In vivo reflectance confocal microscopy (RCM) is a relatively new technique for real time, en face, non-invasive microscopical imaging of the superficial layers of the skin down to the superficial dermis, with cellular-level resolution close to conventional histopathology. The technology works on the bases of light reflection according to the different reflectance indexes of the different skin structures . RCM gives to clinicians the possibility of a real time and non-invasive “virtual” punch biopsy ranging from 2 to 8 mm in horizontal dimension and 250–300 μm in vertical dimension and providing collection of microscopical features and consequential, immediate “clinical-microscopical” correlation. In specific, RCM has been already successfully tested for the evaluation of several inflammatory, neoplastic skin conditions and has been demonstrated to constitute, in selected cases, an excellent alternative to invasive biopsy. In specific, RCM has been used in several inflammatory skin conditions, such as acute contact dermatitis, discoid lupus erythematosus and psoriasis, and has been correlated with conventional histology in several instances [2–4]. Also pigmentary disorders and more recently hair diseases have been evaluated using confocal microscopy [5, 6].
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