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Visualizing the in-vivo application of zinc in sensitive skin using reflectance confocal microscopy.

ABSTRACT: Findings obtained on objective assessments to evaluate sensitive skin do not correlate well with the symptomatology. We utilized reflectance confocal microscopy (RCM) to compare transepidermal application of zinc in sensitive and non-sensitive skin. Thirty-six subjects participated in this study. They were divided into groups based on lactic acid sting test (LAST):'stinger' and 'non-stinger'; transepidermal water loss (TEWL) measurements; and sensitivity self-assessments: 'sensitive' and 'non-sensitive'. RCM images were taken to visualize transepidermal application of topically-applied zinc. The intensity of zinc reflectance at different depths was measured by ImageJ software. Based on LAST scores, the 'stinger' group showed significantly higher reflectance of zinc at 8 µm (stratum corneum) [face (P < 0.001), forearm (P = 0.004)], and at 80-104 µm (dermo-epidermal junction layer) on the face. High-TEWL group showed increased zinc reflectance at 8-24 µm (tight junction layer, P < 0.001). There were no significant differences amongst subjects self-reporting 'sensitive' and 'non-sensitive' skin. RCM demonstrates that in sensitive skin, there is deeper and higher reflectance of zinc at multiple depths. Structural differences are also visualized. We suggest that RCM is a useful tool for evaluating skin barrier integrity.

SUBMITTER: Ahn HJ

PROVIDER: S-EPMC8032733 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:The surgical removal of non-melanoma skin cancers (NMSCs) is guided by the pathologic examination of margins. However, the preparation of histopathology is time consuming, labour-intensive and requires separate laboratory infrastructure. Furthermore, when histopathology indicates positive margins, patients must return for re-excisions. Reflectance confocal microscopy (RCM) with a new video-mosaicking approach can noninvasively delineate margins directly on patients and potentially guide surgery in real-time, augmenting the traditional approaches of histopathology. OBJECTIVE:To assess a new peri-operative RCM video-mosaicking approach for comprehensive delineation of NMSC margins on patients in vivo. METHODS:Thirty-five patients undergoing Mohs micrographic surgery (MMS) in the Mohs surgery unit at Memorial Sloan Kettering Cancer Center, New York, NY were included in the study. RCM imaging was performed before and after the first staged excision by acquiring videos along the surgical margins (epidermal, peripheral and deep dermal) of each wound, which were subsequently processed into video-mosaics. Two RCM evaluators read and assessed video-mosaics, and subsequently compared to the corresponding Mohs frozen histopathology. RESULTS:Reflectance confocal microscopy videos and video-mosaics displayed acceptable imaging quality (resolution and contrast), pre-operatively in 32/35 (91%) NMSC lesions and intra-operatively in 29/35 lesions (83%). Pre-operative delineation of margins correlated with the histopathology in 32/35 (91%) lesions. Intra-operative delineation correlated in 10/14 (71%) lesions for the presence of residual tumour and in 18/21 (86%) lesions for absence. Sensitivity/specificity were 71%/86% and 86%/81% for two RCM video-mosaic evaluators, and overall agreement was 80% and 83% with histopathology, with moderate inter-evaluator agreement (k = 0.59, P ≤ 0.0002). CONCLUSIONS:Peri-operative RCM video-mosaicking of NMSC margins directly on patients may potentially guide surgery in real-time, serve as an adjunct to histopathology, reduce time spent in clinic and reduce the need for re-excisions. Further testing in larger studies is needed.

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Visualizing the in-vivo application of zinc in sensitive skin using reflectance confocal microscopy.

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