Optical coherence tomography (OCT) has developed rapidly since its first realisation in medicine and is currently an emerging technology in the diagnosis of skin disease. OCT is an interferometric technique that detects reflected and backscattered light from tissue and is often described as the optical analogue to ultrasound. The inherent safety of the technology allows for in vivo use of OCT in patients. The main strength of OCT is the depth resolution. In dermatology, most OCT research has turned on non-melanoma skin cancer (NMSC) and non-invasive monitoring of morphological changes in a number of skin diseases based on pattern recognition, and studies have found good agreement between OCT images and histopathological architecture. OCT has shown high accuracy in distinguishing lesions from normal skin, which is of great importance in identifying tumour borders or residual neoplastic tissue after therapy. The OCT images provide an advantageous combination of resolution and penetration depth, but specific studies of diagnostic sensitivity and specificity in dermatology are sparse. In order to improve OCT image quality and expand the potential of OCT, technical developments are necessary. It is suggested that the technology will be of particular interest to the routine follow-up of patients undergoing non-invasive therapy of malignant or premalignant keratinocyte tumours. It is speculated that the continued technological development can propel the method to a greater level of dermatological use.

https://link.springer.com/content/pdf/bfm%3A978-3-319-06419-2%2F1.pdf

Optical Coherence Tomography

The concept of sun-reactive "skin typing" was created in 19751for a specific need: to be able to classify personswith white skinin order to select the correct initial doses of ultraviolet A (UVA) (in joules per cubic centimeter) in the application of the then newly developed technique for the treatment of psoriasis—oral methoxsalen photochemotherapy (PUVA).2The need arose as a result of experience with several patients who were a "dark" phenotype (brown or even black hair, and some with brown eyes) but, to our surprise, developed severe phototoxic reactions following oral ingestion of 0.6 mg/kg of methoxsalen and then, two hours later, were exposed to 4 to 6 J/cm2. These initial doses were obviously too high, and it was then understood that the estimation of the white-skinned person's tolerance level to oral PUVA could not be based solely on the phenotype (hair and eye color).

https://jamanetwork.com/journals/DERM/articlepdf/549509/archderm_124_6_008.pdf

The Validity and Practicality of Sun-Reactive Skin Types I Through VI

Suitably brief pulses of selectively absorbed optical radiation can cause selective damage to pigmented structures, cells, and organelles in vivo. Precise aiming is unnecessary in this unique form of radiation injury because inherent optical and thermal properties provide target selectivity. A simple, predictive model is presented. Selective damage to cutaneous microvessels and to melanosomes within melanocytes is shown after 577-nanometer (3 x 10(-7) second) and 351-nanometer (2 x 10(-8) second) pulses, respectively. Hemodynamic, histological, and ultrastructural responses are discussed.

https://science.sciencemag.org/content/sci/220/4596/524.full.pdf

Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation

Decreased bioavailability of vitamin D in obesity

The known optical properties (absorption, scattering, total attenuation, effective attenuation, and/or anisotropy coefficients) of various biological tissues at a variety of wavelengths are reviewed. The theoretical foundations for most experimental approaches are outlined. Relations between Kubelka-Munk parameters and transport coefficients are listed. The optical properties of aorta, liver, and muscle at 633 nm are discussed in detail. An extensive bibliography is provided. >

A review of the optical properties of biological tissues

The Optics of Human Skin

Oral administration of a photoactive drug, 8-methoxypsoralen (methoxsalen), followed by exposure to a high-intensity, longwave ultraviolet-light system resulted in complete clearing of generalized psoriasis in 21 patients. In 16 of these cases, a paired comparison showed methoxsalen followed by longwave ultraviolet light to be more effective than conventional ultraviolet light. 8-Methoxypsoralen followed by exposure to longwave ultraviolet light has previously been shown to inhibit epidermal DNA synthesis; this may be its mechanism of action in psoriasis, a disorder characterized by an accelerated cell cycle and rate of DNA synthesis. The term photochemotherapy is used to emphasize the point that the effect on epidermal proliferation and the therapeutic response require the interaction of light and drug. (N Engl J Med 291:1207–1211, 1974)

Photochemotherapy of psoriasis with oral methoxsalen and longwave ultraviolet light.

Photosynthesis of previtamin D3 can occur throughout the epidermis in the dermis when hypopigmented Caucasian skin is exposed to solar ultraviolet radiation. Once previtamin D3 is formed in the skin, it undergoes a temperature-dependent thermal isomerization that takes at least 3 days to complete. The vitamin D-binding protein preferentially translocates the thermal product, vitamin D3, into the circulation. These processes suggest a unique mechanism for the synthesis, storage, and slow, steady release of vitamin D3 from the skin into the circulation.

https://science.sciencemag.org/content/sci/210/4466/203.full.pdf

Photosynthesis of previtamin D3 in human skin and the physiologic consequences.

Basic theoretical considerations of the optical and thermal transfer processes that govern the thermal damage induced in tissue by lasers are discussed. An approximate, predictive model and data are proposed for the purpose of selecting a laser that maximizes damage to cutaneous blood vessels and minimizes damage to the surrounding connective tissue and the overlying epidermis. The variables of wavelength, exposure duration, and incident energy density are modeled, and a flashlamp-pumped dye laser operating at or near the 577 nm absorption band of HbO2, with a pulse width (0.3 microsecond) less than the estimated, approximately 1 millisecond, thermal relaxation times for microvessels is chosen for experimental exposures of normal Caucasian skin. Highly specific laser-induced damage to blood vessels is demonstrated both clinically and histologically. This is in striking contrast to the previously reported widespread, diffuse necrosis caused by other lasers. The incident energy and preliminary observations of wavelength and temperature dependence for vascular damage thresholds are consistent with theoretical predictions. Whereas typically 20 joules/cm2 of argon laser irradiation (514 and 488 nm, approximately 100 msec) is required to induce widespread thermal damage, the pulsed dye laser requires only about 2 joules/cm2 to induce highly specific vascular damage. The potential usefulness of dye laser-induced selective vascular damage as a treatment modality for portwine stain hemangiomas and other vascular lesions is discussed. In addition to possible treatment applications, the dye laser or other sources meeting the requirements for producing such damage may also offer a useful experimental tool for inducing predictable damage to microvasculature. Histopathologic and clinical studies related to these possibilities are in progress.

John A. Parrish

Papers

Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation

The Optics of Human Skin

Photochemotherapy of psoriasis with oral methoxsalen and longwave ultraviolet light.

Photosynthesis of previtamin D3 in human skin and the physiologic consequences.

Microvasculature can be selectively damaged using dye lasers: a basic theory and experimental evidence in human skin.