Reflectance Confocal Microscopy Features of Seborrheic Dermatitis for Plaque Psoriasis Differentiation

Abstract

Background: Plaque psoriasis (PP) and seborrheic dermatitis (SD) are chronic inflammatory skin diseases with similar clinical and pathological features. Differential diagnosis can be difficult, especially when particular skin areas of the face are involved. Reflectance confocal microscopy (RCM) has been demonstrated to be useful for ‘real-time' diagnosis of skin inflammatory diseases. Objective: To define distinctive confocal criteria of SD and to evaluate the usefulness of this technique for noninvasive differential diagnosis with PP. Methods: A total of 40 patients affected by PP and 19 patients by SD involving the face were recruited and subjected to RCM evaluation. Univariate and adjusted odds ratios were calculated. Discriminant functions were used to plot ROC curves. Results: The results disclosed specific patterns for SD and PP. The following distinctive confocal features for SD have been identified: spongiosis, dermal inflammation and horizontal orientation of dilated blood vessels. Conclusion: SD has a specific and easily recognizable confocal pattern supporting clinical differentiation with PP.

Multicentre study on inflammatory skin diseases from The International Confocal Working Group: specific confocal microscopy features and an algorithmic method of diagnosis

“…However, these features were not exclusive for those groups. In fact, mild spongiosis (< 10% of the 4 × 4‐mm mosaic) was also observed in psoriasiform dermatitis, especially in the cases of seborrhoeic dermatitis, and mild thickening of the epidermis was detected in a few cases of subacute eczema.…”

Reflectance confocal microscopy for plaque psoriasis therapeutic follow‐up during an anti‐TNF‐α monoclonal antibody: an observational multicenter study

“…Reflectance Confocal Microscopy (RCM) is a non‐invasive technique for real‐time, en‐face imaging of the superficial layers of the skin down to the superficial dermis . RCM has been successfully used not only for the evaluation of skin cancer but also for several inflammatory skin conditions comprehensive also of plaque psoriasis (PP) . Moreover, reports on follow‐up of PP using RCM during topical and physical treatments have been reported in literature demonstrating the possibility of detailed monitoring of microscopic changes during therapy …”

A four‐phase strategy for the implementation of reflectance confocal microscopy in dermatology

“…This resulted in 15 studies which revealed RCM features for diagnostic and monitoring purposes in psoriasis. An extended search until August 2015 showed five additional publications . After reviewing all publications, an overview of general psoriatic RCM features was provided for diagnostic and monitoring purposes (Table ).…”

“…An extended search until August 2015 showed five additional publications. [16][17][18][19][20] After reviewing all publications, an overview of general psoriatic RCM features was provided for diagnostic and monitoring purposes ( Table 1). Four therapeutic follow-up studies monitored different therapeutics; phototherapy [ultravi-olet B (UVB) and psoralen ultraviolet A], topical non-steroidal anti-inflammatory drugs, topical corticosteroids, Methotrexate, Acitretin and/or Calcipotriol and Adalimumab by RCM.…”