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Background: The reliability to non-invasively identify features of inflammatory dermatoses by reflectance confocal microscopy (RCM) remains unknown. Lack of formal training among RCM readers can result in inconsistent assessments, limiting clinical utility. Specific consensus terminology with representative images is necessary to ensure consistent feature-level interpretation among RCM readers., Objectives: (1) Develop a glossary with representative images of RCM features of cutaneous acute graft-versus-host disease (aGVHD) for consistent interpretation among observers, (2) assess the interobserver reproducibility among RCM readers using the glossary, and (3) determine the concordance between RCM and histopathology for aGVHD features., Methods: Through an iterative process of refinement and discussion among five international RCM experts, we developed a glossary with representative images of RCM features of aGVHD. From April to November 2018, patients suspected of aGVHD were imaged with RCM and subsequently biopsied. 17 lesions from 12 patients had clinically and pathologically confirmed cutaneous aGVHD. For each of these lesions, four dermatopathologists and four RCM readers independently evaluated the presence of aGVHD features in scanned histopathology slides and 1.5 × 1.5 mm RCM submosaics at 4 depths (blockstacks) respectively. RCM cases were adjudicated by a fifth RCM expert. Interobserver reproducibility was calculated by mean pairwise difference (U statistic). Concordance between modalities was determined by fraction of assignments with agreement., Results: We present a glossary with representative images of 18 aGVHD features by RCM. The average interobserver reproducibility among RCM readers (75%, confidence interval, CI: 71-79%) did not differ significantly from dermatopathologists (80%, 76-85%). The concordance between RCM and histopathology was 59%., Conclusions: By using the glossary, the interobserver reproducibility among RCM readers was similar to the interobserver reproducibility among dermatopathologists. There was reasonable concordance between RCM and histopathology to visualize aGVHD features. The implementation of RCM can now be advanced in a variety of inflammatory conditions with a validated glossary and representative image set., (© 2022 European Academy of Dermatology and Venereology.)

Background: Actinic keratoses (AKs) are very common lesions on sun damaged skin and, when pigmented, represent a challenge in the differential diagnosis with early melanoma. Non-invasive diagnostic methods, such as dermoscopy and reflectance confocal microscopy (RCM) have been shown to improve the diagnostic accuracy of melanoma and non-melanoma skin cancer, however, only one case report described confocal findings of pigmented AKs up to now., Objectives: The aim of our retrospective morphological study was to analyse dermoscopic and confocal images of a series of histopathologically proven pigmented AKs, located on the face and other body sites, to define peculiar features of these "difficult to diagnose" lesions., Methods: Clinical, dermoscopic and RCM images of 17 histopathologically confirmed pigmented AKs were retrospectively collected from the databases of four skin lesion clinics in Italy and USA. Dermoscopic and RCM images were analysed for prevalent morphological features., Results: The majority of the lesions were located on the face (n = 8); followed by scalp (n = 4) and trunk (n = 4); and one lesion was located on the lower limbs. On dermoscopy the majority of lesions were characterized by grey dots/globules/granularity and structureless brown pigmentation. The main RCM feature of pigmented AKs was as follows: (i) the presence of epidermal changes (atypical keratinocytes, parakeratosis, scaling); (ii) increased epidermal thickness; (iii) bright, small, dermal papillae with enlarged interpapillary space; and (iv) intraepidermal dendritic cells referrable to Langherans cells. Features suggestive of melanocytic lesions, such as nesting, meshwork pattern or atypical cells infiltrating the junction, were never detected in our case series at the dermal epidermal junction (DEJ) level., Conclusion: Larger case series with adequate control population are warranted to validate these findings and to test their value in clinical setting., (© 2014 European Academy of Dermatology and Venereology.)

Background: Melasma is a frequent skin disorder characterized by the appearance of abnormal pigment (melanin) deposits in different layers of the skin. Melasma has been classified into epidermal, dermal and mixed types using Wood's lamp, and the type and extent of the pigment deposits determine the type and invasiveness of the treatment., Aims: The aims of this study were to carry out a preliminary evaluation of the effective usefulness of reflectance confocal microscopy (RCM) in pigment distribution definition and subsequent re-classification of melasma types. Moreover, RCM therapeutical follow-up efficiency to combination therapy with pyruvic acid and hydroquinone was also tested., Materials and Methods: A small group (n=15) of patients previously diagnosed with facial melasma were selected and their pigment distribution was evaluated by RCM. In seven of these patients therapeutical follow-up was performed., Results: The results of the study suggest that RCM is more accurate than techniques previously used in the diagnosis of melasma, thus providing precise information on the location and extent of pigment deposits., Discussion and Conclusion: The non-invasive nature of this technique suggests that RCM may be a suitable tool for treatment monitoring, providing additional information not only on the evolution of the disorder but also on the possible occurrence of therapeutical side or adverse effects., (© 2010 The Authors. Journal of the European Academy of Dermatology and Venereology © 2010 European Academy of Dermatology and Venereology.)

Background: Psoriasis is a common skin inflammatory disease that affects 2% of the general population. Plaque psoriasis (PP) is its most common variant. In vivo reflectance confocal microscopy (RCM) is a non-invasive, reproducible imaging technique that has proven to give useful information for morphometric evaluation of several inflammatory skin conditions, such as acute contact dermatitis and discoid lupus., Objective: This study aimed to define the in vivo RCM features of PP and to analyse correlations with histopathologic findings., Methods: Psoriatic lesions from 36 patients with an established diagnosis of PP were selected for RCM evaluation. Subsequently, a 4-mm punch biopsy specimen of the same imaged areas was taken for histopathologic examination. Normal skin from similar topographic areas of 12 healthy volunteers was evaluated as control samples., Results: Several RCM features of psoriasis were identified and shown to correlate well with histopathologic evaluation. In > 90% of the cases, RCM revealed hyperkeratosis, parakeratosis, reduced or absent granular layer, papillomatosis and dilated blood vessels. Acanthosis was observed in psoriasis cases, with thickness ranging from 75 to 300 microm, compared to normal skin, which ranged from 60 to 90 microm. The diameter of the dermal papillae was also enlarged (> 100 microm) compared to what was observed in normal skin (> 80 microm)., Conclusion: RCM seems to be useful for microscopic evaluation of PP features, and offers a good correlation with histopathologic findings; it thus constitutes a promising adjuvant tool for non-invasive microscopic diagnosis and for therapeutic follow-up.

Background: Vitiligo is the most common pigmentary disorder with a global incidence from 0.1% to 2% in different geographical areas. Histopathology and histochemistry have shown the reduction of melanocytes in achromic patches, but microscopic changes of lesional and non-lesional skin are still not completely understood. Reflectance confocal microscopy (RCM), based on the different light reflectance index of cutaneous structures, allowed in vivo, en face microscopic evaluation of superficial skin layers with a resolution similar to skin histology., Aim: The purpose of this study was to evaluate RCM features of lesional and non-lesional skin of vitiligo patients. Moreover, re-pigmented areas were taken into consideration in order to evaluate melanocyte response to ultraviolet B (UVB) radiation., Subjects and Methods: Sixteen patients of different phototypes affected by active non-segmental vitiligo and 10 controls were enrolled in the study. In vivo skin imaging was done using a commercially available RCM (Lucid, Vivascope 1500. Re-pigmented areas from 6 to 16 patients (after UVB narrow-band therapy) were also examined., Results: Vitiligo lesions showed the disappearance of the bright rings normally seen at the dermo-epidermal junction. Moreover, non-lesional skin of vitiligo patients showed unexpected changes as the presence of half-rings or scalloped border-like features of the bright papillary rings. In re-pigmented areas after UVB narrow band therapy, the presence of activated, dendritic melanocytes was seen., Conclusions: Considering our results, and following further studies, RCM clinical applications could be used in the therapeutic monitoring and evaluation of the evolution of vitiligo.