Allergic contact dermatitis: Correlation of in vivo confocal imaging to routine histology,☆☆,

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Abstract

Background: Allergic contact dermatitis (ACD) is a common and often challenging clinical problem. In vivo near-infrared confocal reflectance microscopy (CM) is a new vital microscopy technique. Objective: CM was used to evaluate acute ACD. Methods: Patch testing by means of Finn Chambers technique was performed in 5 subjects to induce an acute allergic skin reaction. Noninvasive CM images from normal and eczematous skin were sequentially recorded before and after removal of the Finn Chambers. Results: The epidermis and papillary dermis were clearly seen in high resolution. Retention of nuclei in stratum corneum, epidermal edema with microvesicle formation, and transepidermal migration of inflammatory cells were observed in vivo. Isolated dendritic cells were present in the ACD sites of 2 subjects, with morphology, size, and location consistent with Langerhans cells. Dermal vasodilation was observed as well. Conclusion: CM is a useful tool to study ACD and may be able to track Langerhans cell activation.(J Am Acad Dermatol 1999;40:708-13.)

Section snippets

Patients

Five patients, 3 female and 2 male with a clinical history of ACD, were entered after signed informed consent under a Massachusetts General Hospital Institutional Review Board–approved protocol. Patch-testing was performed with specific contact allergens by means of Finn Chambers (Epitest Ltd, Oy, Helsinki) affixed with Scanpor tape (Norgesplaster, Vennesia, Norway). Allergens (balsam of Peru, fragrance mix, and nickel sulfate) were applied to ventral forearm skin for 24 and 48 hours. Contact

Normal skin

In normal skin, CM showed orthokeratotic (no nuclei) and bright stratum corneum at the top of the skin surface (Fig 1, A ).

. Confocal images of normal skin at different depths show (A) stratum corneum (sc), granulosum (sg), (B) spinosum (ss), and (C) dermoepidermal level. Stratum corneum produces the first image of top surface of skin because of backscattered light at water-to-stratum corneum interface. Granular cells of 25 to 35 μm (arrows, A ) and spinous (arrows, B ) keratinocytes of 15 to 25

DISCUSSION

Evaluation of cutaneous delayed hypersensitivity response is of significant interest in dermatology. However, current methods to investigate ACD are limited by the use of indirect techniques that may be inaccurate or insensitive or by the need for multiple invasive biopsies, because it is a dynamic process. Noninvasive imaging tools for the evaluation of contact skin reactions allow the skin to be imaged as many times as required; standard noninvasive imaging tools (eg, magnetic resonance

Acknowledgements

We thank Dr. Aldo González-Serva for critically reviewing the manuscript.

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Supported in part by Lucid Inc.

☆☆

Reprint requests: Salvador González, MD, Wellman Laboratories of Photomedicine, BHX-630, Massachusetts General Hospital, 55 Blossom St, Boston, MA 02114.

0190-9622/99/$8.00 + 0  16/1/97350

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