Acne vulgaris severity graded by in vivo reflectance confocal microscopy and optical coherence tomography

Fuchs, Christine; Andersen, A. J. B.; Ardigò, Marco; Philipsen, Peter Alshede; Hædersdal, Merete; Mogensen, Mette

doi:10.1002/lsm.23008

Cited by 26 publications

(88 citation statements)

References 29 publications

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“…RCM and OCT have previously been used to explore acne and healthy skin morphology . Overall, the studies found that hair follicles of acne patients were enlarged with hyperkeratinized borders and sebum plugs compared to healthy skin follicles.…”

Section: Introductionmentioning

confidence: 98%

Transfollicular delivery of gold microparticles in healthy skin and acne vulgaris, assessed by in vivo reflectance confocal microscopy and optical coherence tomography

et al. 2019

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Introduction Topical application of gold microparticles (GMPs) for selective photothermolysis is a recently FDA‐cleared therapy for acne vulgaris. Current evidence indicates the potential of optical imaging to non‐invasively visualize GMPs and describe photothermal tissue effects. Objectives To qualitatively and quantitatively describe GMP delivery in vivo and visualize laser‐mediated thermal effects of GMPs in facial skin of acne patients and healthy participants, using reflectance confocal microscopy (RCM) and optical coherence tomography (OCT). Methods Patients with facial acne (n = 14), and healthy participants (n = 7) were included. RCM and OCT images were acquired at baseline, after GMP application, and after diode laser exposure. All images were evaluated qualitatively and quantitatively with regards to GMP delivery in skin layers and morphological thermal effects. Lastly, skin biopsies were obtained to compare RCM and OCT findings to histology. Results GMPs were delivered equally in healthy participants and acne patients, and in lesional and non‐lesional acne skin. In RCM images, GMPs appeared as hyperreflective aggregates inside hair follicles and eccrine ducts, corresponding to natural skin openings (NSOs). The fraction of NSOs with hyperreflective content increased significantly after GMP application compared to baseline (50–75% increase, P = 8.88 × 10−16). Similarly, in OCT images, GMPs appeared as hyperreflective columns inside hair follicles and were not detected in surrounding skin. GMPs reached a maximum depth of 920 μm (median 300 μm). After laser exposure, RCM and histology revealed selective perifollicular tissue changes around NSOs. Conclusion Optical imaging visualizes GMP delivery and thermal tissue response following laser exposure and enables bedside monitoring of transfollicular microparticle delivery. Lasers Surg. Med. 51:430–438, 2019. © 2019 Wiley Periodicals, Inc.

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Section: Introductionmentioning

confidence: 98%

Transfollicular delivery of gold microparticles in healthy skin and acne vulgaris, assessed by in vivo reflectance confocal microscopy and optical coherence tomography

et al. 2019

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“…Due to the numerous types of lesions in dermal inflammatory diseases, the external appearance and subcutaneous morphology of the lesions may aid in distinguishing lesion type . A study using OCT has been able to identify morphological variances in pustules of Malassezia fungi (MaF), a folliculitis often mistaken for acne due to its similar dermal appearance .…”

Section: Discussionmentioning

confidence: 99%

First Use of Optical Coherence Tomography on In Vivo Inflammatory Acne‐Like Lesions: A Murine Model

Hermsmeier¹,

Sawant²,

Chowdhury³

et al. 2019

Lasers Surg Med

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Background and Objectives Successful outcomes of clinical studies for acne vulgaris depend greatly on achieving statistically significant reduction in acne lesion count and improvement in Investigator's Global Assessment score of the investigational drug product against its vehicle control. To date, there has not been a validated preclinical acne model to evaluate investigational drug products in order to improve the probability of clinical success. An inflammatory acne‐like lesion mouse model developed in‐house has previously been used for clinical guidance in our drug development program. In this study, we aim to implement and assess the adequacy of swept‐source optical coherence tomography (SS‐OCT) in quantifying the dynamic changes in inflammatory acne‐like lesions. Study Design/Materials and Methods Live Propionibacterium acnes bacteria were injected intradermally resulting in inflammatory acne‐like lesions. Topical 1% and 2% minocycline gels were applied to the lesions in separate groups once daily for 2 weeks and compared with vehicle and untreated control groups. The growth of these lesions was monitored and measured with a ruler (height)/microcaliper (width)—an approach previously developed, and with SS‐OCT. The reliability of the two methods were assessed. Acquired OCT images across the apex of these inflammatory lesions were statistically analyzed for lesion volume reduction from baseline as well as between the treatment groups and the control groups. Results The OCT technique allowed for reliable lesion volume analysis with varying conic profiles. After 14 days of topical minocycline treatments (1%, 2% minocycline), statistically significant reduction in lesion volume (P ≤ 0.05) based on OCT image analysis was observed compared with untreated and vehicle control groups as well as compared with baseline measurements. Under the right conditions, some morphological aspects of the P. acnes injection site were discernible within the skin in images captured with OCT. Conclusions We demonstrated the first use of SS‐OCT in evaluating in vivo inflammatory acne‐like lesions in a murine model. Our findings support the use of OCT in assessing lesion size and evolution of P. acnes injection sites non‐invasively in preclinical in vivo studies, which could potentially lead to more consistent and predictable outcomes in clinical development. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

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“…Although histopathology is considered the optimal method to study the morphological changes associated with acne, it is not feasible for an in vivo follow‐up of the same lesion during time. Recently, Reflectance Confocal Microscopy (RCM) and Dynamic Optical Confocal Microscopy (D‐OCT) have been applied to the non‐invasive exploration of acne at a microscopic resolution . Previous studies demonstrated that, compared to healthy individuals, the pilosebaceous units of the clinically unaffected skin of acne patients showed larger infundibular diameter, with bright border and amorphous material inside, whilst the pilosebaceous units of healthy patients showed well‐defined, roundish/elliptic infundibula, that did not contain amorphous or bright material .…”

Section: Introductionmentioning

confidence: 99%

“…Recently, Reflectance Confocal Microscopy (RCM) and Dynamic Optical Confocal Microscopy (D-OCT) have been applied to the non-invasive exploration of acne at a microscopic resolution. [13][14][15][16] Previous studies demonstrated that, compared to healthy individuals, the pilosebaceous units of the clinically unaffected skin of acne patients showed larger infundibular diameter, with bright border and amorphous material inside, whilst the pilosebaceous units of healthy patients showed well-defined, roundish/elliptic infundibula, that did not contain amorphous or bright material. 13,17 Furthermore, D-OCT imaging enables to identify the alterations of the microcirculation providing information on the dermal blood flow, which is of great value in the characterization of the inflammatory process and in the determination of the functional and metabolic features of skin diseases.…”

Section: Introductionmentioning

confidence: 99%

The evolution of healthy skin to acne lesions: a longitudinal, in vivo evaluation with reflectance confocal microscopy and optical coherence tomography

Manfredini

Bettoli

Sacripanti

et al. 2019

Acad Dermatol Venereol

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Background Comedogenesis is defined as the process of the development of a new comedo, which is of great importance for the understanding of acne. Objective To evaluate the formation and evolution of acne lesions from clinically unaffected skin of patients with mild–moderate acne to characterize the morphological changes and natural resolution by means of in vivo reflectance confocal microscopy (RCM) and dynamic optical coherence tomography (D‐OCT). Methods Ten patients with mild–moderate acne, not assuming any topical or systemic therapy, comprised between 12 and 30 years of age, were recruited. A target area of 4 × 4 mm of the face, without acne lesions at baseline, was selected. A set of standardized clinical pictures, RCM and D‐OCT images were acquired weekly for 6 weeks and evaluated. Results Seventy full sets of clinical, RCM and D‐OCT images were analysed. The appearance of acne lesion is preceded by an increase of large bright follicles in the area corresponding to infundibular keratinization, followed by increment of inflammation parameter, such as increased of small bright cells upon RCM and vascular network upon D‐OCT, which return to normal after the resolution of acute inflammation. Conclusion Acne skin dynamics is complex and seems characterized by the early increase in the number of dysmorphic pilosebaceous units and the hyperkeratinization of the acroinfundibulum of the pilosebaceous duct prior to the occurrence of inflammatory events around the follicle. The processes of hyperkeratinization and inflammatory phenomena may generate a pathologic vicious cycle, which characterizes acne through progressive worsening and a self‐sustainment mechanism.

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Acne vulgaris severity graded by in vivo reflectance confocal microscopy and optical coherence tomography

Cited by 26 publications

References 29 publications

Transfollicular delivery of gold microparticles in healthy skin and acne vulgaris, assessed by in vivo reflectance confocal microscopy and optical coherence tomography

Transfollicular delivery of gold microparticles in healthy skin and acne vulgaris, assessed by in vivo reflectance confocal microscopy and optical coherence tomography

First Use of Optical Coherence Tomography on In Vivo Inflammatory Acne‐Like Lesions: A Murine Model

The evolution of healthy skin to acne lesions: a longitudinal, in vivo evaluation with reflectance confocal microscopy and optical coherence tomography

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