Optical coherence tomography for fast bedside imaging, assessment and monitoring of autoimmune inflammatory skin diseases?

Abstract

Summary Optical coherence tomography (OCT) is a non‐invasive, high‐resolution imaging technique with a growing impact in dermatology. The principle of OCT is comparable to that of sonography, except that it uses infrared laser light instead of ultrasound waves. It has been clinically demonstrated that OCT is suitable for discriminating between different types of non‐melanoma skin cancer at an early stage of disease. Optical coherence tomography generates two‐ or three‐dimensional images of up to 2 mm penetration depth, a field of view of 6 mm × 6 mm, and an acquisition time of seconds. The resolution capability of OCT is more than 3 to 100 times higher than that of ultrasound imaging. It is of particular interest that the additional information on vasculature provided by OCT angiography enables the assessment and monitoring of inflammatory skin diseases. The use of OCT to locate exact blister levels was demonstrated for diagnosing autoimmune bullous diseases. It is anticipated that detection of subclinical lesions could indicate a relapse of the disease. In the future, this could enable intervention and early treatment. Furthermore, the development of high‐speed OCT could allow fast scanning and bedside imaging of large body sites.

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

“…The main limitations of this study was the sample size: however, the prototopic of the device is currently available only in the centers participating to the study; nevertheless, the collected case series is representative of the most frequent AIBDs encountered in clinical activity, and the commercial device will be soon available for dermatologists. Concerning the technical issue, the main current limitation for LC-OCT is that it is still not equipped to realize a specific marking with fluorescent autoantibodies, as in DIF and ex vivo RCM: [37,38] thus, LC-OCT is currently unable to replace immunofluorescence, which rests the golden standard for final diagnosis.…”

Imaging Inflammation – From Whole Body Imaging to Cellular Resolution

“…The clinical applications of OCT in areas other than ophthalmology are currently found in skin imaging, cardiovascular imaging, and gastroenterology, as only there clinically approved OCT devices are commercially available. Previously, most dermatology studies dealt with the visual presentation of tumor diseases and only few papers evaluated OCT’s potential for inflammatory diseases ( 206 , 224 – 226 ) In gastrointestinal diseases the first results from endoscopic optical biopsy were published 20 years ago ( 227 ). OCT could be used to identify transmural inflammation and morphological differentiation between UC and CD from patient ex vivo tissue samples ( 228 ) and in vivo , providing a valuable tool to distinguish CD from UC ( 229 ).…”

“…OCT has the potential to combine fast bedside imaging with the opportunity to monitor therapeutic effects ( 224 ). There are reports on applications of OCT in dermatology mostly for skin tumors ( 231 ), but rarely for inflammatory skin diseases ( 232 ) and evaluation of treatment effects ( 233 ).…”

“…The efficacy of potent biologic treatments could be assessed using OCT. Imaging parameters could be skin structure, epidermal thickness ( Figure 8 ), entrance peak, dermal reflectivity, attenuation coefficient, plexus depth, vessel diameter, density, and tortuosity ( Figure 9 ) ( 224 , 240 ).…”

Hemoporfin-Mediated Photodynamic Therapy for Port-Wine Stains: Multivariate Analysis of Clinical Efficacy and Optical Coherence Tomography Appearance

“…In 1991, Huang et al ( 14 ) first proposed the concept of OCT and successfully used the technique to image microstructures in the retina and coronary artery wall of the human eye. The feasibility of OCT in the field of dermatology has additionally been confirmed in several inflammatory skin diseases, in particular, psoriasis and contact dermatitis, autoimmune skin disorders, such as scleroderma and autoimmune blistering disease ( 15 ), and vascular characteristics of sensitive skin ( 13 ).…”