Line field confocal optical coherence tomography: An adjunctive tool in the diagnosis of autoimmune bullous diseases

Abstract

Autoimmune bullous diseases (AIBDs)still represent a considerable a source of morbidity and mortality: early identification of a specific AIBD is often difficult due to overlapping clinical and/or laboratory features and time-consuming invasive laboratory tests. We aimed to investigate the potential role of a new imaging technology, line-field confocal optical coherence tomography (LC-OCT), in the non-invasive diagnosis of AIBDs. LC-OCT was performed at lesional, perilesional and contralateral healthy sites in 30 patients, before histology and direct immunofluorescence. LC-OCT examination was able to identify the level of split (subcorneal/ suprabasal/subepidermal/sublamina densa), to provide detailed images of the bulla roof morphology and content (eg, erythrocytes/acantholytic cells/polymorphonucleates). Areas of intra/subepidermal detachment were also detected also at clinically normal perilesional skin sites. LC-OCT can support physicians, real time and at bed-site, in the differential diagnosis of various AIBDs and their mimickers. Moreover, it can be used for the identification of subclinical lesions and therapy tapering.

Line‐field confocal optical coherence tomography as a tool for three‐dimensional in vivo quantification of healthy epidermis: A pilot study

“…Lagarrigue et al [6] and Kawasaki et al [22] used a non-automatic quantification method of the dermal papillae density and diameter based on 2D images extracted from a horizontal stack. Kurugol et al [23], Hames et al [24] and Robic et al [25] developed automated algorithms to guide the delineation of the DEJ and Hames et al [24] proposed a quantification of the DEJ 2) 100 ( 6) 98 (6) 140 (13) 137 (12) 201 (27) 195 (24) 332 (44) 322 (44) 72 (2) 104 (6) 146 (15) 212 (32) 349 (46) Nose 71 (1) 71 (1) 104 ( 4) 102 (2) 151 (7) 148 ( 4) 231 (11) 227 (11) 403 (21) 397 (24) 72 (1) 107 (5) 156 (10) 238 (12) 415 (5) Cheek 74 (3) 72 (1) 110 (9) 104 (3) 154 (17) 143 (8) 216 (27) 199 (14) 354 (42) 329 (18) 78 (3) 120 (5) 172 (10) 244…”

Line-Field Confocal Optical Coherence Tomography May Enhance Monitoring of Superficial Basal Cell Carcinoma Treated with Imiquimod 5% Cream: A Pilot Study

“…The interest of using LC-OCT in the diagnosis of skin disorders is growing. Reported applications include benign dermal melanocytic proliferations [ 4 ], skin tumors such as actinic keratoses, squamous and basal cell carcinoma (BCC) [ 1 , 5 , 6 , 7 , 8 ], sebaceous hyperplasia [ 9 ], xanthogranuloma [ 10 ], autoimmune bullous diseases [ 11 ], herpes infection [ 12 ], scabies [ 13 ], aquagenic keratoderma [ 14 ], Kaposi’s sarcoma [ 15 ], and circumscribed palmar hypokeratosis [ 16 ].…”

Delineating papillary dermis around basal cell carcinomas by high and ultrahigh resolution optical coherence tomography—A pilot study

“…Only recently, the papillary dermis was clearly delineated in OCT images, which is only possible in ultrahigh resolution images [12]. Several UHR-OCT studies demonstrate even better resolution (although poorer penetration depth) [7,10,[25][26][27]. However, the majority suggest that DEJ is positioned at the interface to the high reflective layer of reticular dermis; dismissing the single images of dark skin where the basal cell layer is unmistakable due to the high concentration of melanin [26].…”

“…Subsequently, a number of applications in the clinic have found use in exploiting UHR-OCT [6,8,9], with the latest commercial UHR-OCT scanner for dermatology, line Field OCT (LC-OCT), Damae, France, promising an impressive isotropic resolution of 1 μm in tissue, thereby resolving single cells [7]. The fine resolution is, however, achieved on the expense of penetration depth in using a tighter laser beam focus and a center wavelength of ~800 nm whereby only skin depths of 300 to 400 μm [7] can be reached, also found in case reports [10,11]. Despite that UHR-OCT is now competing with RCM in resolution, delineation of the dermoepidermal junction (DEJ) is contradictive in LC-OCT images from study to study.…”