title: Morphologic criteria of vesiculobullous skin disorders by in vivo reflectance confocal microscopy.
abstract: OBJECTIVE
  Reflectance confocal microscopy (RCM) may be a useful method for accurate, rapid, and noninvasive bedside diagnosis of vesiculobullous skin diseases (VSD). The main outcome measure of this study was a descriptive statistical analysis of RCM features associated with selected group of VSD.
  
  
  METHODS
  Single-center, observational study at a university-based dermatology department. Forty skin lesions in 24 patients with bullous pemphigoid (BP), varicella zoster virus infection (VZI), or allergic contact dermatitis (ACD) were assessed.
  
  
  RESULTS
  Patients with BP, VZI, and ACD were assessed for the presence of a large spectrum of RCM features, among others including histopathological correlates for spongiosis, vesicles/blisters, epidermal necrosis, pleomorphic ballooned keratinocytes, and inflammatory infiltrate. The three conditions showed distinct patterns of occurrence with respect to these RCM features. Using a multivariate regression model, we identified sets of morphologic features in BP (vesicles/blisters at the dermoepidermal junction, inflammatory infiltrate within blisters and basal epidermal layers, spongiosis in basal epidermal layers), VZI (acantholysis in the stratum spinosum, epidermal necrosis, pleomorphic ballooned keratinocytes, multinucleated giant cells), and ACD (microvesicles, spongiosis, and prominent inflammatory infiltrate in the stratum granulosum/spinosum).
  
  
  CONCLUSIONS
  RCM seems to be a useful tool in the evaluation and differentiation of a selected group of VSD, and offers a good correlation with histopathological findings.
authors: Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany.
authors: Kinga T
authors: KT
authors: Samhaber
authors: Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany.
authors: Timo
authors: T
authors: Buhl
authors: Department of Dermatology, Venereology, and Allergology, University Medical Center, Rostock, Germany.
authors: Birka
authors: B
authors: Brauns
authors: Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Germany.
authors: Lars
authors: L
authors: Hofmann
authors: Department of Dermatology, Venereology, and Allergology, Medical Center Hildesheim GmbH, Hildesheim, Germany.
authors: Christina
authors: C
authors: Mitteldorf
authors: Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany.
authors: Cornelia S
authors: CS
authors: Seitz
authors: Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Germany.
authors: Michael P
authors: MP
authors: Schön
authors: Institute of Genetic Epidemiology, University Medical Center, Göttingen, Germany.
authors: Albert
authors: A
authors: Rosenberger
authors: Department of Dermatology, Venereology, and Allergology, University Medical Center, Heidelberg, Germany.
authors: Holger A
authors: HA
authors: Haenssle
mesh_terms: D000051:Acantholysis; D017449:Dermatitis, Allergic Contact; D006801:Humans; D015603:Keratinocytes; D018613:Microscopy, Confocal; D012867:Skin; D012872:Skin Diseases, Vesiculobullous / Q000000981:diagnostic imaging*; D012878:Skin Neoplasms