Atopic Dermatitis & Contact Dermatitis

VivoSight can image and measure changes to the skin seen in Atopic Dermatitis and other inflammatory conditions

VivoSight Dynamic OCT has proven value for research into the differential diagnosis and monitoring treatments of inflammatory skin disease:

  • Quantification and monitoring of inflammatory disease severity
  • Detecting and measuring subclinical disease effects
  • Quantification of pharmaceutical treatment effects on Atopic Dermatitis (AD)
  • Accurate, rapid in-vivo measurement of contact dermatitis patch tests

Quantification and Monitoring

Overcome subjectivity with objective OCT measurements

  • Objective measurement of skin response informs therapeutic impact
  • Visual scoring is observer dependent and relatively insensitive
  • Subjective assessment does not pick up subclinical disease

VivoSight Dx detects, measures and analyzes AD related skin changes, such as:

  • Epidermal remodeling and thickness measurement
  • Inflammation and hidden abnormalities, as measured by alterations in vascular morphology, density and blood flow
  • Optical attenuation, as a proxy for collagen density
  • Skin surface roughness
Location determination and morphology assessment of the superficial vascular plexus aid in the management of AD

Structural Alterations

AD severity is characterized by increased epidermal thickness and hypertrophy

  • Structural OCT images from subjects with different AD presentations [1]:
OCT image of healthy individual with no history of AD
OCT image captured from an uninvolved site on an eczema patient, showing slightly extended rete-pegs and an undulating DEJ
OCT image captured from an involved site on a different eczema patient, showing what appears to be inflammatory acanthosis (Long thin epidermal papillae/rete-pegs)

Vascular Alterations

Vascular Alterations Depth of the Superficial Vascular Plexus (SVP) appears to increase with AD severity and may serve as a proxy for epidermal thickness [1].

The SVP depth may represent a robust biomarker for quantifying the severity of clinical and subclinical AD, as epidermal thickness may be difficult to measure directly in severe AD cases due to a not well demarcated dermo-epidermal junction (DEJ).

  • A selection of 2D angiographic OCT images of the cubital fossa illustrates correlation by showing significant differences in detected superficial vascular plexus (SVP) depth for different EASI scores, and further showing morphological differences [1]
Healthy subject
Healthy subject
AD patient, unaffected area. Local EASI = 0
AD patient, unaffected area. Local EASI = 0
Patient with mild AD. 0 < Local EASI < 5
Patient with mild AD. 0 < Local EASI < 5
Patient with severe AD. Local EASI < 5
Patient with severe AD. Local EASI < 5

Measurement and Management of Sub-clinical AD

Detecting subclinical disease may lead to better control of treatment regime

  • Unlike existing subjective clinical assessment, VivoSight Dynamic OCT can measure subclinical changes to the skin
  • These subclinical changes may provide early indication of a disease flare up, and of response to treatment
  • This capability offers potential for improved control of Atopic Dermatitis and other inflammatory conditions using novel treatment strategies with proactive, earlier and less aggressive therapy regimes [1]
The Superficial Vascular Plexus (SVP) depth has the potential to check patients for severity and time-course of sub-clinical AD

Better Control of Flares through Monitoring with dynamic OCT

Visualize and quantify subclinical AD for advanced, proactive management

Quantification of Pharmaceutical Treatment Effects on AD

Shorten timelines of pharmaceutical research

  • Recently, a correlation between clinical improvement of AD and dynamic OCT imaging metrics has been demonstrated on patients undergoing a systemic therapy [2]
  • OCT biomarkers quantify pharmaceutical treatment effects to more efficiently accelerate drug development cycles
  •  

Significant OCT metrics for pharmaceutical treatment effects:

  • In-vivo measurement of vessel density, diameter and plexus depth
  • Epidermal thickness
  • Collagen density

Example:

Vascular depth and density of patient with severe AD before dupilumab treatment
Normalization of vascular patterns 90 days after dupilumab treatment
Graphic representation of changing OCT metrics representing treatment effect of dupilumab. For illustration purposes only.

Use of OCT for Patch Test Grading and Evaluation of Allergic Contact Dermatitis (ACD)

Enhance objectivity and simplicity of ACD assessment

  • Overcome subjectivity of patch test grading
  • More effectively distinguish between allergic and irritant contact dermatitis
  • Correlate OCT morphological and objective measures with type and severity of patch test reactions [3]

OCT detects clear-cut features and measures for the distinction between healthy skin, allergic and contact dermatitis (see table below) [3]

Microvesicles (< 0.1 mm)
Microvesicles (< 0.1 mm)
Macrovesicles (> 0.1 mm)
Macrovesicles (> 0.1 mm)
Coalescing vesicles
Coalescing vesicles
Epidermal thickness
Epidermal thickness
Cutaneous blood flow
Cutaneous blood flow
Attenuation coefficient (AC)
Attenuation coefficient (AC)

VivoSight OCT can be helpful for a more objective evaluation, especially in weak or unclear reactions. An opportunity exists to develop a standardized algorithm for OCT-aided patch test grading [3]:

In case of unclear lesions, an OCT scan is undertaken and the primary OCT measures in the green shaded area inform on the likely type of contact dermatitis, whereas the features in the yellow shaded area inform on the severity of Allergic Contact Dermatitis
In case of unclear lesions, an OCT scan is undertaken and the primary OCT measures in the green shaded area inform on the likely type of contact dermatitis, whereas the features in the yellow shaded area inform on the severity of Allergic Contact Dermatitis
References:

1. Byers RA, Maiti R, Danby SG, Pang EJ, Mitchell B, Carre MJ, Lewis R, Cork MJ, Matcher SJ. Sub-clinical assessment of atopic dermatitis severity using angiographic optical coherence tomography. Biomedical Optics Express (BOE), Vol. 9, No. 4, 1 Apr 2018.

2. Manfredini M, Liberati S, Ciardo S, et al. Microscopic and functional changes observed with dynamic optical coherence tomography for severe refractory atopic dermatitis treated with dupilumab. Skin Res Technol. 2020;00:1–9. https://doi.org/10.1111/srt.12868

3. Ruini, C, Rahimi, F, Fiocco, Z, et al. Optical coherence tomography for patch test grading: A prospective study on its use for noninvasive diagnosis of allergic contact dermatitis. Contact Dermatitis. 2020; 1– 9. https://doi.org/10.1111/cod.13714

4. Rajabi‐Estarabadi, A., Vasquez‐Herrera, N., Martinez‐Velasco, M., Tsatalis, J., Verne, S., Nouri, K. and Tosti, A. (2020), Optical coherence tomography in diagnosis of inflammatory scalp disorders. J Eur Acad Dermatol Venereol, 34: 2147-2151. doi:10.1111/jdv.16304

5. Bieber T. Atopic Dermatitis. Ann Dermatol. 2010 May;22(2):125-137. https://doi.org/10.5021/ad.2010.22.2.125

6. Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet. 2020 Aug 1;396(10247):345-360. doi: 10.1016/S0140-6736(20)31286-1. Erratum in: Lancet. 2020 Sep 12;396(10253):758. PMID: 32738956.

7. Conti A, Ciardo S, Mandel VD, Bigi L, Pellacani G. Speckled variance optical coherence tomography for the assessment of nail involvement in acrodermatitis continua of Hallopeau: A case study. Journal of International Medical Research 2016, Vol. 44(1S) 119–123