Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy.
Human Pathology, Department of Health Promotion and Mother and Child Care, University of Palermo, Palermo, Italy.
J Dermatol. 2018 May;45(5):603-605. doi: 10.1111/1346-8138.14267. Epub 2018 Feb 26.
There is currently a growing interest in new diagnostic tools of the oral cavity and mucosa which are non-invasive, repeatable and reliable. A diagnosis of a suspected, autoimmune pathology was made regarding a 57-year-old patient with desquamative gingivitis. However, a negative Nikolsky's sign did not seem to indicate a diagnosis of mucous membrane pemphigoid neither was there any indication as to the optimum location for an incisional biopsy. As an imaging method, the use of optical coherence tomography (OCT) has enabled the obtaining of tomographic (cross-sectional) scans of tissue. Such images are acquired prior to and after verifying Nikolsky's sign, thereby enabling the clinician to identify the presence (or not) of subepithelial bullae. Thereafter, an assessment of changes in the subepithelium (the split) can be performed, even in the absence of a suitable clinical picture, such as, for example, a negative Nikolsky's sign. Histological analysis and the use of indirect immunofluorescence have facilitated a diagnosis of mucous membrane pemphigoid, an autoimmune pathology, which can be confirmed with the appearance of subepithelial bullae. OCT was found to be a valid, non-invasive, auxiliary diagnostic device, capable of revealing in vivo and real-time bullae, which were hitherto clinically undetectable.
目前，人们对非侵入性、可重复和可靠的口腔和黏膜新诊断工具越来越感兴趣。一位 57 岁患有剥脱性龈炎的患者被诊断为疑似自身免疫性疾病。然而，阴性尼氏征似乎既不能表明黏膜天疱疮的诊断，也不能指示切取活检的最佳位置。作为一种成像方法，光学相干断层扫描 (OCT) 的使用能够获得组织的断层 (横截面) 扫描。在验证尼氏征之前和之后获取这些图像，从而使临床医生能够识别是否存在上皮下水疱。此后，可以评估上皮下的变化（分裂），即使在没有合适的临床症状的情况下，例如，例如，阴性尼氏征。组织学分析和间接免疫荧光的使用有助于诊断自身免疫性疾病黏膜天疱疮，这可以通过上皮下水疱的出现来确认。OCT 被发现是一种有效的、非侵入性的辅助诊断设备，能够实时显示临床上无法检测到的水疱。
