Health Conditions

Actinic Keratosis

Actinic Keratosis (AK) is the most common pre-malignant lesion. It affects more than 58 Million Americans. In addition, the incidence is highest in people living closest to the equator. In Australia, prevalence rates of nearly 60% have been reported, in contrast to the prevalence rate reported in England in 2000 of 15.4% in men and 5.9% in women older than 40. These rates increased to 34.1% and18.2%, respectively, at 70 years of age, when prevalence was most strongly related to 2 objective signs of sun exposure, solar elastosis and lentigines, which is caused by the excessive exposure to ultra-violet radiation. Usually this pathology is associated with the development of NMSC, approximately 10% of which develop SCC. It is characterized by crusty growths (lesions) caused by damage from the sun’s ultraviolet (UV) rays; actinic keratosis (AK) is also known as solar keratosis. Lesions typically appear on sun-exposed areas such as the face, bald scalp, lips and the back of the hands. AK lesions are often elevated, rough in texture, and resemble warts. Most become red, but some will be tan, pink, red and/or flesh-toned. Untreated AKs can advance to Squamous Cell Carcinoma (SCC), the second most common form of skin cancer, and some experts believe they are actually the earliest stage of SCC. The treatment and follow-up of the patient is very important to prevent the progress of cutaneous neoplasias. 1

AK diagnosis is based on clinical inspection and dermatoscopic images. In some cases the final confirmation of the pathology is done by a biopsy. 1 However, the OCT technique has gained importance over time in the detection of AK pathology, since AK in the OCT image is characterized by thickening and strong scattering of the stratum corneum. OCT could be useful to evaluate the response of AK treated by non-surgical methods 5-fv. 2

Skin cancer is one of the most common types of cancer. It has also been estimated that nearly half of all Americans who live to the age of 65 will develop skin cancer at least once. 3

Non Melanoma Skin Cancer (NMSC)

The two most common forms of skin cancer are Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC). Both are often referred to as non-melanoma skin cancers.2 The incidence rates for basal cell carcinoma (BCC) is the most common form of skin cancer; and an estimated 2.8 MM people are diagnosed annually in the US. Approximately 13 million white non-Hispanics living in the US at the beginning of 2007 had at least one Non-Melanoma Skin Cancer (NMSC), typically diagnosed as Basal Cell Carcinoma (BCC) or Squamous Cell Carcinoma (SCC). Therefore, we can assume that BCC represents the largest part of the total. BCC is the most frequent skin cancer disease, representing 75% of the total dermatologic diseases in US, 82% in Australia and 10-24% in Europe.

Surgery to remove non-melanoma cancers is the gold standard therapy for treating BCCs and SCCs. There is an increasing trend of conservative therapy for BCC lesions which requires reliable diagnosis and therapy control. OCT could be an interesting tool to diagnose NMSC and follow the response to non-surgical therapies . 4

 

Basal Cell Carcinoma (BCC)

BCC (Basal Cell Carcinoma) are abnormal, uncontrolled growths or lesions that arise in the skin’s basal cells, which line the deepest layer of the epidermis (the outermost layer of the skin), and in some cases infiltrate the dermis. BCCs often look like open sores, red patches, pink growths, shiny bumps, or scars. Usually caused by a combination of cumulative UV exposure and intense, occasional UV exposure, BCC can be highly disfiguring if allowed to grow, but almost never spreads (metastasis) beyond the original tumour site. Only in exceedingly rare cases can BCC spread to other parts of the body and become life-threatening. This pathology is more common in people over the age of 40. 5

BCC exist in different subtypes: superficial, nodular and infiltrative multi-nodular and sometimes it is not easy to diagnose. Thus, the current medical protocol includes visual observation and the next step is to perform clinical and dermatoscopic imaging. In most cases the final confirmation of the pathology is usually done by a biopsy. 5

Currently, there is excellent correlation between OCT images and histopathological features of BCC can be established. Hence, OCT is useful to differentiate between normal skin and tumours (lesion border). In the OCT image, BCCs are represented as homogeneous regions in the upper dermis. In most cases, the light scattering in the tumour is higher than in the healthy skin, so it is easier to detect this pathology with OCT than with other techniques. BCC lesions are known to show characteristic lobular signal-poor structures when investigated with OCT. 5

OCT improves non-invasive diagnosis, can reduce the need for biopsies and can guide biopsy and Mohs Surgery.

The treatment depends on the tumour’s characteristics but usually involves: Curettage and electrodessication, surgical excision with or without Mohs Surgery, cryosurgery and occasionally radiation therapy.

Squamous Cell Carcinoma (SCC)

SCC (Squamous Cell Carcinoma) is an uncontrolled growth of abnormal cells arising in the squamous cells, which compose most of the skin’s upper layers (the epidermis and dermis). SCCs often look like scaly red patches, open sores, elevated growths with a central depression, or warts; they may crust or bleed. SCC is mainly caused by cumulative UV exposure over the course of a lifetime. It can become disfiguring and sometimes deadly if allowed to grow. 6

SCC exists in different subtypes: in situ and invasive and sometimes it is not easy to diagnose. Thus, the current medical protocol includes visualization/observation and the next step is clinical and dermatoscopic imaging. Usually the final confirmation of the pathology is made by a biopsy. 6

OCT allows an early diagnosis and it could improve the prognosis because SCC has a risk of metastases. SCC in the histology shows pronounced hyperkeratosis represented by a multi-layered surface reflectivity in the OCT image due to the hyperkeratosis with high light scattering. 7

Psoriasis

Psoriasis is a skin disease that occurs when the immune system overreacts and causes inflammation and flaking of the skin. Psoriasis is an autoimmune disease that affects the skin. It is a common, chronic, relapsing, inflammatory skin disorder with a strong genetic basis. Normally, skin cells grow gradually and flake off every four weeks. 8

There are five types of psoriasis: plaque, guttate, inverse, pustular and erythrodermic. The most common form, plaque psoriasis, is characterized by circular-to-oval red plaques distributed over extended body surfaces and the scalp. 8

Individuals suffering from psoriasis may experience significant physical discomfort as well as disability. Psoriasis most commonly occurs on the elbows, knees, lower back, scalp, palms, face, and soles of the feet. 8

Globally, the prevalence of psoriasis is estimated to be 0.6 percent to 4.8 percent, often affecting individuals between the ages of 15 to 25, but may appear at any age. Psoriasis is the most prevalent autoimmune disease in the US, with 7.5 million people affected. The prevalence of psoriasis in the UK is estimated to be about 1.5-2 percent, with more young female patients affected than young male patients. 9

The disease afflicts men and women equally and is present in all races and socioeconomic classes.

Psoriasis is a chronic inflammatory skin disease, histopathologically characterized by hyperkeratosis, parakeratosis, acanthosis, Munro’s micro abscesses and elongation of the rete ridge (papillomatosis). Inflammatory cell infiltration can be observed in the upper dermis. 9

On OCT images of psoriatic patches, the regional parakeratosis is seen as a strong entrance signal, sometimes composed of several parallel layers. OCT features in psoriasis: typical thickening of the epidermis, protrusions in the dermis, strong hyperkeratosis as a darker superficial band and signal–poor rounded structures in the dermis corresponding to dilated vessels. It is possible to detect psoriasis with OCT without resorting to invasive and painful procedures.

The diagnosis with OCT is expected to be more precise and quantitative than solely considering the appearance of the skin. OCT can provide additional information (epidermal thickness, sub epidermal inflammation) and can definitely help in monitoring clinical evolution and response to therapies. 9

Eczema / Contact Dermatitis

Dermatitis is inflammation of the skin resulting in rashes, itching, and skin lesions such as blisters.

Atopic dermatitis (eczema), dandruff, and rashes caused by contact with certain metals are some of the examples of dermatitis. In irritant contact dermatitis larger and more irregular skin folds are seen on the skin surface. 8

It is a common condition, generally not life threatening or contagious. A number of health conditions, allergies, genetic factors, and irritants can cause different types of dermatitis. 6

Overall estimates of the prevalence and incidence of contact dermatitis in the general population are scarce. Globally, eczema affected approximately 230 million people as of 2010 (3.5% of the population).The prevalence in the US is approximately 11 percent, with approximately 2.5 percent of Americans under the age of 65 suffering from dermatitis. 8

The most common diagnostic method to date is dermatoscopy, but it has some important limitations. Although it may be possible to visualize the dilated vessels and scaly patches are visible, the resolution does not provide information on the finer vascular network. Furthermore, no depth information is available. OCT examination can reveal perfusion and the vasculature can become more visible as it will increase shadowing artefacts as compared to a healthy case. 8

Contact dermatitis showed pronounced skin folds, thickened and/or disrupted entrance signals and a significant increase in epidermal thickness. 10

The spongiosis can be visualized as thin, poorly backscattering fissures at the background of the signal intense epidermis, whereas intercellular edema leads to a decrease of backscattering from cellular layers. 10

Acne

Acne appears when the hair follicle is plugged with oil and dead skin cells, clogging the pores and trapping skin oil inside, allowing bacterial growth and thereby inflaming the skin. The exact etiology of acne is not known so far, but it is assumed that testosterone plays a part, as well as heredity. Though it is not a serious health risk, it can damage an individual’s self-esteem.

Acne most commonly occurs on the face, neck, and chest. There is significant progress in developing drugs that target the pathophysiology of acne. 8

Acne vulgaris is a very common condition characterized by papules, pustules, comedowns (blackheads) and scars. Acne is the most common adolescent skin disease, affecting over 80 percent of teenagers (aged between 13 and 18 years) at some point. Overall incidence of acne is similar in both men and women, and peaks when the subject is 17 years of age. This Pathology is a common skin disease that affects 85 to 100% of people at some time during their lives, particularly in their youth. 6 Acne is most common in the US, affecting 40 million to 50 million Americans. The prevalence of acne in the UK has been recorded at 50 percent. The data on the prevalence of acne among Asian teenagers and adults who suffer from acne is lower. 8

Skin cancer is one of the most common types of cancer. It has also been estimated that nearly half of all Americans who live to the age of 65 will develop skin cancer at least once. 3

Non Melanoma Skin Cancer (NMSC)

The two most common forms of skin cancer are Basal Cell Carcinoma (BCC) and Squamous Cell Carcinoma (SCC). Both are often referred to as non-melanoma skin cancers.2 The incidence rates for basal cell carcinoma (BCC) is the most common form of skin cancer; and an estimated 2.8 MM people are diagnosed annually in the US. Approximately 13 million white non-Hispanics living in the US at the beginning of 2007 had at least one Non-Melanoma Skin Cancer (NMSC), typically diagnosed as Basal Cell Carcinoma (BCC) or Squamous Cell Carcinoma (SCC). Therefore, we can assume that BCC represents the largest part of the total. BCC is the most frequent skin cancer disease, representing 75% of the total dermatologic diseases in US, 82% in Australia and 10-24% in Europe.

Surgery to remove non-melanoma cancers is the gold standard therapy for treating BCCs and SCCs. There is an increasing trend of conservative therapy for BCC lesions which requires reliable diagnosis and therapy control. OCT could be an interesting tool to diagnose NMSC and follow the response to non-surgical therapies . 4

 

Basal Cell Carcinoma (BCC)

BCC (Basal Cell Carcinoma) are abnormal, uncontrolled growths or lesions that arise in the skin’s basal cells, which line the deepest layer of the epidermis (the outermost layer of the skin), and in some cases infiltrate the dermis. BCCs often look like open sores, red patches, pink growths, shiny bumps, or scars. Usually caused by a combination of cumulative UV exposure and intense, occasional UV exposure, BCC can be highly disfiguring if allowed to grow, but almost never spreads (metastasis) beyond the original tumour site. Only in exceedingly rare cases can BCC spread to other parts of the body and become life-threatening. This pathology is more common in people over the age of 40. 5

BCC exist in different subtypes: superficial, nodular and infiltrative multi-nodular and sometimes it is not easy to diagnose. Thus, the current medical protocol includes visual observation and the next step is to perform clinical and dermatoscopic imaging. In most cases the final confirmation of the pathology is usually done by a biopsy. 5

Currently, there is excellent correlation between OCT images and histopathological features of BCC can be established. Hence, OCT is useful to differentiate between normal skin and tumours (lesion border). In the OCT image, BCCs are represented as homogeneous regions in the upper dermis. In most cases, the light scattering in the tumour is higher than in the healthy skin, so it is easier to detect this pathology with OCT than with other techniques. BCC lesions are known to show characteristic lobular signal-poor structures when investigated with OCT. 5

OCT improves non-invasive diagnosis, can reduce the need for biopsies and can guide biopsy and Mohs Surgery.

The treatment depends on the tumour’s characteristics but usually involves: Curettage and electrodessication, surgical excision with or without Mohs Surgery, cryosurgery and occasionally radiation therapy.

Squamous Cell Carcinoma (SCC)

SCC (Squamous Cell Carcinoma) is an uncontrolled growth of abnormal cells arising in the squamous cells, which compose most of the skin’s upper layers (the epidermis and dermis). SCCs often look like scaly red patches, open sores, elevated growths with a central depression, or warts; they may crust or bleed. SCC is mainly caused by cumulative UV exposure over the course of a lifetime. It can become disfiguring and sometimes deadly if allowed to grow. 6

SCC exists in different subtypes: in situ and invasive and sometimes it is not easy to diagnose. Thus, the current medical protocol includes visualization/observation and the next step is clinical and dermatoscopic imaging. Usually the final confirmation of the pathology is made by a biopsy. 6

OCT allows an early diagnosis and it could improve the prognosis because SCC has a risk of metastases. SCC in the histology shows pronounced hyperkeratosis represented by a multi-layered surface reflectivity in the OCT image due to the hyperkeratosis with high light scattering. 7

ENLIGHTENING SKINCARE