1. General introduction 23 1. Furthermore, in the BLEOJET study, the Laser Speckle Contrast Imaging (LSCI) technique was used (Figure 7). This imaging technique is a highly sensitive technique to visualize the blood flow of the skin.66 Erythrocytes act as a virtual contrast agent, outlining blood vessels and hereby enable the highly sensitive measurement of blood flow in the skin, which may correlate with the extent of dermal inflammation in keloids. In skin, erythrocytes are the main source of moving scatters. When coherent laser light interacts with skin tissue containing moving erythrocytes, it produces a speckle pattern because of the interference of scattered light waves. This pattern changes over time as erythrocytes move, with regions of slower flow exhibiting less variability in intensity compared to faster flowing areas. A. B. Figure 7. A. The Laser Speckle Contrast Imaging (LSCI), a highly sensitive technique to visualize the blood flow of the skin. B. Visualization of the blood flow of a keloid lesion before EPI treatment using the LSCI, with a heat map showing the intensity of the blood flow. The final step in evaluating the clinical applicability of EPI-assisted jet injections in recalcitrant keloids was to examine the effectiveness, tolerability and patient satisfaction in a real-world setting. Tolerability, safety and patient satisfaction were assessed by daily photographs made by the patient using an innovative custom-made e-diary app and 1 cm
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