In vivo reflectance confocal microscopy features of cutaneous microcirculation and epidermal and dermal changes in diffuse systemic sclerosis and correlation with histological and videocapillaroscopic findings

Abstract

349 To cite this article: Venturini M, Arisi M, Zanca A, Cavazzana I, Gonzàlez S, Franceschini F, Calzavara-Pinton P. In vivo reflectance confocal microscopy features of cutaneous microcirculation and epidermal and dermal changes in diffuse systemic sclerosis and correlation with histological and videocapillaroscopic findings. Eur J Dermatol 2014; 24(3): 349-55 In vivo reflectance confocal microscopy features of cutaneous microcirculation and epidermal and dermal changes in diffuse systemic sclerosis and correlation with histological and videocapillaroscopic findingsBackground: Videocapillaroscopy of the nail fold is the current gold standard to assess progressive changes of the capillary network in patients with systemic sclerosis (SSc). Reflectance confocal microscopy (RCM) is a non-invasive optical imaging tool that allows in vivo visualization of the skin structures and cutaneous microcirculation. Objective: To investigate qualitative and quantitative changes of the cutaneous microcirculation and dermal-epidermal alterations of SSc patients by RCM and to correlate the images with findings of videocapillaroscopy and histology. Methods: Ten patients affected by diffuse-type SSc with skin involvement and 10 healthy controls were enrolled. All subjects underwent RCM of the dorsal and ventral surfaces of the middle third of the left forearm and nailfold videocapillaroscopy. Skin biopsies for histological and immunohistochemical investigations were taken from 5 patients and 2 healthy controls. Results: At RCM observation, the diameter, perimeter and area of cutaneous capillaries were significantly increased in comparison to healthy controls, as histologically confirmed, whereas blood flow speed was significantly slower. Videocapillaroscopy showed a pathologic pattern of disease activity in 8 SSc patients and was non-specific in the remaining 2. In addition, RCM showed epidermal atrophy, flattening of rete ridges and dermal fibrosis in 7 SSc patients with long-standing disease but not in 3 patients with a recent onset. Conclusion: RCM provides measurable morphological and functional findings of microcirculation in patients suffering from diffuse-type SSc. These findings can integrate with, but not substitute, those provided by standard videocapillaroscopy. In addition, unlike videocapillaroscopy, RCM allows the investigation of epidermal and dermal changes.

Reflectance Confocal Microscopy, Optical Coherence Tomography, and Multiphoton Microscopy in Inflammatory Skin Disease Diagnosis

“…Confocal imaging was applied in systemic sclerosis (SSc) in two studies [31,32]. Stationary RCM revealed reproducible histologic features, including increased thickness of tissue in dermal papillae superior to first dermal papilla vessel, epidermal hypotrophy, and fibrosis for dislocation of capillaries by collagen deposits in the dermis [32].…”

“…Stationary RCM revealed reproducible histologic features, including increased thickness of tissue in dermal papillae superior to first dermal papilla vessel, epidermal hypotrophy, and fibrosis for dislocation of capillaries by collagen deposits in the dermis [32]. RCM imaging also revealed an increased cutaneous capillary size and slower speed of blood flow confirmed by videocapillaroscopy, epidermal atrophy, flattening of rete ridges, and dermal fibrosis, though only in long‐standing disease patients [31].…”

“… Dermal fibrosis, reduced blood flow, epidermal atrophy, and flattening of rete ridges are characteristic of SSc across all imaging modalities [31‐36]. MPM also noted irregular basal cells and nuclei and irregular collagen deposition [36].…”

Clinical Nonlinear Laser Imaging of Human Skin: A Review

“…Although skin morphology can be noninvasively imaged with high resolution by other laser scanning imaging techniques, such as confocal reflectance microscopy [ 56 – 68 ], the nonlinear approach offers several advantages with respect to the confocal reflectance. First, the nonlinear dependence of the signal on the excitation light intensity allows selectively exciting only molecules located in an extremely confined volume around the focal point.…”

An Updated Review of Methods and Advancements in Microvascular Blood Flow Imaging

“…Confocal microscopy has been used to study the principles of vessel regression , erythrocyte properties , detecting skin lesions in oncology , and in studying the effect of glutamic acid on the blood–brain barrier and the neurovascular unit in glutaric acidemia I . It has also been used to quantify capillary cell blood flow and in evaluating cutaneous microcirculation and dermal changes in systemic sclerosis . Figure B and C show the reflectance confocal images of a dermal melanoma lesion showing increased vascularization.…”