Histometric data obtained by in vivo confocal laser scanning microscopy in patients with systemic sclerosis

Abstract

BackgroundIt would be a benefit if time-saving, non-invasive methods could give hints for diagnosing systemic sclerosis. To investigate the skin of patients with systemic sclerosis using confocal laser scanning microscopy in vivo and to develop histometric parameters to describe characteristic cutaneous changes of systemic sclerosis observed by this new technique, we conducted an exploratory study.Materials and MethodsFifteen patients with systemic sclerosis treated with extracorporal photopheresis were compared with 15 healthy volunteers and 10 patients with other disorders also treated with extracorporal photopheresis. All subjects were investigated using confocal laser scanning microscopy in vivo.ResultsMicromorphologic characteristics of skin of patients with systemic sclerosis and measuring parameters for melanisation, epidermal hypotrophy, and fibrosis for dislocation of capillaries by collagen deposits in the papillary dermis were evaluated. An interesting finding was an increased thickness of the tissue in the dermal papillae superior to the first dermal papilla vessel. It was also possible to reproduce characteristic histologic features by confocal laser scanning microscopy in vivo. Histometric parameters for fibrosis and vascular features developed in this study showed significant differences in patients with systemic sclerosis compared to controls.ConclusionsAlthough the predominant histopathological features in systemic sclerosis are findings of the reticular dermis and the subcutis, and in histopathological investigation the epidermis seems to remain unaffected by the disease, we have demonstrate some characteristic differences in the epidermis and papillary dermis by confocal laser scanning microscopy in vivo. Some of them have not been described so far. However, to use this technique as a tool for diagnosis and/or staging of systemic sclerosis, further studies are needed investigating the sensitivity and specificity of the histometric parameters developed in this study.

Topically applied vitamin C increases the density of dermal papillae in aged human skin

“…In aged skin, the cells in the apical granular layer show larger projection areas than in the skin of younger individuals [8] similar to the enlargement of the size of corneocytes with age described earlier by Grove and Kligman [9]. Kligman shows an inverse relationship between turnover and the size of corneocytes [9].…”

“…This is partly due to the avoidance of shrinkage artefacts after fixation for histological sectioning. Confocal microscopy is more suitable to construct a three dimensional image than conventional serial sections are [8]. …”

In vivo reflectance confocal microscopy features of cutaneous microcirculation and epidermal and dermal changes in diffuse systemic sclerosis and correlation with histological and videocapillaroscopic findings

“…fibrosis and altered morphology of collagen fibers. Atrophy was evaluated measuring the thickness of the epidermis (distance between skin surface and the most apical recognizable dermal structure); fibrosis was measured according to a semiquantitative parameter [21], the dermal reflectivity index, which evaluates the relative reflectiveness of the dermis as the contrast between stratum spinosum and papillary dermis. In accordance with the in vivo RCM morphological evaluation of collagen proposed by Longo and co-workers [22,23], we classified the collagen fibers as: thin reticulated (thin, reflecting fibers forming a reticulated architecture), coarse (filamentous, thick structures forming a grossly arranged network with small occasional holes), huddled (large blotches of amorphous material) and curled (highly refractive, thick and short, wavy fibers, sometimes forming compact masses).…”

Konfokale Laserscan-Mikroskopie

“…Hier kann im Idealfall der Blutfluss in den oberflächlichen Kapillargefäßen dargestellt werden. Unterhalb der Junktionszone zeigen sich die retikulären Bündel des oberflächlich dermalen Bindegewebes, wobei hier topographische und altersabhängige Unterschiede bestehen [4,5].…”