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      Imaging Blood Vessel Morphology in Skin: Dynamic Optical Coherence Tomography as a Novel Potential Diagnostic Tool in Dermatology

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          Abstract

          Conventional optical coherence tomography (OCT) enables the visualization of morphological changes of skin cancer. The use of OCT in the diagnostic investigation and in the therapy decision of non-melanoma skin cancer and other skin changes is already established, and has found its way into routine practice. With the development of speckle-variance OCT, also named dynamic OCT (D-OCT), the vascular architecture and the blood flow of the skin can be displayed in vivo and in 3D. This novel angiographic variant of OCT offers the ability to visualize and measure vessel morphology providing a new insight into healthy, inflammatory and neoplastic skin lesions such as malignant melanoma. This review focuses on the possibilities of using D-OCT on healthy and diseased skin. We suggest and illustrate key diagnostic characteristics by analyzing the initial publications and preliminary unpublished data on vessel morphology and distribution. The potential of D-OCT as a diagnostic tool in dermatology is examined and may give rise to future studies on D-OCT, which are needed to confirm the aforementioned features.

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          Most cited references38

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          Speckle variance detection of microvasculature using swept-source optical coherence tomography.

          We report on imaging of microcirculation by calculating the speckle variance of optical coherence tomography (OCT) structural images acquired using a Fourier domain mode-locked swept-wavelength laser. The algorithm calculates interframe speckle variance in two-dimensional and three-dimensional OCT data sets and shows little dependence to the Doppler angle ranging from 75 degrees to 90 degrees . We demonstrate in vivo detection of blood flow in vessels as small as 25 microm in diameter in a dorsal skinfold window chamber model with direct comparison with intravital fluorescence confocal microscopy. This technique can visualize vessel-size-dependent vascular shutdown and transient vascular occlusion during Visudyne photodynamic therapy and may provide opportunities for studying therapeutic effects of antivascular treatments without on exogenous contrast agent.
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            Optical coherence tomography in dermatology: a review.

            J Welzel (2001)
            Optical coherence tomography (OCT) is a non-invasive technique for morphological investigation of tissue. Since its development in the late 1980s it is mainly used as a diagnostic tool in ophthalmology. For examination of a highly scattering tissue like the skin, it was necessary to modify the method. Early studies on the value of OCT for skin diagnosis gave promising results. The OCT technique is based on the principle of Michelson interferometry. The light sources used for OCT are low coherent superluminescent diodes operating at a wavelength of about 1300 nm. OCT provides two-dimensional images with a scan length of a few millimeters (mm), a resolution of about 15 microns and a maximum detection depth of 1.5 mm. The image acquisition can be performed nearly in real time. The measurement is non-invasive and with no side effects. The in vivo OCT images of human skin show a strong scattering from tissue with a few layers and some optical inhomogeneities. The resolution enables the visualization of architectural changes, but not of single cells. In palmoplantar skin, the thick stratum comeum is visible as a low-scattering superficial well defined layer with spiral sweat gland ducts inside. The epidermis can be distinguished from the dermis. Adnexal structures and blood vessels are low-scattering regions in the upper dermis. Skin tumors show a homogenous signal distribution. In some cases, tumor borders to healthy skin are detectable. Inflammatory skin diseases lead to changes of the OCT image, such as thickening of the epidermis and reduction of the light attenuation in the dermis. A quantification of treatment effects, such as swelling of the horny layer due to application of a moisturizer, is possible. Repeated measurements allow a monitoring of the changes over time. OCT is a promising new bioengineering method for investigation of skin morphology. In some cases it may be useful for diagnosis of skin diseases. Because of its non-invasive character, the technique allows monitoring of inflammatory diseases over time. An objective quantification of the efficacy and tolerance of topical treatment is also possible. Due to the high resolution and simple application, OCT is an interesting addition to other morphological techniques in dermatology.
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              Is Open Access

              A Review of Scar Scales and Scar Measuring Devices

              Objective: Pathologic scarring affects millions of people worldwide. Quantitative and qualitative measurement modalities are needed to effectively evaluate and monitor treatments. Methods: This article reviews the literature on available tools and existent assessment scales used to subjectively and objectively characterize scar. Results: We describe the attributes and deficiencies of each tool and scale and highlight areas where further development is critical. Conclusion: An optimal, universal scar scoring system is needed in order to better characterize, understand and treat pathologic scarring.
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                Author and article information

                Contributors
                Julia.Welzel@klinikum-augsburg.de
                Journal
                Dermatol Ther (Heidelb)
                Dermatol Ther (Heidelb)
                Dermatology and Therapy
                Springer Healthcare (Cheshire )
                2193-8210
                2190-9172
                3 March 2017
                3 March 2017
                June 2017
                : 7
                : 2
                : 187-202
                Affiliations
                [1 ]Department of Dermatology, General Hospital Augsburg, Augsburg, Germany
                [2 ]GRID grid.436543.3, , Michelson Diagnostics Ltd., ; Maidstone, UK
                [3 ]ISNI 0000 0001 2167 4782, GRID grid.469511.e, , CMB Collegium Medicum Berlin, ; Berlin, Germany
                [4 ]GRID grid.476266.7, Department of Dermatology, , Zealand University Hospital, ; Roskilde, Denmark
                [5 ]ISNI 0000000121697570, GRID grid.7548.e, Department of Dermatology, , University of Modena and Reggio Emilia, ; Modena, Italy
                Article
                175
                10.1007/s13555-017-0175-4
                5453917
                28258554
                2040bfa7-52ff-4425-8168-c329a6d6ff4c
                © The Author(s) 2017
                History
                : 23 November 2016
                Categories
                Review
                Custom metadata
                © Springer Healthcare 2017

                Dermatology
                degenerative skin diseases,dynamic optical coherence tomography,healthy skin,imaging method,inflammatory skin diseases,malignant melanoma,noninvasive diagnosis,non-melanoma skin cancer,skin blood vessels,treatment effects

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