Reflectance confocal microscopy: an effective tool for monitoring ultraviolet B phototherapy in psoriasis

• Published in: British journal of dermatology (1951) Vol. 167; no. 2; pp. 396 - 403
• Main Authors: Wolberink, E.A.W., van Erp, P.E.J., de Boer-van Huizen, R.T., van de Kerkhof, P.C.M., Gerritsen, M.J.P.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2012; Wiley-Blackwell
• Subjects: Adult; Biological and medical sciences; Dermatology; Dermoscopy; Female; Humans; Immunohistochemistry; Male; Medical sciences; Microscopy, Confocal - methods; Middle Aged; Pilot Projects; Psoriasis - pathology; Psoriasis - radiotherapy; Psoriasis. Parapsoriasis. Lichen; Treatment Outcome; Ultraviolet Therapy - methods; Skin disease; Treatment; Psoriasis; Surveillance; Dermatology; Confocal microscopy; Phototherapy
• ISSN: 0007-0963; 1365-2133
• DOI: 10.1111/j.1365-2133.2012.10988.x

Summary Background  In vivo reflectance confocal microscopy (RCM) is a novel, noninvasive imaging technique which enables imaging of skin at a cellular resolution comparable to conventional microscopy. Objectives  We performed a pilot study to evaluate RCM as a noninvasive tool for monitoring ultraviolet (UV) B phototherapy in psoriasis. Methods  In six patients with psoriasis, lesional and nonlesional skin was selected for RCM imaging using a standardized protocol. Well‐known histological features of psoriasis were visualized: parakeratosis, acanthosis, agranulosis, papillomatosis, presence of epidermal inflammatory cells, increased number of papillary capillaries and increased capillary blood flow. RCM imaging was performed before the first irradiation with UVB phototherapy, after nine irradiations, at clearance and 12 weeks after clearance. In four patients, 4‐mm punch biopsies were obtained and stained with haematoxylin‐eosin. Additionally, immunohistochemical staining was performed with monoclonal antibodies specific for CD31, CD3, filaggrin, K16, Ki67 and CD1a for correlation to RCM images. Results  There was a high correlation between clinical, RCM and histological features. Normalization of RCM and histological features corresponded highly to clinical improvement of psoriasis. Conclusions  This study is the first to establish the use of RCM as an effective tool for noninvasive monitoring of UVB phototherapy in patients with psoriasis. Potentially, RCM could be used in many other skin diseases for monitoring therapeutic response on a cellular level in a clinical or research setting.