An investigation of striae distensae using reflectance confocal microscopy

Background: Striae distensae, otherwise known as stretch marks, are white or red scar‐like streaks on the skin. Although they are not associated with adverse health outcomes, striae are associated with significant cosmetic morbidity. While they have been well characterised histopathologically, a non‐invasive method of microscopic lesion assessment of striae would be welcome. Methods: To gain insight into the small‐scale morphological features associated with striae we undertook an in vivo investigation of nine patients with striae alba and one with striae rubra utilising reflectance confocal microscopy (RCM). Results: Here we demonstrate that features known to be present using light microscopy, such as parallel collagen bundles in the dermis, and some features that are not well recognised by light microscopy, including distortion of dermal papillae, are demonstrable using RCM. Conclusions: Characterising the features of early and established striae distensae with confocal microscopy is an important foundation for future work. The potential ability to reliably identify the earliest pathological changes in skin in early lesions or before clinically manifest striae develop – a task facilitated by our findings – will increase the understanding of their pathogenesis and will have significant practical utility in monitoring the impact of future preventative interventions.     

Preliminary evaluation of vitiligo using in vivo reflectance confocal microscopy

BACKGROUND: Vitiligo is the most common pigmentary disorder with a global incidence from 0.1% to 2% in different geographical areas. Histopathology and histochemistry have shown the reduction of melanocytes in achromic patches, but microscopic changes of lesional and non-lesional skin are still not completely understood. Reflectance confocal microscopy (RCM), based on the different light reflectance index of cutaneous structures, allowed in vivo, en face microscopic evaluation of superficial skin layers with a resolution similar to skin histology. AIM: The purpose of this study was to evaluate RCM features of lesional and non-lesional skin of vitiligo patients. Moreover, re-pigmented areas were taken into consideration in order to evaluate melanocyte response to ultraviolet B (UVB) radiation. SUBJECTS AND METHODS: Sixteen patients of different phototypes affected by active non-segmental vitiligo and 10 controls were enrolled in the study. In vivo skin imaging was done using a commercially available RCM (Lucid, Vivascope 1500. Re-pigmented areas from 6 to 16 patients (after UVB narrow-band therapy) were also examined. RESULTS: Vitiligo lesions showed the disappearance of the bright rings normally seen at the dermo-epidermal junction. Moreover, non-lesional skin of vitiligo patients showed unexpected changes as the presence of half-rings or scalloped border-like features of the bright papillary rings. In re-pigmented areas after UVB narrow band therapy, the presence of activated, dendritic melanocytes was seen. CONCLUSIONS: Considering our results, and following further studies, RCM clinical applications could be used in the therapeutic monitoring and evaluation of the evolution of vitiligo.     

Skin imaging with reflectance confocal microscopy

Confocal microscopy is a new imaging modality for noninvasive real-time tissue imaging with high resolution and contrast comparable with conventional histology. Application of this technology to skin imaging during the last decade has been an exciting advance in dermatology, allowing a virtual widow into living skin without the need for a conventional biopsy or histologic processing of tissue. High-resolution noninvasive skin imaging with confocal microscopy has potential broad applications in the clinical and research arenas, including differentiating between benign and malignant skin lesions, tumor margin mapping, monitoring response to medical or surgical treatments, and pathophysiologic study of inflammatory processes.     

反射式共聚焦显微镜在筛检面部难辨认癣的临床应用

目的:评价反射式共聚焦显微镜(RCM)在诊断浅部真菌病中的应用价值。方法:对46例临床诊断为面部湿疹等但不排除难辨认癣的患者,进行RCM扫描及光学显微镜检查,观察镜下菌丝特征,并与真菌图片相比较。结果:RCM诊断难辨认癣42例(阳性率91.12%),真菌涂片检查阳性40例(阳性率87.83%),差异无统计学意义(P0.05),二者结果具有较好的一致性。结论:RCM是筛检难辨认癣与鉴别皮炎湿疹等皮肤病很好的辅助工具。     

疥疮在反射式共聚焦显微镜下的特征分析

目的:明确疥疮在反射式共聚焦显微镜(RCM)检查中的图像特征.方法:对临床初步诊断为疥疮的患者进行RCM多层扫描,观察镜下特征.结果:共检测69例患者,RCM阳性病例共61例(88.4％).在RCM可见疥螨、疥卵和粪球.61例患者中均发现粪球和隧道结构,27例发现粪球+疥螨,12例发现粪球+疥螨+疥卵,8例发现粪球+疥...     

反射式共聚焦显微镜在炎症性皮肤病诊疗中的应用

反射式共聚焦激光扫描显微镜(RCM)作为一种在体无创性皮肤检查设备,能够实时动态反应细胞形态及皮肤结构的变化,在某些皮肤病中其图像特征与组织病理学检查结果具有高度的一致性,本文就RCM在炎症性皮肤病的诊断、疗效评价和疾病进展中的应用作一综述。     

反射式共聚焦扫描显微镜在日光性角化病诊断中的应用

目的：明确反射式共聚焦扫描显微镜（RCM）下日光性角化病的形态学特征及在诊断日光性角化病中的应用价值。方法：对136例拟诊为日光性角化病患者进行RCM技术扫描并与常规组织病理进行比较分析。结果：136例患者RCM成像特征为棘细胞层排列紊乱及角质形成细胞异型性,与日光性角化病组织病理改变一致,符合率100%。结论：日光性角化病在RCM下具有典型特征,可作为无创诊断日光性角化病的重要依据。     

硬化性苔藓反射式共聚焦显微镜特征分析

观察一例硬化性苔藓在反射式共聚焦显微镜下的图像特征,并回顾相关文献。反射式共聚焦显微镜下可见毛囊角栓,表皮厚度略薄,表皮突变平,真皮乳头水肿,真皮浅层纤维排列致密,折光度增高,浅层血管周围见少量炎细胞浸润,与组织病理学检查结果高度相符。     

麻风病皮损的反射式共聚焦显微镜图像特征

 目的: 探讨麻风病皮损的反射式共聚焦显微镜（RCM）图像特征,为无创辅助诊断麻风病提供新方法。方法：采用RCM检查8例麻风病患者皮损,与同处皮损的组织病理对照,分析其图像特征及意义。 结果： 与组织病理特点比对,麻风病皮损RCM图像特点为:瘤型麻风（LL）、界线类偏瘤型（BL）见表皮萎缩、角化过度、棘层萎缩,真皮浅层片、灶状“蛙籽样”组织细胞（泡沫细胞）浸润,明显可见“无浸润带”形成;界线类偏结核样型（BT）见角化过度,真皮浅层血管扩张,管周散在淋巴细胞和组织细胞浸润。结论：RCM可以作为筛查麻风病的辅助检查技术,为今后麻风病的诊断与鉴别提供新的思路和方法。     

Pigmented skin lesions displaying regression features: Dermoscopy and reflectance confocal microscopy criteria for diagnosis

Melanomas and nevi displaying regression features can be difficult to differentiate. To describe reflectance confocal microscopy features in benign and malignant pigmented skin lesions characterized by regression features in dermoscopy. Observational retrospective study. Inclusion criteria were presence of dermoscopic features of regression; availability of clinical, dermoscopic and RCM imaging; definite histopathologic diagnosis. The study sample comprised 217 lesions; 108 (49.8%) melanomas and 109 were benign lesions, of which 102 (47.0%) nevi and 7 (3.2%) lichen planus‐like keratosis (lplk). Patients with melanoma were significantly older than those with benign lesions (61.9 ± 15.4 vs 46.1 ± 14.8; P < 0.001) and a higher proportion of melanomas displayed dermoscopic regression structures in more than 50% of lesion surface (n = 83/108; 76.9%; P < 0.001). On RCM examination, pagetoid cells were significantly more reported in melanoma group, than in benign lesions (86.1% vs 59.6%; P < 0.001) and were more frequently widespread distributed (65.6% vs 20.0%; P < 0.001) and both dendritic and roundish (36.6% vs 15.4%; P < 0.001) in shape. Aspecific architecture at the dermo‐epidermal junction (DEJ) was more commonly seen among melanomas than benign lesions (23.1% vs 11.9%; P = 0.002) with higher presence of dendritic and both dendritic and roundish atypical cells at the DEJ (28.7% vs 18.3% and 19.4% vs 3.7%; P < 0.001, respectively). Focal pagetoid infiltration and ringed or clod patterns were more commonly seen in benign lesion. In conclusion, the correct interpretation of regressing lesions remains a challenge, assessing carefully the extent and characteristics of architectural and cytologic atypia on RCM is an additional piece of the complex puzzle of melanoma diagnosis.     

First experiences using reflectance confocal microscopy on equivocal skin lesions in Queensland

Background/Objectives: Reflectance confocal microscopy (RCM) is a non‐invasive method of imaging human skin in vivo. The purpose of this study was to observe the experience of using RCM on equivocal skin lesions in a tertiary clinical setting in Queensland. Methods: Fifty equivocal lesions on 42 patients were imaged using a reflectance confocal microscope immediately prior to being excised. The images were then analysed blind to the histopathological diagnosis. The experience and problems encountered when using RCM on skin lesions for the first time was also observed. Results: On RCM analysis 12/13 melanomas (92.3% sensitivity, 75% specificity), 19/22 benign naevi (86% sensitivity, 95% specificity), 6/9 basal cell carcinomas (66.7% sensitivity, 100% specificity)and 6/6 squamous cell carcinomas and its precursors (100% sensitivity, 75% specificity) were diagnosed correctly when using histology as the gold standard. We identified three common problems that affected image quality: object artefacts; positioning artefacts; and movement artefacts. Conclusions: Using simple techniques we found that common RCM features were readily identifiable and common artefacts could be minimized, making RCM a useful tool to aid the diagnosis of equivocal skin lesions in a clinical setting.     

In vivo reflectance confocal microscopy of erythematosquamous skin diseases

Background:  In vivo reflectance confocal microscopy (RCM) represents a promising imaging tool that allows a non-invasive examination of skin morphology in real time at nearly histological resolution, showing microanatomical structures and individual cells.
Objectives:  The aim of our study was to evaluate the diagnostic accuracy of confocal examination of erythematosquamous skin diseases, to define typical RCM-features and assess them for their presence or absence, diagnostic performance and reliability.
Methods:  Three independent observers received standardized instructions about diagnostic RCM-features of erythematosquamous skin diseases. A total of 1700 RCM images obtained from 75 patients with psoriasis, contact dermatitis, mycosis fungoides, chronic discoid lupus erythematosus (CDLE) or subacute cutaneous lupus erythematosus (SCLE) and from 10 'healthy adults' without any skin disease were evaluated by each observer.
Results:  Overall, sensitivity and specificity values as observed by three observers were, respectively, 89.13% and 95.41% for psoriasis; 83.33% and 92.31% for contact dermatitis; 62.96% and 94.53% for SCLE/CDLE; and 63.33% and 92.89% for mycosis fungoides.
Conclusions:  Reflectance confocal microscopy examination appears to be a promising method for non-invasive assessment of erythematosquamous skin diseases. This study provides a set of well-described morphological criteria with obvious diagnostic impact, which should be used in further investigations.