Line-field confocal optical coherence tomography for the differential diagnosis of porokeratosis from clinical mimickers: a preliminary study

Background Porokeratosis variants are relatively rare and can be clinically misdiagnosed with several common papulokeratotic mimickers. Line-field confocal optical coherence tomography (LC-OCT) is a new technology able to explore the skin in vivo up to a depth of 500 mu m.Objectives To investigate the role of LC-OCT in the diagnosis of many porokeratosis variants in a preliminary study.Method In total, 130 LC-OCT images were obtained from 98 patients, 45 affected by a porokeratosis variant (69 images) and 53 with a mimicker condition (61 images).Results We found almost perfect interobserver agreement for LC-OCT image interpretation and perfect correspondence with the findings from histological slides. In addition, a series of morphological in vivo and three-dimensional features related to the cornoid lamella were detected by LC-OCT that were not visible from the histology.Conclusions This device can be proposed to assist with rapid bedside noninvasive differentiation of porokeratosis variants from their mimickers, possibly sparing incisional biopsy in patients where the diagnosis is uncertain. Porokeratosis variants are relatively rare and can be clinically misdiagnosed with several common papulokeratotic mimickers. Line-field confocal optical coherence tomography (LC-OCT) is a new technology that can be used to explore the skin in vivo up to a depth of 500 mu m. In this preliminary study, we aimed to investigate the role of LC-OCT in the diagnosis of porokeratosis variants.