Combined Use of RCM, OCT Allows for More Accurate Grading of Acne Vulgaris

Acne vulgaris on chin
Acne vulgaris on chin
Acne lesion morphology was not associated with the severity of an individual's acne.

The combined in vivo use of reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) has the ability to elucidate the distinctive follicle infundibulum features and degree of inflammation that are associated with severity of acne vulgaris, according to the results of an explorative study ( identifier: NCT03524040) published in Lasers in Surgery and Medicine.

The investigators sought to identify the morphologic characteristics of acne that may be linked to clinical disease severity via use of RCM and OCT. A total of 14 patients with mild to moderate facial acne (Investigators Global Assessment [IGA] scale, 1-3) and 7 healthy participants (IGA, 0) were included in this study. Overall, 108 RCM image blocks and 54 OCT scans, with each image measuring 6 × 6 mm, were captured from lesional-, perilesional-, and lesion-free areas of participants’ skin. A comparison of acne lesions, infundibular regions of follicles, and degree of inflammation was performed in patients with acne and healthy control patients.

The combined use of RCM and OCT revealed acne lesions, infundibular morphology, and blood flow. Moreover, RCM images of perilesional- and lesion-free skin in patients with acne demonstrated follicle infundibula with hyperkeratinized borders and abundant keratin plugs when compared with the skin of healthy participants.

Higher levels of acne severity were significantly associated with increased number of follicles with hyperkeratotic borders (P =.04) and keratin plugs (P =.006), increased density of inflammatory cells (P <.001), increased infundibulum diameter (P <.001), and blood flow (P =.03). Acne lesion morphology, however, was not associated with the severity of an individual’s acne.

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The investigators concluded that future trials may apply the combined use of RCM and OCT to support clinical acne grading, allow for the monitoring of noninvasive treatments, and potentially refine therapeutic plans by image diagnostics. Larger studies are warranted to validate the findings of this current explorative analysis.


Fuchs CSK, Andersen AJB, Ardigo M, Philipsen PA, Haedersdal M, Mogensen M. Acne vulgaris severity graded by in vivo reflectance confocal microscopy and optical coherence tomography [published online August 2, 2018]. Lasers Surg Med. doi: 10.1002/lsm.23008