inflammatory infiltrate are associated with DLE in both RCM and OCT [22‐26,67,68,69]. RCM is able to distinguish chronic DLE and SCLE with high sensitivity; OCT is not [26,68].…”

New‐generation diagnostics in inflammatory skin diseases: Immunofluorescence and histopathological assessment using ex vivo confocal laser scanning microscopy in cutaneous lupus erythematosus

“…Besides conventional diagnostic methods, in vivo CLSM has been used in mucosal, skin and scalp lesions of CLE, which showed a diagnostic concordance with conventional histopathology to a certain degree and seems to be promising in the noninvasive recognition of the histomorphological features of CLE 22‐24 …”

Patrones tricoscópicos de las alopecias cicatrizales

“…El lupus eritematoso discoide es una alopecia cicatrizal de causa autoinmunitaria; es el subtipo más frecuente de lupus cutáneo y afecta con mayor frecuencia a mujeres jóvenes y se presenta por lo general en zonas fotoexpuestas. Alrededor de 50% de los pacientes con lupus cutáneo puede experimentar afectación de la piel cabelluda 29 .…”