Optical coherence tomography angiography of normal skin and inflammatory dermatologic conditions

Background In clinical dermatology, the identification of subsurface vascular and structural features known to be associated with numerous cutaneous pathologies remains challenging without the use of invasive diagnostic tools. Objective To present an advanced optical coherence tomography angiography (OCTA) method to directly visualize capillary‐level vascular and structural features within skin in vivo. Methods An advanced OCTA system with a 1310 nm wavelength was used to image the microvascular and structural features of various skin conditions. Subjects were enrolled and OCTA imaging was performed with a field of view of approximately 10 × 10 mm. Skin blood flow was identified using an optical microangiography (OMAG) algorithm. Depth‐resolved microvascular networks and structural features were derived from segmented volume scans, representing tissue slabs of 0–132, 132–330, and 330–924 μm, measured from the surface of the skin. Results Subjects with both healthy and pathological conditions, such as benign skin lesions, psoriasis, chronic graft‐versus‐host‐disease (cGvHD), and scleroderma, were OCTA scanned. Our OCTA results detailed variations in vascularization and local anatomical characteristics, for example, depth‐dependent vascular, and structural alterations in psoriatic skin, alongside their resolve over time; vascular density changes and distribution irregularities, together with corresponding structural depositions in the skin of cGvHD patients; and vascular abnormalities in the nail folds of a patient with scleroderma. Conclusion OCTA can image capillary blood flow and structural features within skin in vivo, which has the potential to provide new insights into the pathophysiology, as well as dynamic changes of skin diseases, valuable for diagnoses, and non‐invasive monitoring of disease progression and treatment. Lasers Surg. Med. 50:183–193, 2018. © 2018 Wiley Periodicals, Inc.