Optical coherence tomography imaging of bullous diseases

Background  Optical coherence tomography (OCT) is a non-invasive optical imaging technique with a micrometer resolution that may potentially offer real-time bedside imaging of sufficient detail to allow for morphological discrimination between different types of bullae. Objective  To explore the potential of OCT in bullous skin disorders by looking at a set of patients with skin blisters of known origin and study the OCT images for possible hallmarks of the blistering level. Materials and methods  OCT provides cross-sectional, tomographic images of the skin. A consecutive series of patients were recruited and their lesions imaged by OCT: 3 patients with bullous pemphigoid (BP), 1 patient with extensive bullae following burns, 1 patient with pemphigus, 1 patient with subcorneal pustular dermatosis, and a patient with Dariers disease. The latter two were included due to similarity to pemphigus with respect to the level of defect cell adhesion. Results  In OCT images, BP bullae are easily depicted as dark, ovoid to round well-demarquated areas, and BP bulla morphology is clearly different from the burn blisters and the pemphigus-like disease with respect to the blistering level. Discussion  Differentiation of epidermal and subepidermal blisters is demonstrated using OCT. The variation within pemphigoid lesions and pemphigus-like diseases is however too subtle to allow for differential diagnosis; this may be ascribed to limited resolution. Enhanced resolution of OCT may overcome this obstacle.