Mogensen Mette, Hendel Kristoffer, Ung Vilde, Wenande Emily, Togsverd-Bo Katrine, Forman Julie L, Haedersdal Merete
Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark.
Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark.
Dermatology. 2022;238(3):422-429. doi: 10.1159/000517960. Epub 2021 Aug 27.
Image-guided quantitative and semi-quantitative assessment of skin can potentially evaluate treatment efficacy. Optical coherence tomography (OCT) and reflectance confocal microscopy (RCM) are ideal for this purpose. This study assessed clinically relevant statistical changes in RCM and OCT features in photoaged skin after light and energy-based therapy.
Novel statistical analyses were performed using OCT and RCM data collected during a previously published trial: a 12-week study of female décolleté skin randomized to four areas treated with thulium laser (L), photodynamic therapy (PDT), combined L-PDT, and control. Eight semi-quantitative RCM scores of photodamage and OCT measurements of skin roughness, blood flow, and epidermal thickness (ET) were evaluated and compared to dermoscopy and clinical skin scores. In statistical analysis, estimated treatment difference (ETD) was calculated.
Twelve women with moderate to severe photodamage were included. RCM and OCT data demonstrated a trend towards rejuvenation of epidermis with increased ET, changes in skin surface, and improved honeycomb pattern in RCM. In angiographic OCT, non-significant changes towards more regular capillary meshes were shown, which matched a decline in appearance of gross telangiectasias in dermoscopy. Improved skin tone after laser and L-PDT was identified in RCM, showing less edged papillae in 36% and 45%, and lentigo number declined in 55% of patients after treatments in dermoscopy. Based on clinical scores, L-PDT provided the greatest clinical improvement, which corresponded to superior ETD outcomes in ET and edged papillae shown in OCT and RCM, respectively.
Objective OCT and RCM assessment of skin rejuvenation was demonstrated in this study. Importantly, image-based improvements corresponded to favorable clinical skin scores and fewer photoaging characteristics in dermoscopy. Importantly, most changes did not reach statistical significance, prompting further studies and emphasizing the modest value of non-randomized, non-blinded anti-aging trials.
图像引导下对皮肤进行定量和半定量评估有可能评估治疗效果。光学相干断层扫描（OCT）和反射式共聚焦显微镜（RCM）非常适合此目的。本研究评估了光老化皮肤在光和能量治疗后RCM和OCT特征的临床相关统计变化。
使用先前发表的一项试验中收集的OCT和RCM数据进行了新的统计分析：一项为期12周的研究，对女性胸部皮肤进行随机分组，分为四个区域，分别接受铥激光（L）、光动力疗法（PDT）、联合L-PDT治疗以及作为对照。评估了八个光损伤的半定量RCM评分以及皮肤粗糙度、血流和表皮厚度（ET）的OCT测量值，并与皮肤镜检查和临床皮肤评分进行比较。在统计分析中，计算了估计治疗差异（ETD）。
纳入了12名中度至重度光损伤的女性。RCM和OCT数据显示出表皮年轻化的趋势，表现为ET增加、皮肤表面变化以及RCM中蜂巢状图案改善。在血管造影OCT中，显示向更规则的毛细血管网有非显著变化，这与皮肤镜检查中粗大毛细血管扩张外观的下降相匹配。在RCM中发现激光和L-PDT治疗后肤色改善，皮肤镜检查显示治疗后36%和45%的患者边缘乳头减少，55%的患者雀斑数量减少。基于临床评分，L-PDT带来了最大的临床改善，这分别对应于OCT和RCM中ET和边缘乳头的卓越ETD结果。
本研究证明了对皮肤年轻化进行客观的OCT和RCM评估。重要的是，基于图像的改善与良好的临床皮肤评分以及皮肤镜检查中较少的光老化特征相对应。重要的是，大多数变化未达到统计学意义，这促使进行进一步研究，并强调了非随机、非盲法抗老化试验的有限价值。
