Noninvasive Imaging Is Transforming Vitiligo Monitoring With OCT Technology

A recent letter to the editor published in the Journal of Cosmetic Dermatology by Tan et al. highlights the transformative potential of noninvasive imaging modalities in managing vitiligo.¹

The autoimmune pigmentary disorder presents unique challenges in treatment and monitoring. Among the tools discussed, optical coherence tomography (OCT) stands out as a promising technology for real-time assessment of therapeutic efficacy.

Image Credit: © shurkin_son- stock.adobe.com

The Promise of Noninvasive Imaging in Vitiligo

Effective monitoring is pivotal in optimizing treatment strategies for vitiligo. Noninvasive imaging tools offer clinicians the ability to evaluate skin changes without relying on invasive biopsies, thus improving patient comfort and outcomes.

OCT, an advanced imaging technique, integrates optical interferometry with near-infrared light to generate high-resolution, 3D images of the skin, enabling detailed analysis of structural and cellular changes.²

OCT’s Role in Vitiligo Monitoring

OCT enables imaging up to 1–2 mm deep into the skin, providing a unique capability to visualize changes at the dermal and epidermal levels.³

Key applications of OCT in vitiligo include:

1. Repigmentation Assessment: OCT has demonstrated efficacy in detecting early signs of melanocyte recovery following treatments such as skin grafting. Studies reveal that OCT can visualize repigmentation as early as 30 days post-treatment, identifying melanocyte dendrites at the epidermal–dermal junction.⁴
2. Melanin Quantification: By detecting scattering contrast variations, OCT helps assess melanin distribution and density, offering a reliable method for evaluating therapeutic efficacy.
3. Structural Changes: OCT excels in identifying dermal papillae and other structural alterations, aiding in comprehensive tracking of treatment progress.

Comparing Imaging Modalities

While OCT provides unique advantages, it is often compared with other imaging techniques, such as reflectance confocal microscopy (RCM), according to Tan et al.

RCM’s ability to capture melanocyte migration and fine cellular details complements OCT’s broader imaging depth, making them valuable in tandem for a more holistic view of vitiligo treatment responses.⁵

Clinical Case Studies

A study utilizing high-resolution full-field optical coherence tomography demonstrated significant promise in vitiligo treatment monitoring.⁴ Over 6 months, this technology successfully tracked melanocyte recovery and quantified melanin changes in patients undergoing tissue grafting. These findings underscore OCT’s utility in guiding clinical decision-making and refining therapeutic approaches.

Future Directions

Advancements in OCT and its integration with other technologies are set to expand its applications in dermatology. Promising areas of research include:

• AI Integration: Employing artificial intelligence for enhanced image analysis and automated diagnostics.
• Targeted Drug Delivery: Using OCT to precisely guide therapeutic agent delivery to specific skin layers.
• Multispectral Imaging Combination: Merging OCT with multispectral imaging for comprehensive pigmentation analysis.
• Improved Resolution and Depth: Developing next-generation OCT systems for finer visualization of skin structures.

Conclusions

By enabling precise, real-time monitoring of treatment responses, these tools not only enhance diagnostic accuracy but also improve patient care outcomes, according to Tan et al. Continued research and technological integration hold immense potential for advancing dermatological practice.

References

1. Tan IJ, Wolfe SM, Cohen BA. Advancements in noninvasive imaging: optical coherence tomography for evaluating therapeutic efficacy in vitiligo. J Cosmet Dermatol. 2025;24(1):e16771. doi:10.1111/jocd.16771
2. Zeppieri M, Marsili S, Enaholo ES, et al. Optical coherence tomography (OCT): a brief look at the uses and technological evolution of ophthalmology. Medicina (Kaunas). 2023;59(12):2114. Published 2023 Dec 3. doi:10.3390/medicina59122114
3. Mamalis A, Ho D, Jagdeo J. Optical coherence tomography imaging of normal, chronologically aged, photoaged and photodamaged skin: a systematic review. Dermatol Surg. 2015;41(9):993-1005. doi:10.1097/DSS.0000000000000457
4. Lu LY, Chen YT, Chen IL, et al. Feasibility of high-cellular-resolution full-field, artificial-intelligence-assisted, real-time optical coherence tomography in the evaluation of vitiligo: a prospective longitudinal follow-up study. Bioengineering (Basel). 2024;11(2):196. Published 2024 Feb 19. doi:10.3390/bioengineering11020196
5. Shiu J, Lentsch G, Polleys CM, et al. Noninvasive imaging techniques for monitoring cellular response to treatment in stable vitiligo. J Invest Dermatol. 2024;144(4):912-915.e2. doi:10.1016/j.jid.2023.10.006