Department of Dermatology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark.
Department of Dermatology, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark.
Acta Derm Venereol. 2024 Nov 25;104:adv42190. doi: 10.2340/actadv.v104.42190.
Treatment-resistant actinic keratosis (AK) is of concern in clinical practice, often requiring retreatment. Microvascular assessments might help differentiate treatment-resistant from treatment-responsive AKs, enabling targeted treatment. Using dynamic optical coherence tomography, AK vascularization was investigated following daylight photodynamic therapy, comparing treatment-resistant with cleared AKs. AKs on face/scalp were graded according to the Olsen Classification Scheme and scanned with dynamic optical coherence tomography pre-treatment, and 3- and 12-months post-treatment. Employing dynamic optical coherence tomography, total vessel length, mean vessel length, mean vessel diameter, vessel area density, and branchpoint density were quantified. Thirty-eight patients with 62 AKs were enrolled, including 37 AK I, 18 AK II, and 7 AK III. Treatment-resistant AKs displayed a trend toward intensified vascularization compared with cleared AK at baseline (AKs I, II), suggested by higher total vessel length (median 144.0, IQR 104.3-186.6) and vessel area density (median 27.7, IQR 18.4-34.2) than in cleared AK (median 120.9, IQR 86.9-143.0 and median 22.9, IQR 17.3-26.8). Additionally, vascularization in treatment-resistant AK I-II appeared disorganized, with trends toward shorter mean vessel length (median 151.0, IQR 138.5-167.5) and increased branchpoint density (median 3.2, IQR 2.3-3.8) compared with cleared AK (median 160.0, IQR 152.0-169.3 and median 2.6, IQR 2.2-3.0). These findings suggest that dynamic optical coherence tomography holds potential to identify treatment-resistant AKs.
治疗抵抗性光化性角化病（AK）在临床实践中受到关注，通常需要再次治疗。微血管评估可能有助于区分治疗抵抗性和治疗反应性 AK，从而实现靶向治疗。本研究采用动态光学相干断层扫描（OCT）技术，比较治疗抵抗性和清除性 AK 患者，评估日光光动力疗法（PDT）后 AK 的血管生成情况。根据 Olsen 分类方案对面部/头皮 AK 进行分级，并在治疗前、治疗后 3 个月和 12 个月进行动态 OCT 扫描。采用动态 OCT 技术，定量分析总血管长度、平均血管长度、平均血管直径、血管面积密度和分叉密度。共纳入 38 例 62 处 AK 患者，包括 37 处 AK I 级、18 处 AK II 级和 7 处 AK III 级。与清除性 AK 相比，治疗抵抗性 AK 基线时（AK I 级和 AK II 级）的血管化程度呈加重趋势，总血管长度（中位数 144.0，IQR 104.3-186.6）和血管面积密度（中位数 27.7，IQR 18.4-34.2）均高于清除性 AK（中位数 120.9，IQR 86.9-143.0 和中位数 22.9，IQR 17.3-26.8）。此外，治疗抵抗性 AK I-II 的血管化程度紊乱，平均血管长度（中位数 151.0，IQR 138.5-167.5）和分叉密度（中位数 3.2，IQR 2.3-3.8）较清除性 AK 缩短和增加（中位数 160.0，IQR 152.0-169.3 和中位数 2.6，IQR 2.2-3.0）。这些发现提示动态 OCT 可能有助于识别治疗抵抗性 AK。
