Optical non-invasive approaches to diagnosis of skin diseases

A multimodal approach to acne mechanica associated to medical face masks using clinical examination, fluorescent photography, and in vivo reflectance confocal microscopy

With yet unclear pathogenesis, acne mechanica associated to medical face masks(MFM) gained increased attention during the COVID-19 pandemic. Between November 2021-January 2022 we conducted an exploratory, cross-sectional study evaluating the differences between the glabella and cheek-chin junction using clinical examination, fluorescent photography (FP), videodermatoscopy and in vivo reflectance confocal microscopy (RCM). Medical doctors from our country and 6th year medical students were invited. Participants self-identified as consistent MFM users during work hours. We analysed 19,432 images from 14 consecutive subjects, 11 females, 3 males, mean age,29.93 years (SD = 4.69). Clinical examination revealed more inflammatory lesions on the cheeks and chin (+ 9.35;95%CI + 2.31to + 16.39;d = 0.76, P =.01). FP considered ultraviolet red fluorescing spots(UVRFs) from the glabella and the cheek-chin junction, with significantly more spots in the former (+ 5.43;95%CI + 2.64to + 8.20; d = 1.12; P =.001). The average area in mm2 covered by the spots was significantly larger in the glabella (+ 3.26;95%CI + 1.43to + 5.08;d = 1.02; P =.002). RCM considered 9546 follicles, 4966 from the glabella, and 4580 from the cheek-chin junction. The cheek-chin junction had a significantly higher proportion of hyperkeratotic follicles than the glabella (+ 9%;95%CI + 2%to + 16%;d = 0.79;P =.01). In the dermal-epidermal junction, the cheek-chin region had a significantly higher proportion of follicles with signs of inflammation than the glabella (+ 10%;95% CI + 3%to + 18%; d = 0.80; P =.010). Perifollicular stratum corneum thickness was significantly lower in the cheek-chin junction, 19.56 μm (SD = 4.84) compared to the glabella, 24.25 μm (± 4.93) (-4 μm;95% CI-1 μm to- 8 μm; r =.88; P =.01). The distribution of UVRFs, known to correlate with microbial activity and sebum production, is similar to pre-pandemic studies, suggesting that in acne mechanica associated to MFM, follicular hyperkeratinisation, inflammation, and irritation, may outweigh other possible alterations.

Recent Progress and Opportunities of Wearable Non-Invasive Epidermal Sensors for Skin Disease Diagnosis

With deteriorating environment and increased stress in modern life, skin diseases have become the fourth leading cause of nonfatal and chronic diseases. An early diagnosis might improve the chances of a successful treatment. Wearable epidermal sensors have been emerged as new non-invasive tools for clinical practice and research in dermatology, which can act as a complement to the otherwise mostly visual and tactile judgments. This review discusses the recent progress and opportunities of wearable epidermal sensors for skin disease diagnosis. The configuration, material choice, and fundamental platforms of wearable epidermal sensors are first summarized. Then, their emerging application in monitoring skin diseases is demonstrated by detecting skin hardness, skin hydration, and biomakers. With the advances highlighted here and the ongoing research efforts, the continuous breakthrough in wearable epidermal sensors and their attractive application in skin disease management is foreseeable in the future.

Methods of Quantitative Assessment of the Response of Dilated Skin Blood Vessels to High-Energy Light Treatments

Background: The techniques of choice used in the treatment of extensive vascular lesions of the face are methods based on high-energy light sources, such as lasers and IPL (intense pulsed light). The techniques commonly employed to detect blood vessel abnormalities in skin primarily rely on semi-quantitative or qualitative scales. Methods: The study was conducted on a group of 38 volunteers; a series of three treatments was performed using an IPL source (Lumecca, Inmode, Israel). The vessels' response to the high-energy light was verified using the following quantitative methods: mexametric measurements, hyperspectral imaging, and directional reflectance measurements. Results: In the mexameter measurement, statistically non-significant differences were obtained in the hemoglobin content in the skin condition prior to and following multiple intense pulsed light sessions. Studies performed using a hyperspectral camera showed that at a wavelength of 580 nm, the increase in skin reflectance after the treatment was statistically significant. Total directional reflectance measurements showed that at wavelengths of 400-540 nm and 480-600 nm, following the IPL treatment, the skin reflectance increased statistically significantly. Implementing three consecutive intense pulsed light procedures appears adequate to obtain a clinically satisfactory reduction in vascular changes in the facial skin. Mexametric measurements do not enable the assessment of the reaction of blood vessels to IPL. Conclusions: Hyperspectral imaging is an effective method for the quantitative assessment of skin vascular lesions. The best results in the assessment of vascular lesions using hyperspectral imaging are obtained at wavelengths of 420 nm and 580 nm. The hemispheric directional reflectance method allows for a quick, accurate, and repeatable assessment of vascular skin changes.

Acne-related UVA-induced facial fluorescence: An exploratory study from physiological properties to tissue structure information

UVA-induced facial fluorescence (UVAF) is recognized as an objective measurement technique to quantify the severity of acne. However, notable inconsistencies in quantitative outcomes have been observed in various studies, possibly due to the fact that different colors of fluorescence represent different pathophysiological implications. This study investigated the pathophysiological importance of UVAF color differences and improved its reliability in assessing acne severity. MIDOO Smart Skin Imager was used to capture UVAF and analyze the correlation between fluorescence colors and acne lesions. Techniques such as two-photon excited fluorescence microscopy, scanning electron microscopy, western blot, and high performance liquid chromatography-mass spectrometry (HPLC-MS/MS) were used to examine the biochemical composition and structure of comedonal plugs and follicular casts associated with different fluorescence colors. We found that green fluorescence correlates with non-inflammatory acne lesions (comedones), while orange-red fluorescence shows no correlation with either type of lesion. Green fluorescence is associated with higher levels of keratin, indicating keratinization, while orange-red fluorescence is associated with porphyrin from S. epidermidis. UVAF color differences - orange-red are from porphyrins and green from keratin. This distinction helps to understand the structural and physiological bases of facial fluorescence, with potential implications for clinical evaluations of acne.

State-of-the-Art in Skin Fluorescent Photography for Cosmetic and Skincare Research: From Molecular Spectra to AI Image Analysis

Autofluorescence is a remarkable property of human skin. It can be excited by UV and observed in the dark using special detection systems. The method of fluorescence photography (FP) is an effective non-invasive tool for skin assessment. It involves image capturing by a camera the emission of light quanta from fluorophore molecules in the skin. It serves as a useful tool for cosmetic and skincare research, especially for the detection of pathological skin states, like acne, psoriasis, etc. To the best of our knowledge, there is currently no comprehensive review that fully describes the application and physical principles of FP over the past five years. The current review covers various aspects of the skin FP method from its biophysical basis and the main fluorescent molecules of the skin to its potential applications and the principles of FP recording and analysis. We pay particular attention to recently reported works on the automatic analysis of FP based on artificial intelligence (AI). Thus, we argue that FP is a rapidly evolving technology with a wide range of potential applications. We propose potential directions of the development of this method, including new AI algorithms for the analysis and expanding the range of applications.

Testing the Reliability of Optical Coherence Tomography to Measure Epidermal Thickness and Distinguish Volar and Nonvolar Skin

In persons with limb loss, prosthetic devices cause skin breakdown, largely because residual limb skin (nonvolar) is not intended to bear weight such as palmoplantar (volar) skin. Before evaluation of treatment efficacy to improve skin resiliency, efforts are needed to establish normative data and assess outcome metric reliability. The purpose of this study was to use optical coherence tomography to (i) characterize volar and nonvolar skin epidermal thickness and (ii) examine the reliability of optical coherence tomography. Four orientations of optical coherence tomography images were collected on 33 volunteers (6 with limb loss) at 2 time points, and the epidermis was traced to quantify thickness by 3 evaluators. Epidermal thickness was greater (P < .01) for volar skin (palm) (265.1 ± 50.9 μm, n = 33) than for both nonvolar locations: posterior thigh (89.8 ± 18.1 μm, n = 27) or residual limb (93.4 ± 27.4 μm, n = 6). The inter-rater intraclass correlation coefficient was high for volar skin (0.887-0.956) but low for nonvolar skin (thigh: 0.292-0.391, residual limb: 0.211-0.580). Correlation improved when comparing only 2 evaluators who used the same display technique (palm: 0.827-0.940, thigh: 0.633-0.877, residual limb: 0.213-0.952). Despite poor inter-rater agreement for nonvolar skin, perhaps due to challenges in identifying the dermal-epidermal junction, this study helps to support the utility of optical coherence tomography to distinguish volar from nonvolar skin.

A comparative study of an advanced skin imaging system in diagnosing facial pigmentary and inflammatory conditions

Visual assessment, while the primary method for pigmentation and erythema evaluation in clinical practice, is subjective, time-consuming, and may lead to variability in observations among clinicians. Objective and quantitative techniques are required for a precise evaluation of the disease's severity and the treatment's efficacy. This research examines the precision and utility of a newly developed skin imaging system in assessing pigmentation and erythema. Sixty participants were recruited, and their facial images were analyzed with the new OBSERV 520 x skin imaging system, compared to DERMACATCH for regional analysis and VISIA for full-face examination. The degree of skin pigmentation was clinically graded using the MASI scores evaluated by dermatologists. The data revealed positive correlations between the novel skin imaging system and the two conventional instruments in quantifying pigmentation and erythema, whether in regional or full-face analysis. Furthermore, the new skin imaging system positively correlated with the clinical MASI scores (r = 0.4314, P < 0.01). In contrast, our study found no significant correlation between the traditional system and clinical assessment, indicating a more substantial capacity for hyperpigmentation assessment in the new system. Our study validates the innovative skin imaging system's accuracy in evaluating pigmentation and erythema, demonstrating its feasibility for quantitative evaluation in both clinical and research purposes.

Line-Field Confocal Optical Coherence Tomography (LC-OCT) for Skin Imaging in Dermatology

Line-field confocal optical coherence tomography (LC-OCT) is a non-invasive optical imaging technique based on a combination of the principles of optical coherence tomography and reflectance confocal microscopy with line-field illumination, which can generate cell-resolved images of the skin in vivo. This article reports on the LC-OCT technique and its application in dermatology. The principle of the technique is described, and the latest technological innovations are presented. The technology has been miniaturized to fit within an ergonomic handheld probe, allowing for the easy access of any skin area on the body. The performance of the LC-OCT device in terms of resolution, field of view, and acquisition speed is reported. The use of LC-OCT in dermatology for the non-invasive detection, characterization, and therapeutic follow-up of various skin pathologies is discussed. Benign and malignant melanocytic lesions, non-melanocytic skin tumors, such as basal cell carcinoma, squamous cell carcinoma and actinic keratosis, and inflammatory and infectious skin conditions are considered. Dedicated deep learning algorithms have been developed for assisting in the analysis of LC-OCT images of skin lesions.

Investigating the Influence of Probe Pressure on Human Skin Using Diffusive Reflection Spectroscopy

The skin has emerge as a compelling subject for investigation owing to its accessibility and the relatively straightforward application of optical procedures to it. Diffusive reflection spectroscopy (DRS) was employed to study the influence of probe pressure on human skin. A comprehensive non-invasive study was conducted, which covers almost all the important body parts for in vivo measurements. Reflection spectra were measured for the fingertip, forearm, forehead, neck, and foot under a set of probe pressures (0-265 kPa). Importantly, each tissue type's unique composition and morphology influenced the shape, size, intensity, and position of the recorded peak, highlighting the tissue-specific responses to pressure. In addition, time-based reflection spectroscopy was also performed on the forearm under blood occlusion for 5 min to study the effect. DRS measurements were performed on volunteers of different skin tones, including dark, medium, and fair. Later, a change in the intensity of the oxyhemoglobin peak was confirmed using a green laser light of a wavelength of 532 nm. Besides the dermal studies, diffusive reflection spectroscopy was also employed to investigate the probe pressure effect on human nails. A probe pressure ranging from 0 to 385 kPa was applied for nail spectroscopy. The same trend of intensity change was observed following the previous measurements. The suggested sensing system may be crucial in applications requiring pressure sensing when the human body is subjected to varying pressures, such as exercise, weightlifting, and other sports.

Analysis of facial redness by comparing VISIA and YLGTD

BACKGROUND

Erythema, characterized by redness of the skin, is a common symptom in various facial skin conditions. Recent advancements in image processing and analysis techniques have led to the development of methods for analyzing and assessing skin texture. This study aimed to investigate the correlation between the parameters of "You Look Good Today" (YLGTD) and VISIA in the detection and assessment of facial redness.

MATERIALS AND METHODS

Thirty female subjects participated in this experiment, undergoing assessments using both YLGTD and VISIA. The subjects were evaluated for facial redness, and the feature count results within the red zone were measured by VISIA. YLGTD analyzed the number and percentage of red zone pixels. The assessments were conducted between [specific dates] in [location].

RESULTS

The results demonstrated a significant positive correlation between the feature count results within the red zone measured by VISIA and the number of red zone pixels. Similarly, YLGTD exhibited a significant positive correlation with the number and percentage of red zone pixels.

CONCLUSION

In conclusion, our findings suggest a correlation between YLGTD and VISIA in the measurement of facial erythema. YLGTD can serve as a portable device for primary screening assessments, offering a convenient and reliable method to evaluate facial redness. This research contributes to the development of non-invasive techniques for assessing and monitoring facial skin conditions, providing valuable insights for dermatological diagnosis and cosmetic testing.

Quantitative Evaluation of the Effectiveness of Chemical Peelings in Reducing Acne Lesions Based on Gray-Level Co-Occurrence Matrix (GLCM)

Purpose

Acne vulgaris is a chronic, inflammatory disease accompanied by lesions affecting the structure of the skin. Chemical peels are one of the methods of reducing acne vulgaris. There is still a lack of quantitative methods of assessing impact of cosmetic procedure on the skin. Skin condition depends on skin texture characterization; therefore, the analysis that provides data about the textures can be helpful in assessing the effectiveness of cosmetic treatments.

Patients and Methods

The study involved 24 volunteers with acne lesions. Each participant underwent 4 treatments using chemical peels at two-week intervals. Before, during and after procedure clinical photography were made. To assess effectiveness of chemical peeling in acne lesion reduction, we were used gray-level co-occurrence matrix (GLCM) analysis. Qualitative assessment of acne severity was made by 12 experts in dermatology.

Results

After a series of treatments, the GLCM contrast value decreased in each area of the face, and the GLCM homogeneity value increased, which means that the number of acne lesions was reduced. Expert assessment according to the IGA scale confirms the effectiveness of therapy with both salicylic and glycolic acid and pyruvic acid.

Conclusion

The results of this study prove that GLCM analysis is a useful tool for assessing the effectiveness of chemical peel treatments. It can also be used for quantitative assessment of skin texture.

Automating reflectance confocal microscopy image analysis for dermatological research: a review

SIGNIFICANCE

Reflectance confocal microscopy (RCM) is a noninvasive, in vivo technology that offers near histopathological resolution at the cellular level. It is useful in the study of phenomena for which obtaining a biopsy is impractical or would cause unnecessary tissue damage and trauma to the patient.

AIM

This review covers the use of RCM in the study of skin and the use of machine learning to automate information extraction. It has two goals: (1) an overview of information provided by RCM on skin structure and how it changes over time in response to stimuli and in disease and (2) an overview of machine learning approaches developed to automate the extraction of key morphological features from RCM images.

APPROACH

A PubMed search was conducted with additional literature obtained from references lists.

RESULTS

The application of RCM as an in vivo tool in dermatological research and the biologically relevant information derived from it are presented. Algorithms for image classification to epidermal layers, delineation of the dermal-epidermal junction, classification of skin lesions, and demarcation of individual cells within an image, all important factors in the makeup of the skin barrier, were reviewed. Application of image analysis methods in RCM is hindered by low image quality due to noise and/or poor contrast. Use of supervised machine learning is limited by time-consuming manual labeling of RCM images.

CONCLUSIONS

RCM has great potential in the study of skin structures. The use of artificial intelligence could enable an easier, more reproducible, precise, and rigorous study of RCM images for the understanding of skin structures, skin barrier, and skin inflammation and lesions. Although several attempts have been made, further work is still needed to provide a definite gold standard and overcome issues related to image quality, limited labeled datasets, and lack of phenotype variability in available databases.

Skin optical properties in the obese and their relation to body mass index: a review

SIGNIFICANCE

Obesity is a worldwide epidemic contributing directly to several cardiovascular risk factors including hypertension and type 2 diabetes. Wearable devices are becoming better at quantifying biomarkers relevant for the management of health and fitness. Unfortunately, both anecdotal evidence and recent studies indicate that some wearables have higher levels of error when utilized by populations with darker skin tones and high body mass index (BMI). There is an urgent need for a better evaluation of the limits of wearable health technologies when used by obese individuals.

AIMS

(1) To review the current know-how on changes due to obesity in the skin epidermis, dermis, and subcutis that could affect the skin optical properties; (2) for the green wavelength range, to evaluate the difference in absorption and scattering coefficients from the abdominal skin between individuals with and without elevated BMI. The changes include alterations in layer thickness and cell size, as well as significant differences in chromophores and scatterer content, e.g., water, hemoglobin, collagen, and lipids.

APPROACH

We have summarized literature pertaining to changes in skin and its components in obesity and report the results of our search using articles published between years 1971 and 2020. A linear model was used to demonstrate the absorption and reduced scattering coefficient of the abdominal skin of individuals with and without elevated BMI in the green wavelength range (530 to 550 nm) that is typically found in most wearables.

RESULTS

The general trends indicate a decrease in absorption for both dermis and subcutis and an increase in reduced scattering for both epidermis and dermis. At 544-nm wavelength, a typical wavelength used for photoplethysmography (PPG), the absorption coefficient's relative percentage difference between high and low BMI skin, was 49% in the subcutis, 19% in the dermis, and negligible in the epidermis, whereas the reduced scattering coefficient relative difference was 21%, 29%, and 165% respectively.

CONCLUSIONS

These findings suggest that there could be significant errors in the output of optical devices used for monitoring health and fitness if changes due to obesity are not accounted for in their design.

Quantification of soft tissue parameters from spatially resolved diffuse reflectance finite element models

Spatially resolved diffuse reflectance spectroscopy (SRDRS) is a non-invasive optical technique that helps in clinical diagnosis of various tissue microcirculation and skin pigmentation disorders based on collected backscattered light from multi-layered tissue. The extraction of the optical properties from the reflectance spectrum using analytical solutions is laborious. Model-based light tissue interaction studies help in quantifying the optical properties. This work presents the use of finite element models of light tissue interaction for this purpose. A bilayer model mimicking human skin was considered and the diffused reflectance spectra at multiple detector points were generated using finite element modelling for varying melanin concentration, epidermal thickness, blood volume fraction, oxygen saturation and scattering components. The reflectance value based on varying optical parameters from multiple detection points lead to the generation of a look-up table (LUT), which is further used for finding the tissue parameters that contribute to the spatially resolved reflectance values. The tissue parameters estimated after inverse modelling showed a high degree of agreement with the expected tissue parameters for a test dataset different from the training dataset.

Skin erythema assessment techniques

Skin erythema may present owing to many causes. One of the common causes is prolonged exposure to sunrays. Other than sun exposure, skin erythema is an accompanying sign of dermatologic diseases, such as psoriasis and acne. Quantifying skin erythema in patients enables the dermatologist to assess the patient's skin health. Quantitative assessment of skin erythema has been the focus of several studies. The clinical standard for erythema evaluation is visual assessment; however, this standard has some deficiencies. For instance, visual assessment is subjective and ineffectual for precise color information exchange. To overcome these limitations, in the past three decades various methodologies have been developed in an attempt to achieve objective erythema assessments, such as diffuse reflectance spectroscopy and both optical and nonoptical systems. This review considers the studies published during the past three decades and discusses the performance, the mathematical tactics for computation, and the limited capabilities of erythema assessment techniques for cutaneous diseases. The achievements and limitations of the current techniques in erythema assessment are presented. The advantages and development trends of optical and nonoptical methods are presented to make the reader aware of the present technological advances and their potential for dermatological disease research.

Skin erythema and pigmentation: a review of optical assessment techniques

BACKGROUND

Skin erythema may present due to many causes. One of the common causes is prolonged exposure to sun rays. Other than sun exposure, skin erythema is an accompanying sign of dermatological diseases such as acne, psoriasis, melasma, post inflammatory hyperpigmentation, fever, as well as exposure to specific electromagnetic wave bands.

METHODS

Quantifying skin erythema in patients enables the dermatologist to assess the patient's skin health. Therefore, quantitative assessment of skin erythema was the target of several studies. The clinical standard for erythema evaluation is visual assessment. However, the former standard has some imperfections. For instance, it is subjective, and unqualified for precise color information exchange. To overcome these shortcomings, the past three decades witnessed various methodologies that aimed to achieve erythema objective assessment, such as diffuse reflectance spectroscopy (DRS), and both optical and non-optical systems.

DISCUSSION

This review article reports on the studies published in the past three decades where the performance, the mathematical tactics for computation, and the capabilities of erythema assessment techniques for cutaneous diseases are discussed. In particular, the achievements and limitations of the current techniques in erythema assessment are presented.

CONCLUSION

The profits and development trends of optical and non-optical methods are displayed to provide the researcher with awareness into the present technological advances and its potential for dermatological diseases research.

Towards shifted position-diffuse reflectance imaging of anatomically correctly scaled human microvasculature

Due to significant advantages, the trend in the field of medical technology is moving towards minimally or even non-invasive examination methods. In this respect, optical methods offer inherent benefits, as does diffuse reflectance imaging (DRI). The present study attempts to prove the suitability of DRI—when implemented alongside a suitable setup and data evaluation algorithm—to derive information from anatomically correctly scaled human capillaries (diameter: \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$10\,\upmu \hbox {m}$$\end{document}10μm, length: \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$45\,\upmu \hbox {m}$$\end{document}45μm) by conducting extensive Monte–Carlo simulations and by verifying the findings through laboratory experiments. As a result, the method of shifted position-diffuse reflectance imaging (SP-DRI) is established by which average signal modulations of up to 5% could be generated with an illumination wavelength of \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\lambda =424\,\hbox {nm}$$\end{document}λ=424nm and a core diameter of the illumination fiber of \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$50\,\upmu \hbox {m}$$\end{document}50μm. No reference image is needed for this technique. The present study reveals that the diffuse reflectance data in combination with the SP-DRI normalization are suitable to localize human capillaries within turbid media.

Nanoscale investigation of human skin and study of skin penetration of Janus nanoparticles

Janus nanoparticles (JNP) are innovative nanocarriers with an interesting pharmaceutical and cosmetic potential. They are characterized by the presence of a lipid compartment associated with an aqueous compartment delimited by a phospholipid bilayer containing phospholipids and non-ionic surfactants. The hydrodynamic diameter of JNP varies between 150 and 300 nm. The purpose of this study was to answer the following questions: after cutaneous application, are JNP penetrating? If so, how deep? And in which state, intact or degraded? It was essential to understand these phenomena in order to control the rate and kinetics of diffusion of active ingredients, which can be encapsulated in this vehicle for pharmaceutical or cosmetic purposes. An innovative technique called AFM-IR, was used to elucidate the behavior of JNP after cutaneous application. This instrument, coupling atomic force microscopy and IR spectroscopy, allowing to perform chemical analysis at the nanometer scale thanks to local absorption measurements. The identification of organic molecules at the nanoscale is possible without any labelling. Before cutaneous application of JNP, the nano-structure of untreated human skin was investigated with AFM-IR. Then, in vitro human skin penetration of JNP was studied using Franz cells, and AFM-IR allowed us to perform ultra-local information investigations.

Screening of Gunshot Residue in Skin Using Attenuated Total Reflection Fourier Transform Infrared (ATR FT-IR) Hyperspectral Microscopy

The detection of gunshot residues (GSR) in skin is important in criminal forensic investigations related with firearms. Conventionally, the procedure is based on the detection of metallic or inorganic residues (IGSR). In this work, we propose attenuated total reflectance Fourier transform infrared (ATR FT-IR) hyperspectral microscopy as a complementary and nondestructive technique for detection of organic GSR (OGSR). The spectra were acquired from GSR of three ammunition manufacturers, which were collected from shooter's hands by the tape-lifting method. Before spectroscopic analysis, a Na-Ca bleach solution was added to all GSR samples on the tape for destroying skin debris. Positive detection of OGSR spectra were achieved by ATR FT-IR hyperspectral microscopy. Spectra show characteristic patterns of nitrate ester compounds which agrees with the propellant chemical composition. Characteristic ATR FT-IR spectral patterns of OGSR were measured from visualized GSR particles demonstrating the potential of ATR FT-IR hyperspectral microscopy.

Non-invasive imaging in dermatology and the unique potential of raster-scan optoacoustic mesoscopy

In recent years, several non‐invasive imaging methods have been introduced to facilitate diagnostics and therapy monitoring in dermatology. The microscopic imaging methods are restricted in their penetration depth, while the mesoscopic methods probe deeper but provide only morphological, not functional, information. ‘Raster‐scan optoacoustic mesoscopy’ (RSOM), an emerging new imaging technique, combines deep penetration with contrast based on light absorption, which provides morphological, molecular and functional information. Here, we compare the capabilities and limitations of currently available dermatological imaging methods and highlight the principles and unique abilities of RSOM. We illustrate the clinical potential of RSOM, in particular for non‐invasive diagnosis and monitoring of inflammatory and oncological skin diseases.

Objective Assessment of Skin Repigmentation Using a Multilayer Perceptron

Background:

Vitiligo is a pathology that causes the appearance of achromic macules on the skin that can spread on to other areas of the body. It is estimated that it affects 1.2% of the world population and can disrupt the mental state of people in whom this disease has developed, generating negative feelings that can become suicidal in the worst of cases. The present work focuses on the development of a support tool that allows to objectively quantifying the repigmentation of the skin.

Methods:

We propose a novel method based on artificial neural networks that use characteristics of the interaction of light with the skin to determine areas of healthy skin and skin with vitiligo. We used photographs of specific areas of skin containing vitiligo. We select as independent variables: the type of skin, the amount of skin with vitiligo and the amount of repigmented skin. Considering these variables, the experiments were organized in an orthogonal table. We analyzed the result of the method based on three parameters (sensitivity, specificity, and F1-Score) and finally, its results were compared with other methods proposed in similar research.

Results:

The proposed method demonstrated the best performance of the three methods, and it also showed its capability to detect healthy skin and skin with vitiligo in areas up to 1 × 1 pixels.

Conclusion:

The results show that the proposed method has the potential to be used in clinical applications. It should be noted that the performance could be significantly improved by increasing the training patterns.

Line-field confocal optical coherence tomography for high-resolution noninvasive imaging of skin tumors

An optical technique called line-field confocal optical coherence tomography (LC-OCT) is introduced for high-resolution, noninvasive imaging of human skin in vivo. LC-OCT combines the principles of time-domain optical coherence tomography and confocal microscopy with line illumination and detection using a broadband laser and a line-scan camera. LC-OCT measures the echo-time delay and amplitude of light backscattered from cutaneous microstructures through low-coherence interferometry associated with confocal spatial filtering. Multiple A-scans are acquired simultaneously while dynamically adjusting the focus. The resulting cross-sectional B-scan image is produced in real time at 10  frame  /  s. With an isotropic spatial resolution of ∼1  μm, the LC-OCT images reveal a comprehensive structural mapping of skin at the cellular level down to a depth of ∼500  μm. LC-OCT has been applied to the imaging of various skin lesions, in vivo, including carcinomas and melanomas. LC-OCT images are found to strongly correlate with conventional histopathological images. The use of LC-OCT as an adjunct tool in medical practice could significantly improve clinical diagnostic accuracy while reducing the number of biopsies of benign lesions.

Optical coherence tomography for the diagnosis of malignant skin tumors: a meta-analysis

Optical coherence tomography (OCT) is an emergent imaging tool used for noninvasive diagnosis of skin diseases. The present meta-analysis was carried out to assess the accuracy of OCT for the diagnosis of skin cancer. We conducted a systematic literature search though EMBASE, Medline, PubMed, the Cochrane Library, and Web of Science database for relevant articles published up to June 6, 2017. The quality of the included studies was assessed using the QUADAS-2 tool and the Oxford Levels of Evidence Scale. Statistical analyses were conducted using the software Meta-Disc version 1.4 and STATA version 12.0. A total of 14 studies involving more than 813 patients with a total of 1958 lesions were included in our analyses. The pooled sensitivity and specificity of OCT for skin cancer diagnoses were 91.8% and 86.7%, respectively. Subgroup analysis showed that the pooled sensitivities of OCT for detecting basal cell carcinoma (BCC), squamous cell carcinoma (SCC), actinic keratosis, and malignant melanoma were 92.4%, 92.3%, 73.8%, and 81.0%, respectively. The pooled specificities were 86.9%, 99.5%, 91.5%, and 93.8%, respectively. OCT appears to be useful for the detection of BCC and SCC. It is a valuable diagnostic method when screening for early skin cancers.

Melanin quantification by in vitro and in vivo analysis of near-infrared fluorescence

Objective measurements of melanin can provide important information for differentiating melanoma from benign pigmented lesions and in assessing pigmentary diseases. Herein, we evaluate near-infrared (NIR) fluorescence as a possible tool to quantify melanin. Various concentrations of in vitro Sepia melanin in tissue phantoms were measured with NIR fluorescence and diffuse reflectance spectroscopy. Similar optic measurements were conducted in vivo on 161 normal human skin sites. Diffuse reflectance spectroscopy was used to quantify the melanin content via Stamatas-Kollias algorithm. At physiologic concentrations, increasing in vitro melanin concentrations demonstrated higher fluorescence that was linearly correlated (R²  = 0.99, p < .001). At higher concentrations, the fluorescence signal plateaued. A linear relationship was also observed with melanin content in human skin (R²  = 0.59, p < .001). Comparing the fluorescence and reflectance signals with in vitro and in vivo samples, the estimated melanin concentration in human skin ranged between 0 and 1.25 mg/ml, consistent with previous quantitative studies involving invasive methods.

Rosacea Subtypes Visually and Optically Distinct When Viewed with Parallel-Polarized Imaging Technique

Background

Parallel-polarized light (PPL) photography evaluates skin characteristics by analyzing light reflections from the skin surface.

Objective

The aim of this study was to determine the significance of quantitative analysis of PPL images in rosacea patients, and to provide a new objective evaluation method for use in clinical research and practice.

Methods

A total of 49 rosacea patients were enrolled. PPL images using green and white light emitting diodes (LEDs) were taken of the lesion and an adjacent normal area. The values from the PPL images were converted to CIELAB coordinates: L^* corresponding to the brightness, a^* to the red and green intensities, and b^* to the yellow and blue intensities.

Results

A standard grading system showed negative correlations with L^* (r=−0.67862, p=0.0108) and b^* (r=−0.67862, p=0.0108), and a positive correlation with a^* (r=0.64194, p=0.0180) with the green LEDs for papulopustular rosacea (PPR) types. The xerosis severity scale showed a positive correlation with L^* (r=0.36709, p=0.0276) and a negative correlation with b^* (r=−0.33068, p=0.0489) with the white LEDs for erythematotelangiectatic rosacea (ETR) types. In the ETR types, there was brighter lesional and normal skin with white LEDs and a higher score on the xerosis severity scale than the PPR types.

Conclusion

This technique using PPL images is applicable to the quantitative and objective assessment of rosacea in clinical settings. In addition, the two main subtypes of ETR and PPR are distinct entities visually and optically.

Measuring acne using Coproporphyrin III, Protoporphyrin IX, and lesion-specific inflammation: an exploratory study

Propionibacterium acnes: (P. acnes) produce Porphyrins; however, fluorescence measurement of Porphyrins from Ultraviolet-A (UVA) images has failed to establish a correlation. Acne clinical research and imaging has ignored the spectral excitation-emission characteristics and the exact pattern of the Porphyrins synthesized by P. acnes. In this exploratory study, for the first time, the possible relationships of Coproporphyrin III (CpIII) and Protoporphyrin IX (PpIX) fluorescence as well as acne lesion-specific inflammation measurements with clinical signs of acne are investigated. Furthermore, the sensitivity of these measurements in tracking and differentiating the known treatment effects of Benzoyl Peroxide (BPO) 5%, and combination of Clindamycin + BPO are also evaluated. Comedonal and papulopustular lesions identified by investigators during a live assessment of 24 mild-to-severe acne subjects were compared with fluorescence and inflammation measurements obtained from analysis of VISIA^®-CR images. CpIII fluorescence spots showed a strong correlation (r = 0.69-0.83), while PpIX fluorescence spots showed a weak correlation (r = 0.19-0.27) with the investigators' comedonal lesion counts. A strong correlation was also observed between the investigators' papulopustular lesion counts and acne lesion-specific inflammation (r = 0.76). Our results suggest that CpIII fluorescence and acne lesion-specific-inflammation measurement can provide objective indication of comedonal and papulopustular acne severity, respectively. Furthermore, these measurements may be more sensitive and specific in evaluating treatment effects and early signs of acne lesion progression compared to investigators' lesion counts.

Three-dimensional multispectral optoacoustic mesoscopy reveals melanin and blood oxygenation in human skin in vivo

Optical imaging plays a major role in disease detection in dermatology. However, current optical methods are limited by lack of three-dimensional detection of pathophysiological parameters within skin. It was recently shown that single-wavelength optoacoustic (photoacoustic) mesoscopy resolves skin morphology, i.e. melanin and blood vessels within epidermis and dermis. In this work we employed illumination at multiple wavelengths for enabling three-dimensional multispectral optoacoustic mesoscopy (MSOM) of natural chromophores in human skin in vivo operating at 15-125 MHz. We employ a per-pulse tunable laser to inherently co-register spectral datasets, and reveal previously undisclosed insights of melanin, and blood oxygenation in human skin. We further reveal broadband absorption spectra of specific skin compartments. We discuss the potential of MSOM for label-free visualization of physiological biomarkers in skin in vivo.

Quantitative assessment of skin, hair, and iris variation in a diverse sample of individuals and associated genetic variation

OBJECTIVES

The main goals of this study are to 1) quantitatively measure skin, hair, and iris pigmentation in a diverse sample of individuals, 2) describe variation within and between these samples, and 3) demonstrate how quantitative measures can facilitate genotype-phenotype association tests.

MATERIALS AND METHODS

We quantitatively characterize skin, hair, and iris pigmentation using the Melanin (M) Index (skin) and CIELab values (hair) in 1,450 individuals who self-identify as African American, East Asian, European, Hispanic, or South Asian. We also quantify iris pigmentation in a subset of these individuals using CIELab values from high-resolution iris photographs. We compare mean skin M index and hair and iris CIELab values among populations using ANOVA and MANOVA respectively and test for genotype-phenotype associations in the European sample.

RESULTS

All five populations are significantly different for skin (P <2 × 10(-16) ) and hair color (P <2 × 10(-16) ). Our quantitative analysis of iris and hair pigmentation reinforces the continuous, rather than discrete, nature of these traits. We confirm the association of three loci (rs16891982, rs12203592, and rs12913832) with skin pigmentation and four loci (rs12913832, rs12203592, rs12896399, and rs16891982) with hair pigmentation. Interestingly, the derived rs12203592 T allele located within the IRF4 gene is associated with lighter skin but darker hair color.

DISCUSSION

The quantitative methods used here provide a fine-scale assessment of pigmentation phenotype and facilitate genotype-phenotype associations, even with relatively small sample sizes. This represents an important expansion of current investigations into pigmentation phenotype and associated genetic variation by including non-European and admixed populations. Am J Phys Anthropol 160:570-581, 2016. © 2015 Wiley Periodicals, Inc.

Multimodal and time-lapse skin registration

BACKGROUND/PURPOSE

Computational skin analysis is revolutionizing modern dermatology. Patterns extracted from image sequences enable algorithmic evaluation. Stacking multiple images to analyze pattern variation implicitly assumes that the images are aligned per-pixel. However, breathing and involuntary motion of the patient causes significant misalignment. Alignment algorithms designed for multimodal and time-lapse skin images can solve this problem. Sequences from multi-modal imaging capture unique appearance features in each modality. Time-lapse image sequences capture skin appearance change over time.

METHODS

Multimodal skin images have been acquired under five different modalities: three in reflectance (visible, parallel-polarized, and cross-polarized) and two in fluorescence mode (UVA and blue light excitation). For time-lapse imagery, 39 images of acne lesions over a 3-month period have been collected. The method detects micro-level features like pores, wrinkles, and other skin texture markings in the acquired images. Images are automatically registered to subpixel accuracy.

RESULTS

The proposed registration approach precisely aligns multimodal and time-lapse images. Subsurface recovery from multimodal images has misregistration artefacts that can be eliminated using this approach. Registered time-lapse imaging captures the evolution of appearance of skin regions with time.

CONCLUSION

Misalignment in skin imaging has significant impact on any quantitative or qualitative image evaluation. Micro-level features can be used to obtain highly accurate registration. Multimodal images can be organized with maximal overlap for successful registration. The resulting point-to-point alignment improves the quality of skin image analysis.

Polarization-sensitive hyperspectral imaging in vivo: a multimode dermoscope for skin analysis

Attempts to understand the changes in the structure and physiology of human skin abnormalities by non-invasive optical imaging are aided by spectroscopic methods that quantify, at the molecular level, variations in tissue oxygenation and melanin distribution. However, current commercial and research systems to map hemoglobin and melanin do not correlate well with pathology for pigmented lesions or darker skin. We developed a multimode dermoscope that combines polarization and hyperspectral imaging with an efficient analytical model to map the distribution of specific skin bio-molecules. This corrects for the melanin-hemoglobin misestimation common to other systems, without resorting to complex and computationally intensive tissue optical models. For this system's proof of concept, human skin measurements on melanocytic nevus, vitiligo, and venous occlusion conditions were performed in volunteers. The resulting molecular distribution maps matched physiological and anatomical expectations, confirming a technologic approach that can be applied to next generation dermoscopes and having biological plausibility that is likely to appeal to dermatologists.

In vivo measurement of mid-infrared light scattering from human skin

Two mid-infrared light sources, a broadband source from a Fourier Transform Infrared Spectrometer (FTIR) and a pulsed Quantum Cascade (QC) Laser, are used to measure angle-resolved backscattering in vivo from human skin across a broad spectral range. Scattering profiles measured using the FTIR suggest limited penetration of the light into the skin, with most of the light interacting with the stratum corneum layer of the epidermis. Scattering profiles from the QC laser show modulation patterns with angle suggesting interaction with scattering centers in the skin. The scattering is attributed to interaction of the laser light with components such as collagen fibers and capillaries in the dermis layer of the skin.

Investigation of basal cell carcinoma using dynamic focus optical coherence tomography

Optical coherence tomography (OCT) is becoming a popular modality for skin tumor diagnosis and assessment of tumor size and margin status. We conducted a number of imaging experiments on periocular basal cell carcinoma (BCC) specimens using an OCT configuration. This configuration employs a dynamic focus (DF) procedure where the coherence gate moves synchronously with the peak of the confocal gate, which ensures better signal strength and preservation of transversal resolution from all depths. A DF-OCT configuration is used to illustrate morphological differences between the BCC and its surrounding healthy skin in OCT images. The OCT images are correlated with the corresponding histology images. To the best of our knowledge, this is the first paper to look at DF-OCT imaging in examining periocular BCC.

Molecular conformation changes along the malignancy revealed by optical nanosensors

An interdisciplinary approach employing functionalized nanoparticles and ultrasensitive spectroscopic techniques is reported here to track the molecular changes in early stage of malignancy. Melanoma tissue tracking at molecular level using both labelled and unlabelled silver and gold nanoparticles has been achieved using surface enhanced Raman scattering (SERS) technique. We used skin tissue from ex vivo mice with induced melanoma. Raman and SERS molecular characterization of melanoma tissue is proposed here for the first time. Optical nanosensors based on Ag and Au nanoparticles with chemisorbed cresyl violet molecular species as labels revealed sensitive capability to tissues tagging and local molecular characterization. Sensitive information originating from surrounding native biological molecules is provided by the tissue SERS spectra obtained either with visible or NIR laser line. Labelled nanoparticles introduced systematic differences in tissue response compared with unlabelled ones, suggesting that the label functional groups tag specific tissue components revealed by proteins or nucleic acids bands. Vibrational data collected from tissue are presented in conjunction with the immunohistochemical analysis. The results obtained here open perspectives in applied plasmonic nanoparticles and SERS for the early cancer diagnostic based on the appropriate spectral databank.

Fluorescence spectroscopy as a tool to detect and evaluate glucocorticoid-induced skin atrophy

Topical glucocorticoid (GC) therapy has been successfully used in the treatment of several common cutaneous diseases in clinical practice for a long time, and skin atrophy is one of the most typical cutaneous side effects of this therapy. The aim of this study was to evaluate the potential of noninvasive fluorescence spectroscopy (FS) technique in the detection and classification of GC-induced skin atrophy. A total of 20 male Wistar rats were used in the experimental protocol under controlled environmental conditions and with free access to food. One group received topical application of clobetasol propionate 0.05% for 14 days to induce cutaneous atrophy (atrophic group) and the other (control) group received only vehicle application following the same protocol and schedule. Histological analyses and FS measurements with laser excitation at both 532 nm and 408 nm were obtained on days 1 and 15. The FS results were classified as "normal" or "atrophic" according by histological analysis. Fluorescence spectra obtained with excitation at 408 nm allowed a clear distinction between the control and atrophic groups, and were more informative than the those obtained at 532 nm. Our results reveal that, if correctly applied, FS allows noninvasive evaluation of corticosteroid-induced skin atrophy, and thus represents an important step towards better monitoring of undesirable side effects of cutaneous therapy.

Effects of motion on optical properties in the spatial frequency domain

Spatial frequency domain imaging (SFDI) is a noncontact and wide-field optical imaging technology currently being used to study the optical properties and chromophore concentrations of in vivo skin including skin lesions of various types. Part of the challenge of developing a clinically deployable SFDI system is related to the development of effective motion compensation strategies, which in turn, is critical for recording high fidelity optical properties. Here we present a two-part strategy for SFDI motion correction. After verifying the effectiveness of the motion correction algorithm on tissue-simulating phantoms, a set of skin-imaging data was collected in order to test the performance of the correction technique under real clinical conditions. Optical properties were obtained with and without the use of the motion correction technique. The results indicate that the algorithm presented here can be used to render optical properties in moving skin surfaces with fidelities within 1.5% of an ideal stationary case and with up to 92.63% less variance. Systematic characterization of the impact of motion variables on clinical SFDI measurements reveals that until SFDI instrumentation is developed to the point of instantaneous imaging, motion compensation is necessary for the accurate localization and quantification of heterogeneities in a clinical setting.

State of the art of diagnostic technology for early-stage melanoma

In the past few decades, rapid improvements in noninvasive optical technologies have revolutionized the diagnosis of early-stage melanoma. Current knowledge and limitations of these tools will be reviewed in this article. Dermoscopy has been recognized as the 'gold standard' in the screening phase. Digital dermoscopy monitoring and total-body photography are used to identify so-called 'featureless' melanoma only on the criteria of change over time. Automated instruments, as well as optical and nonmorphological methods, are still under development, and offer many opportunities to improve the speed and accuracy of the diagnosis of melanoma and/or to reduce the need for expertise. Despite a penetration depth limited to the upper dermis, the quasi-histological imaging achieved by in vivo reflectance confocal microscopy has been demonstrated to significantly aid diagnostic accuracy for selected melanocytic lesions. Future perspectives on diagnostic instrumentation will also be explored.

Using optical coherence tomography for the longitudinal non-invasive evaluation of epidermal thickness in a murine model of chronic skin inflammation

BACKGROUND

Non-invasive methods are desirable for longitudinal studies examining drug efficacy and disease resolution defined as decreases in epidermal thickness in mouse models of psoriasiform skin disease. This would eliminate the need for either sacrificing animals or collecting serial skin biopsies to evaluate changes in disease progression during an individual study. The quantitation of epidermal thickness using optical coherence tomography (OCT) provides an alternative to traditional histology techniques.

METHODS

Using the KC-Tie2 doxycycline-repressible psoriasiform skin disease mouse model, OCT imaging was completed on diseased back skin of adult KC-Tie2 (n = 3-4) and control (n = 3-4) mice, followed immediately by the surgical excision of the same region for histologic analyses. Animals were then treated with doxycycline to suppress transgene expression and to reverse the skin disease and additional OCT images and tissues were collected 2 and 4 weeks following. Epidermal thickness was measured using OCT and histology.

RESULTS

Optical coherence tomography and histology both demonstrated that KC-Tie2 mice had significantly thicker epidermis (~4-fold; P < 0.0001) than control animals. By 2 weeks following gene repression, decreases in epidermal thickness were observed using both OCT and histology, and were sustained through 4 weeks. Correlation analyses between histology and OCT values at all time points and in all animals revealed high significance (R(2) = 0.78); with correlation being highest in KC-Tie2 mice (R(2) = 0.92) compared to control animals (R(2) = 0.16).

CONCLUSION

Non-invasive OCT imaging provided similar values as those collected using standard histologic measures in thick skin of KC-Tie2 mice but became less reliable in thinner control mouse skin, possibly reflecting limitations in resolution of OCT. Future advances in resolution of OCT may improve and allow greater accuracy of epidermal thickness measurements.

Documentation of impaired epidermal barrier in mild and moderate diaper dermatitis in vivo using noninvasive methods

The presence of irritants from feces and urine with the concurrent mechanical friction and occlusion creates an environment in the diapered area that renders the skin prone to diaper dermatitis. Besides being a source of discomfort to the infant, these skin irritations pose a risk of secondary infections. In this study, we used noninvasive in vivo techniques to define measurable parameters that correlate with diaper dermatitis pathophysiology. In 35 infants (16 with mild or moderate and 19 without diaper dermatitis) we compared skin of diapered areas afflicted with diaper dermatitis to lesion-free diapered sites and to skin outside the diapered area (thigh). Our findings show significantly elevated cutaneous erythema, pH, and hydration, with significantly compromised water barrier function in involved areas compared to nonlesional sites both within and outside the diapered area. Furthermore, skin pH in nonlesional diapered skin for the diaper dermatitis cohort was significantly higher compared to the nondiapered sites. These observations are consistent with the current understanding of pathological skin changes in diaper dermatitis. In this study, we demonstrate that noninvasive methods can document relevant parameters to diaper dermatitis in vivo.