VivoScene

November 2021 Issue

Potential for significant cost savings from high predictive value of OCT imaging biomarkers

A new study by Orit Markowitz, MD and Cynthia Chan, MD is the first to show data supporting VivoSight OCT Onychomycosis markers as early indicators of the success or failure at two months of a 48 weeks regimen of topical efinaconazole [1].

The authors recommend OCT at 2 months as early indicators of treatment failure which could tremendously reduce the cost of Onychomycosis therapy for millions of patients by indicating the need to change the therapy instead of continuing with one that isn’t working.

See details in the open article here: https://jcadonline.com/onychomycosis-outcomes-2-monthsefinaconazole/.

VivoSight OCT can well image nailfold tissue and pathology markers

“Technologies for assessing skin disease are getting better and are crucial for a modern dermatologic institution” says Emma Guttman, MD, Professor and Health System Chair of the Department of Dermatology at Icahn School of Medicine at Mount Sinai, New York City.

“Right now we are so excited to initiate The Kimberly and Eric J. Waldman Melanoma and Skin Cancer Center that transforms skin cancer care, in which patients will experience state-of-the-art new technologies (many unique only to Mount Sinai), that together with amazing surgical care, oncodermatology and unique research, will bring the best prevention and treatment strategies for our patients with skin cancer.”

 

Emma Guttman, MD, PhD

“With the new center, latest skin assessment technologies are under one roof which makes Mount Sinai a leader in its field. “The goal is to usher in a new era of patient care and discovery” states Jonathan Ungar, MD, Medical Director, Waldman Melanoma and Skin Cancer Center, Assistant Professor, Dermatology and Medical Education. “VivoSight OCT is part of the high-tech armamentarium through its capability to image skin morphology quickly, precisely and non-invasively. Often we can evaluate suspicious lesions sufficiently without having to revert to skin biopsies”.

Jonathan Ungar, MD
VivoSight OCT in use at Mount Sinai

The VivoSight system looks 1 mm deep into the skin and provides the following images and measures

  • Visualization of subsurface pathology, such as basal cell carcinoma nests
  • Vascular plexus depth, modal diameter of vessels and density of vasculature at this level
  • Changes in vascular density by depth Epidermal thickness and variability
  • Quantification of skin surface roughness
  • Epidermal brightness as a proxy for collagen density

Dr. Guttman continues, “OCT is employed for several dermatologic conditions in our department where its use expedites our research and stimulates new ways of interacting with patients. Specifically, we are a leading center for research in inflammatory and autoimmune skin diseases. OCT is well suited for comparison studies and to objectively quantify treatment effects based on measurable changes in structural and vascular skin morphology. We have active studies in several fields, including Atopic Dermatitis, and collaborate with other sites where VivoSight OCT is also available making the research more efficient”.

Dr. Ungar adds, “interestingly, our patients like being scanned with OCT for their status evaluation, they like the non-invasiveness of the procedure, and many of them take an interest in looking at the images facilitating the physician patient communication. In summary, VivoSight OCT enables us to look 1mm deep into the skin and see more skin morphology including lesions and vascularity which advances our analysis and patient care.”

The renowned German research group of Ruini et al. reports about the latest advances in Optical Coherence Tomography. Abstract included in English language: https://doi.org/10.1007/s00105-021-04905-2.

In this review and summary article, the authors elaborate on new OCT application areas like inflammatory and autoimmune skin disease, teleangiectasia, wound healing, skin ageing and melanocytic lesions.

 

Furthermore, the purpose of OCT is discussed such as being well suited for comparison studies, quantifying treatment efficacy and for non-invasive monitoring of disease activity.

Nailfold Microvascular Imaging by Dynamic Optical Coherence Tomography in Systemic Sclerosis: A Case-Controlled Pilot Study [3]

Through correlations with the standard technique of Nailfold Video Capillaroscopy (NVC), Abignano et al. demonstrate the potential of VivoSight OCT vascular metrics as new objective outcome measures for systemic sclerosis clinical trials and practice.

See details in Open Access article here: https://doi.org/10.1016/j.jid.2021.08.436

In vivo examination of healthy human skin after short-time treatment with moisturizers [4]

In this study, two novel noninvasive diagnostic techniques, optical coherence tomography (OCT) and confocal Raman spectroscopy (RS), were used to quantify the effects of applying a commercially available moisturizing lotion on the forearm.

As a conclusion, short time moisturizing appears insufficient to provide significant changes in skin morphology and composition, as assessed by OCT and RS. A larger sample size and longer treatment schedules may be needed to analyze skin changes under treatment with moisturizers. https://doi.org/10.1111/srt.13101

BCC Diagnosed with OCT in Germany

In Germany, VivoSight OCT has been in use as a powerful aid for dermatologists for Basal Cell Carcinoma (BCC) for over a decade (since 2011): according to our records over 150,000 patients have been scanned with VivoSight to date, and OCT is now included in the Guidelines for Diagnosis of BCC in Germany [5].

Multiple OCT Metrics Correlate with Age

In several case series, subjects age correlates with distinct OCT metrics. OCT quantification may allow for more targeted therapies. Age is most strongly correlated with dermal brightness, epidermal thickness variation and epidermal contrast, all metrics that can be measured with the VivoTools analysis software.

Epidermal thickness plotted vs. age: There is a trend that epidermis thins with age by about 3.4 μm per 10 years

Compliments to the Sheffield Dermatology Research department under the leadership of Prof. Michael J. Cork (https://sheffielddermatologyresearch.com).

The research team at Sheffield Dermatology is a prime example how advanced imaging technologies can be utilized to gain profound insights into inflammatory skin diseases. 

Prof. Cork’s team focuses especially on Atopic Dermatitis (AD) where OCT accelerates their research and enables new innovative patient care. One example is to utilize OCT imaging biomarkers to assess subclinical signs of a developing AD flare-up, and mitigate accordingly, as well as evaluate the effectiveness of a treatment regimen (https://sheffielddermatologyresearch.com/oct).

We’re excited to bring you latest updates, stories and educational materials also in 2022.

In the next year, our newsletter VivoScene will be issued quarterly

Software Update: New Metric of Dermal Brightness

Starting December 2021, the new metric of “Dermal Brightness” is added to the VivoTools analysis software.

Dermal Brightness is the ratio of the dermal OCT signal to the top surface brightness (OCT signal). It is a normalized representation of the dermal OCT signal density and a proxy for collagen density.

Dermal Brightness vs. Age shows a clear downward trend. But these results also show that brightness varies between individuals, likely due to differences in their skin’s collagen content.

Dermal Brightness quantification may help evaluate skin response to therapies targeting collagen (see section “Did You Know?” in Education & Training)

Johann Tillmann is Managing Director of DermoScan GmbH , a manufacturer of high end dermoscopy systems which also distributes the VivoSight OCT system in Germany.

“Our customers want practical, high quality skin imaging solutions that get the job done. Constant contact with dermatologists allows us to understand their needs and also avoid overengineering.

The skin is a fascinating organ and for non-invasive lesion assessment about 3 – 4 distinct imaging products and services will generally be sufficient. We offer dermoscopy devices and systems that physicians use in their everyday work.

Still, innovation doesn’t stand still and in Germany dermatologists are early adopters of new imaging technologies should they prove beneficial. So it is with OCT, which is an excellent upgrade when dermatoscopes reach their limits. The physician or assistant resorts to VivoSight OCT mainly for these reasons:

  • Higher sensitivity and specificity for many pathologies, especially NMSC suspicious lesions
  • Need for visualization of structural and vascular morphology up to > 1 mm deep at high resolution
  • Objective quantification of many relevant skin parameters

It is satisfying to see how practitioners “move around” from just illuminating magnifiers all the way up to VivoSight OCT, and with advanced dermatoscopes and practical software options in between. The spectrum of skin conditions is matched by the spectrum of our imaging solutions. Each device complements the other and the dermatologist feels covered for any patient situation that walks through the door that day.

Johann Tillmann, CEO of DermoScan
Total body mapping with DermoScan X2

Education and Training is very important for VivoSight, as it is a more involved technology. For many years we have excellent relationships with the manufacturer (Michelson Diagnostics Ltd.) and expert users, like at the University Hospital of Augsburg, Germany. Together we have created an extensive, interactive online course “OCT in Practice” (overview >> here). The modular course especially covers how to assess the most common skin tumors and pathologies based on typical visual criteria and provides helpful tips and explanations for OCT image interpretation. Our dermatologist customers position themselves to their patients as different and unique offering VivoSight OCT capabilities, and we love seeing them thrive clinically.”

References

1. Markowitz, O., Chan, C., Evaluating Onychomycosis Outcomes Two Months into an 11-month-long Efinaconazole Regimen: The Role of Optical Coherence Tomography; https://jcadonline.com/onychomycosis-outcomes-2-months-efinaconazole/

2. Ruini, C., Daxenberger, F., Gust, C. et al. Neues von der optischen Kohärenztomographie. Hautarzt (2021). https://doi.org/10.1007/s00105-021-04905-2

3. Abignano G, Green L, Eng S, Emery P, Del Galdo F, Nailfold Microvascular Imaging by Dynamic Optical Coherence Tomography in Systemic Sclerosis: A Case-Controlled Pilot Study, Journal of Investigative Dermatology (2021). https://doi.org/10.1016/j.jid.2021.08.436

4. Ruini C, Kendziora B, Ergun EZ, Sattler E, Gust C, French LE, et al. In vivo examination of healthy human skin after short-time treatment with moisturizers using confocal Raman spectroscopy and optical coherence tomography: Preliminary observations. Skin Res Technol. 2021;1-14. https://doi.org/10.1111/srt.13101

5. Lang BM, Balermpas P, Bauer A, Blum A, Brölsch GF, Dirschka T, Follmann M, Frank J, Frerich B, Fritz K, Hauschild A, Heindl LM, Howaldt HP, Ihrler S, Kakkassery V, Klumpp B, Krause- Bergmann A, Löser C, Meissner M, Sachse MM, Schlaak M, Schön MP, Tischendorf L, Tronnier M, Vordermark D, Welzel J, Weichenthal M, Wiegand S, Kaufmann R, Grabbe S. S2k Guidelines for Cutaneous Basal Cell Carcinoma – Part 1: Epidemiology, Genetics and Diagnosis. J Dtsch Dermatol Ges. 2019 Jan;17(1):94-103. doi: 10.1111/ddg.13733. Epub 2018 Dec 28. PMID: 30592557.