A novel technique for noninvasive diagnosis of herpesvirus-related skin conditions

Line-field confocal optical coherence tomography (LC-OCT) is a new noninvasive imaging technique that provides high-resolution skin imaging similar to that obtained with histopathology. The aim of this study was to evaluate the usefulness of LC-OCT in the diagnosis of herpesvirus skin infections. Patients with a clinical or anamnestic suspicion of herpesvirus infection underwent LC-OCT evaluation followed by Tzanck test. The examinations were performed in a blinded manner by different dermatologists. In total, 72 patients (38 male, 34 female; age range 13-84 years) were evaluated. In 57 patients, LC-OCT enabled the recognition of typical herpetic intraepidermal vesicles containing giant ballooning/multinucleated cells, as confirmed by Tzanck test. The final diagnoses were herpes zoster in 31 patients, herpes simplex in 16 patients, varicella in 8 patients and Kaposi varicelliform eruption in 2 patients. In the remaining 15 patients, both LC-OCT and Tzanck test results excluded a diagnosis of herpetic infection. Although the diagnosis of herpesvirus skin infection is generally clinical, in patients with minimal and/or atypical cases, LC-OCT could be a rapid and valid alternative to semi-invasive/invasive or time-consuming procedures, such as the Tzanck test, viral culture, polymerase chain reaction or histopathology.