Reflectance confocal microscopy may differentiate acute allergic and irritant contact dermatitis in vivo.
BACKGROUND
Acute irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD) may be difficult to distinguish by clinical or histologic assessment. Reflectance confocal microscopy (RCM) enables real-time, high-resolution skin imaging in vivo.


OBJECTIVE
We sought to image, characterize, and distinguish acute ACD and ICD in vivo.


METHODS
Volunteers with ACD were patch tested with an allergen and the irritant, sodium lauryl sulfate. RCM imaging and transepidermal water loss measurements were performed at 24 and 72 hours. Biopsy specimens were correlated with RCM images.


RESULTS
Spongiosis, epidermal inflammatory cell infiltrate, and vesicle formation were observed in ACD and ICD. Compared with ACD, ICD showed greater disruption of the stratum corneum, and more parakeratosis. There was a significantly greater increase in transepidermal water loss for ICD compared with ACD.


CONCLUSIONS
RCM is a promising tool for dynamic, noninvasive assessment and may help to differentiate acute ACD and sodium lauryl sulfate-induced ICD.
Swindells
Kirsty
K
Wellman Laboratories of Photomedicine, Massachusetts Geneeral Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Burnett
Nadine
N
Rius-Diaz
Francisca
F
González
Ernesto
E
Mihm
Martin C
MC
González
Salvador
S
D000328:Adult; D000368:Aged; D001706:Biopsy; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis* / Q000473:pathology; D017453:Dermatitis, Irritant / Q000175:diagnosis* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal / Q000379:methods; D008875:Middle Aged; D012680:Sensitivity and Specificity; D012882:Skin Tests