Dynamic Optical Coherence Tomography of Cutaneous Blood Vessels in Melasma and Vessel Response to Oral Tranexamic Acid

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

Combining Low Power Fractional CO2 With QS‐NdYAG Toning in the Treatment of Melasma Reduces the Incidence of Punctate Leukoderma

“…At 8‐12 weeks after the last laser session, EI readings decreased in all modalities due to the reduction of vasculature that helps downregulate melanogenesis [6,30]. No significant changes of the EI measurements after each modality separately were detected.…”

Diagnostic tools for hyperpigmentation disorders in skin of color: An updated review

“…For example, “confetti melanin” appears dense and is concentrated in the stratum spinosum, while “grain melanin” has a higher density in the dermoepidermal junction, demonstrating OCT's potential to classify melasma in a noninvasive approach 33 . Similarly, Pomerantz et al 103 used dynamic optical coherence tomography and found that dermal blood vessels were increased in size and flow at baseline with subsequent reduction in both measures after oral tranexamic acid, further supporting OCT for measuring treatment response in melasma. Although these studies were limited to a small cohort, they highlight OCT as a useful tool with the potential to study the microscopy features of melasma in an objective and noninvasive approach.…”

“…Although invasive, histopathology remains the gold standard in diagnosing ochronosis and confirms it accurately 103 . When ochronosis lesions were graded using the Dogliotti and Phillips classifications, clinical‐histopathological concordance was observed at 80% and 60% of cases, respectively.…”

Neues von der optischen Kohärenztomographie

“…Da der Algorithmus die Bewegung der Pixel im Blut im Vergleich zu den statischen Anteilen der Haut berechnet, ist die Aussagekraft bei langsamem Blutfluss ebenfalls eingeschränkt. Die D-OCT erlaubt jedoch nicht nur eine Einschätzung des Blutflusses, sondern, wie oben bereits genannt, auch eine Beurteilung der Gefäßmorphologie [30]. Eine Einteilung gelingt hier nach der von Ulrich et al (2018) vorgeschlagenen Terminologie.…”

“…Bei Melasma konnte gezeigt werden, dass die dermalen Blutgefäße in Durchmesser und Fluss im Vergleich zur gesunden Haut erhöht sind und dass oral verabreichte Tranexamsäure beide Parameter reduziert [30].…”