Clinical Applications of Reflectance Confocal Microscopy in Paediatric Dermatology: A Systematic Review

This systematic review evaluates the clinical applications of reflectance confocal microscopy (RCM) in paediatric dermatology. The objective was to summarise evidence on the diagnostic and monitoring value of RCM in patients aged ≤ 18 years across dermatologic conditions. Eligible studies included original studies, observational studies, case series and case reports that used RCM in paediatric patients; non-original studies and those lacking extractable paediatric data were excluded. MEDLINE and Web of Science were searched on June 23, 2025. Risk of bias in observational studies was assessed using the modified published criteria. Data were synthesised narratively due to heterogeneity in study design, populations and outcomes. Seventy-three studies met the inclusion criteria which were classified across four condition groups: the 'Neoplastic and related lesions' category (25 studies), 'Congenital anomalies' (8), 'Inflammatory conditions' (30), and 'Infections and infestations' (14). Because some studies evaluated more than one condition, they were included in multiple categories; therefore, category-specific counts exceed the number of unique included studies. Across categories, RCM facilitated non-invasive diagnosis, differentiation of clinically similar conditions, and longitudinal monitoring, especially for melanocytic lesions, congenital pigmentary disorders, lichen sclerosus, vitiligo, acne, molluscum contagiosum, verruca plana, dermatophytosis and scabies. Several studies emphasised the advantages in sensitive regions, such as the genital area. Risk-of-bias assessment revealed variable methodological rigour, reflecting a predominance of observational designs and limited paediatric-specific data. Study heterogeneity, small sample sizes and frequent reliance on case reports or series limited evidence. Overall, findings support RCM as a safe, repeatable tool that reduces reliance on invasive procedures and aids diagnosis and treatment monitoring in paediatric dermatology. Trial Registration: PROSPERO CRD420251018599.