In vivo reflectance confocal microscopy: usefulness for diagnosing hair diseases

Abstract

Background: Reflectance confocal laser scanning microscopy (R-CSLM) is a new diagnostic technique which allows visualization of "optical intersections" within the epidermis and superficial layers of the dermis. Outlines of cells and their architecture are imaged and may be analyzed both horizontally and vertically to the skin surface. The method proved useful in early melanoma detection. We evaluated the potential usefulness of this method in a short series of patients with hair diseases.Main observations: Two healthy persons and 6 patients with hair diseases (1 with alopecia areata, 1 with androgenic alopecia and 4 with genetic hair shaft abnormalities) were examined with the use of Vivascope 1500. In all patients one scalp location and one location in the mid forearm were evaluated. R-CSLM examination gave in all cases high quality images of the hair shaft intersections, at 1μm intervals, which allowed detailed analysis of the hair structure. Hair follicles could be partly visualized at a depth of up to 200μm, which allowed analysis of only superficial parts of the hair follicles. An additional hurdle was bright reflection within the follicular ostia, which decreased the perception of details in these images.Hair could be best visualized, when analyzed on flat surfaces. Receiving good quality images from convex surfaces on the scalp required additional effort from the patient (to not move) and from the physician (to obtain best possible fit of the "optic window" to the scalp).Conclusions: These preliminary data show that R-CSLM may develop into a valuable tool in evaluation of hair shaft diseases. Further development is needed to apply this technique in abnormalities of the hair follicle and the perifollicular area.

Alopecia areata developing paralell to improvement of psoriasis during ustekinumab therapy

“…After 7 months of therapy he developed alopecia areata of the scalp, confirmed by trichoscopy 9 and reflectance confocal microscopy. 10 The triggering factor of alopecia areata is unclear. It seems unlikely that this was an adverse event related to ustekinumab therapy.…”

Review paper The use of reflectance confocal microscopy in selected inflammatory skin diseases

“…Recent studies have shown that RCM may be a useful auxiliary tool in the diagnosis of hair diseases such as alopecia areata, androgenetic alopecia, or hereditary hair dystrophy, although its superiority over trichoscopy has not yet been demonstrated [34]. Ardigo et al [35] performed an RCM study of stratum spinosum of the epidermis in patients with alopecia areata.…”

Trichoscopy: a new frontier for the diagnosis of hair diseases

“…Furthermore, sophisticated methods for trichoscopy are expected to be developed in the future. As a new technique, reflectance confocal laser scanning microscopy has been reported to be helpful for observing hair follicle structures in hair loss diseases [63][64][65] and is expected to be investigated in more detail. Through agreements that the AMA has made with agencies in some countries, AMA PRA credit may be acceptable as evidence of participation in CME activities.…”