![]() ![]() Reflectance confocal microscopy imaging of inflammatory skin conditions with epidermal alterations has already been studied in detail. ![]() Combining in vivo imaging with the conceptual approach by Ackerman and colleagues may therefore be a significant step forward for skin imaging. Because of the optical complexity of skin, which contains numerous reflective elements, two essential options exist for in vivo imaging: either sufficient optical resolution is achieved in a sufficient volume of skin to allow diagnosis, with accuracy comparable to that of histopathology, or in vivo methods have to rely on pattern recognition at a lower magnification. One of the challenges of skin imaging is diagnostic accuracy in comparison to the gold standard of histopathology. Ackerman and colleagues thus defined eight basic patterns of inflammatory diseases of the skin, where the pattern strongly indicates diagnosis prior to more detailed studies. Specific stains and biomarkers aid this process, but it has been suggested that overall pattern analysis is both specific and sufficient in the practical management of many diseases. Inflammatory diseases are dynamic, and knowledge of the point of time when a dermatitis is biopsied is essential to optimal microscopic evaluation.įollowing the first sorting, more detailed diagnosis is then produced by identifying the specific qualitative and quantitative characteristics. In general, the majority of pathologic processes can be classified into one of these groups, although challenging exceptions occur, particularly when overlapping features appear. In dermatopathology, the initial approach is often to classify the changes broadly according to whether a process is predominantly inflammatory, predominantly proliferative/neoplastic, both inflammatory and proliferative or non-inflammatory/non-proliferative. Later dermatopathology evolved with its own special vocabulary of terms used to describe histological skin alterations, allowing dermatopathologists to classify skin diseases in great detail. Most dermatological diseases were originally defined morphologically, and terms such as papules and pustules are still important when diagnosing skin disease. This new technique appears to be a promising method for non-invasive diagnosis, evaluation and management of common inflammatory skin diseases. An adapted algorithmic method for pattern analysis of common inflammatory skin diseases could be proposed. This study provides a set of morphological features generated by HD-OCT imaging very similar to those described for reflectance confocal microscopy but with the advantages not only to visualize individual cells up to a depth of 570 μm but also in both slice and en face mode. The other categories of Ackerman’s pattern recognition need to be evaluated. Additional studies to test the sensitivity and specificity of the proposed algorithm for pattern analysis are essential. These patterns are spongiotic dermatitis, psoriasiform dermatitis, interface dermatitis and ballooning dermatitis. A set of morphological features corresponding to dermatopathological descriptors are obtained and the discriminative accuracy of HD-OCT of inflammatory reaction patterns could be demonstrated. The generated HD-OCT images of 160 patients presenting an inflammatory skin disease were analyzed with respect to the following criteria: visualization of individual cells in the epidermis and dermis and morphology of dermo-epidermal junction, papillary dermis and reticular dermis. Secondly, to assess the discriminative accuracy of common inflammatory reaction patterns with epidermal alteration using HD-OCT by applying Ackerman’s algorithmic method of pattern recognition. The aim of this study is first to correlate dermatopathologic descriptors of inflammatory skin conditions with epidermal alteration to features observed by HD-OCT. ![]() High-definition optical coherence tomography (HD-OCT) is a non-invasive technique for morphological investigation of tissue with cellular resolution filling the imaging gap between reflectance confocal microscopy and conventional optical coherence tomography. ![]()
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