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Dynamic optical coherence tomography (D-OCT) enables quantification of the skin\u00b4s vasculature, potentially helpful to improve the link between clinical and subclinical features. We aimed to compare microvascular characteristics across AK grades using D-OCT with automated vascular analysis. This explorative study examined AK and photodamaged skin (PD) on the face or scalp. AKs were clinically graded according to the Olsen Classification scheme before D-OCT assessment. Using an open-source software tool, the OCT angiographic analyzer (OCTAVA), we quantified vascular network features, including <jats:italic>total<\/jats:italic> and <jats:italic>mean vessel length<\/jats:italic>, <jats:italic>mean vessel diameter<\/jats:italic>, <jats:italic>vessel area density<\/jats:italic> (VAD), <jats:italic>branchpoint density<\/jats:italic> (BD), and <jats:italic>mean tortuosity<\/jats:italic> from enface maximum intensity projection images. Additionally, we performed subregional analyses on selected scans to overcome challenges associated with imaging through hyperkeratosis (each lesion group; <jats:italic>n<\/jats:italic>\u2009=\u200918). Our study included 45 patients with a total of 205 AKs; 93 grade I lesions, 65 grade II, 47 grade III and 89 areas with PD skin. We found that all AK grades were more extensively vascularized relative to PD, as shown by greater total vessel length and VAD (<jats:italic>p<\/jats:italic>\u2009\u2264\u20090.009). Moreover, AKs displayed a disorganized vascular network, with higher BD in AK I-II (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), and mean tortuosity in AK II-III (<jats:italic>p<\/jats:italic>\u2009\u2264\u20090.001) than in PD. Vascularization also increased with AK grade, showing significantly greater total vessel length in AK III than AK I (<jats:italic>p<\/jats:italic>\u2009=\u20090.029). Microvascular quantification of AK unveiled subclinical, quantitative differences among AK grades I-III and PD skin. D-OCT-based microvascular assessment may serve as a supplement to clinical AK grading, potentially raising perspectives to improve management strategies.<\/jats:p>","DOI":"10.1007\/s00403-024-03022-z","type":"journal-article","created":{"date-parts":[[2024,6,15]],"date-time":"2024-06-15T09:01:42Z","timestamp":1718442102000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Vascular feature identification in actinic keratosis grades I-III using dynamic optical coherence tomography with automated, quantitative analysis"],"prefix":"10.1007","volume":"316","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3903-2651","authenticated-orcid":false,"given":"Gabriella","family":"Fredman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stine R.","family":"Wiegell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Merete","family":"Haedersdal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gavrielle R.","family":"Untracht","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,6,15]]},"reference":[{"key":"3022_CR1","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1111\/bjd.15107","volume":"176","author":"D de Berker","year":"2017","unstructured":"de Berker D, McGregor JM, Mohd Mustapa MF et al (2017) British Association of Dermatologists\u2019 guidelines for the care of patients with actinic keratosis 2017. 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