Digital image analysis of facial erythema over time in persons with varied skin pigmentation

No effect of Turkish bath (Hammam) on sunburn after exposure to natural ultraviolet radiation: A randomized controlled blinded trial

BACKGROUND

Scrubbing of the skin during Hammam, a Turkish spa treatment, removes cells from the ultraviolet radiation absorbing stratum corneum.

AIM

The aim of this study was to assess if skin is more susceptible to sunburn after a Hammam treatment.

METHODS

In this randomized controlled trial with a paired design, healthy adult participants with skin types 1-3 were randomized to receive Hammam treatment on one side of the back while the other side was used as control. Participants had 30 minutes of sun exposure on their backs. Erythema and pain were assessed before and 1, 4, 8, and 24 hours after sun exposure. Erythema was assessed by a visual scale and by using chromatography on high-resolution photos. Pain was assessed with the Visual Analogue Scale (VAS). The primary outcome was the difference in chromatography-assessed erythema from baseline to the 24-hour assessment, compared between the Hammam- and the control side. Secondary outcomes were differences in pain and visually assessed erythema.

RESULTS

Twelve participants were included with complete follow-up. Eight participants had type-3 skin and four had type-2 skin. There was no difference between the Hammam and the control side for any of the outcomes. Even though erythema assessed by chromatography was slightly higher for the Hammam side, the difference was insignificant.

CONCLUSION

Hammam treatment did not increase sunburn, measured by UV-induced skin erythema and pain, compared with untreated skin following 30 minutes of sun exposure.

Digital imaging analysis to assess scar phenotype

In order to understand the link between the genetic background of patients and wound clinical outcomes, it is critical to have a reliable method to assess the phenotypic characteristics of healed wounds. In this study, we present a novel imaging method that provides reproducible, sensitive, and unbiased assessments of postsurgical scarring. We used this approach to investigate the possibility that genetic variants in orofacial clefting genes are associated with suboptimal healing. Red-green-blue digital images of postsurgical scars of 68 patients, following unilateral cleft lip repair, were captured using the 3dMD imaging system. Morphometric and colorimetric data of repaired regions of the philtrum and upper lip were acquired using ImageJ software, and the unaffected contralateral regions were used as patient-specific controls. Repeatability of the method was high with intraclass correlation coefficient score > 0.8. This method detected a very significant difference in all three colors, and for all patients, between the scarred and the contralateral unaffected philtrum (p ranging from 1.20(-05) to 1.95(-14) ). Physicians' clinical outcome ratings from the same images showed high interobserver variability (overall Pearson coefficient = 0.49) as well as low correlation with digital image analysis results. Finally, we identified genetic variants in TGFB3 and ARHGAP29 associated with suboptimal healing outcome.

Intra- and inter-rater reliability of digital image analysis for skin color measurement

BACKGROUND

We determined the intra- and inter-rater reliability of data from digital image color analysis between an expert and novice analyst.

METHODS

Following training, the expert and novice independently analyzed 210 randomly ordered images. Both analysts used Adobe(®) Photoshop lasso or color sampler tools based on the type of image file. After color correction with Pictocolor(®) in camera software, they recorded L*a*b* (L*=light/dark; a*=red/green; b*=yellow/blue) color values for all skin sites. We computed intra-rater and inter-rater agreement within anatomical region, color value (L*, a*, b*), and technique (lasso, color sampler) using a series of one-way intra-class correlation coefficients (ICCs).

RESULTS

Results of ICCs for intra-rater agreement showed high levels of internal consistency reliability within each rater for the lasso technique (ICC ≥ 0.99) and somewhat lower, yet acceptable, level of agreement for the color sampler technique (ICC = 0.91 for expert, ICC = 0.81 for novice). Skin L*, skin b*, and labia L* values reached the highest level of agreement (ICC ≥ 0.92) and skin a*, labia b*, and vaginal wall b* were the lowest (ICC ≥ 0.64).

CONCLUSION

Data from novice analysts can achieve high levels of agreement with data from expert analysts with training and the use of a detailed, standard protocol.

Update on techniques for the quantitation of facial skin characteristics

The purpose of this article is to review the strategies and methods for quantifying treatment outcomes, perhaps defined by the consumer/patient as a "decrease in perceived age." The demand for the rejuvenation of facial skin is expected to increase as the population ages and seeks optimal outcomes from the array of available treatment modalities. This information will be of value to the plastic surgeon in collaborating with patients on evaluation and treatment strategies.