Line field confocal optical coherence tomography: An adjunctive tool in the diagnosis of autoimmune bullous diseases
Linda Tognetti, Élisa Cinotti, Mariano Suppa, Raffaella Guazzo, Cyril Habougit, Francesco Santi, G. Diet, Margot Fontaine, V. Bérot, Jilliana Monnier, Elisa Pianigiani, V. del Mármol, Josep Malvehy, Jean Perrot, Pietro Rubegni
Abstract
Autoimmune bullous diseases (AIBDs) still represent a considerable a source of morbidity and mortality: early identification of a specific AIBD is often difficult due to overlapping clinical and/or laboratory features and time-consuming invasive laboratory tests. We aimed to investigate the potential role of a new imaging technology, line-field confocal optical coherence tomography (LC-OCT), in the non-invasive diagnosis of AIBDs. LC-OCT was performed at lesional, perilesional and contralateral healthy sites in 30 patients, before histology and direct immunofluorescence. LC-OCT examination was able to identify the level of split (subcorneal/suprabasal/subepidermal/sublamina densa), to provide detailed images of the bulla roof morphology and content (eg, erythrocytes/acantholytic cells/polymorphonucleates). Areas of intra/subepidermal detachment were also detected also at clinically normal perilesional skin sites. LC-OCT can support physicians, real time and at bed-site, in the differential diagnosis of various AIBDs and their mimickers. Moreover, it can be used for the identification of subclinical lesions and therapy tapering.