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Hillmer D, Merhi R, Boniface K, Taieb A, Barnetche T, Seneschal J, Hagedorn M. Evaluation of Facial Vitiligo Severity with a Mixed Clinical and Artificial Intelligence Approach. J Invest Dermatol 2024; 144:351-357.e4. [PMID: 37586608 DOI: 10.1016/j.jid.2023.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/18/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
Vitiligo is the most common depigmenting skin disorder. Given the ongoing development of new targeted therapies, it has become important to evaluate adequately the surface area involved. Assessment of vitiligo scores can be time consuming, with variations between investigators. Therefore, the aim of this study was to build an artificial intelligence system capable of assessing facial vitiligo severity. One hundred pictures of faces of patients with vitiligo were used to train and validate the artificial intelligence model. Sixty-nine additional pictures of facial vitiligo were then used as a final dataset. Three expert physicians scored the facial vitiligo on the same 69 pictures. Inter and intrarater performances were evaluated by comparing the scores between raters and artificial intelligence. Algorithm assessment achieved an accuracy of 93%. Overall, the scores reached a good agreement between vitiligo raters and the artificial intelligence model. Results demonstrate the potential of the model. It provides an objective evaluation of facial vitiligo and could become a complementary/alternative tool to human assessment in clinical practice and/or clinical research.
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Affiliation(s)
- Dirk Hillmer
- BRIC (BoRdeaux Institute of onCology), INSERM UMR1312, Team 5, University of Bordeaux, Bordeaux, France
| | - Ribal Merhi
- CNRS, UMR 5164, Immuno ConcEpT, University of Bordeaux, Bordeaux, France
| | - Katia Boniface
- CNRS, UMR 5164, Immuno ConcEpT, University of Bordeaux, Bordeaux, France
| | - Alain Taieb
- BRIC (BoRdeaux Institute of onCology), INSERM UMR1312, Team 5, University of Bordeaux, Bordeaux, France
| | - Thomas Barnetche
- Department of Rheumatology, National Reference Center for Rare Systemic Autoimmune Diseases, FHU ACRONIM, Pellegrin Hospital, CHU de Bordeaux, Bordeaux, France
| | - Julien Seneschal
- CNRS, UMR 5164, Immuno ConcEpT, University of Bordeaux, Bordeaux, France; Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, UMR 5164, Saint-André Hospital, University Hospital of Bordeaux, Bordeaux, France.
| | - Martin Hagedorn
- BRIC (BoRdeaux Institute of onCology), INSERM UMR1312, Team 5, University of Bordeaux, Bordeaux, France
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Hou Y, Wei Z, Jiang Q, Chen H, Chen L, Wu J. In-depth study of Wood's lamp examination combined with reflective confocal laser scanning microscopy for the guidance of vitiligo staging and treatment. J Cosmet Dermatol 2023. [PMID: 38158739 DOI: 10.1111/jocd.16145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/15/2023] [Accepted: 12/10/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Both Wood's lamp and reflective confidential laser scanning microcopy are helpful for the diagnosis and treatment of vitiligo. However, there is few research that contains large samples and consistent observations. AIMS To analyze the characteristics of Wood's lamp images and reflectance confocal microscopy (RCM) images of vitiligo lesions and to evaluate their significance in vitiligo staging. METHODS We analyzed the characteristics of RCM images, Wood's lamp images, the vitiligo disease activity (VIDA) score, and clinical features to guide vitiligo staging and treatment. RESULTS The expert consensus based on the clinical features, VIDA score, Wood's lamp findings, and isomorphic response was consistent with the Wood's lamp findings (χ2 = 3.63, p > 0.05) and RCM findings (χ2 = 3.60, p > 0.05) in diagnosing vitiligo and assessing the disease stage. There was a correlation between the three lesion grades based on the Wood's lamp findings and the stage of vitiligo (p < 0.01). Lesions that appeared porcelain white under the Wood's lamp were in the slowly progressive stage; lesions that appeared gray-white or trichromatic under the Wood's lamp were in the rapidly progressive stage; lesions with clear borders under the Wood's lamp needed further analysis by RCM for the stage to be determined; lesions with blurred borders under the Wood's lamp were in the rapidly progressive stage; lesions that were visible under the naked eye and under the Wood's lamp were in the rapidly progressive stage. CONCLUSION The study demonstrates a reliable correlation between the findings of RCM (a sophisticated expensive tool) and Wood's lamp examination (a simple, readily available, inexpensive tool) in the assessment of the disease activity of vitiligo lesions.
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Affiliation(s)
- Yongqing Hou
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
- Hubei University of Chinese Medicine, Wuhan, China
| | - Zijia Wei
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
- Hubei University of Chinese Medicine, Wuhan, China
| | - Qian Jiang
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
- Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, China
| | - Hongying Chen
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
- Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, China
| | - Liuqing Chen
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
- Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, China
| | - Jiyuan Wu
- Department of Dermatology, Wuhan No. 1 Hospital, Wuhan, China
- Hubei Province & Key Laboratory of Skin Infection and Immunity, Wuhan, China
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Marin Dit Bertoud Q, Bertold C, Ezzedine K, Pandya AG, Cherel M, Castillo Martinez A, Seguy MA, Abdallah M, Bae JM, Böhm M, Parsad D, Rosmarin D, Wolkerstorfer A, Bahadoran P, Blaise M, Dugourd PM, Philippo V, Delaval JM, Passeron T. Reliability and agreement testing of a new automated measurement method to determine facial vitiligo extent using standardized ultraviolet images and a dedicated algorithm. Br J Dermatol 2023; 190:62-69. [PMID: 37615581 DOI: 10.1093/bjd/ljad304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/08/2023] [Accepted: 08/17/2023] [Indexed: 08/25/2023]
Abstract
BACKGROUND Facial repigmentation is the primary outcome measure for most vitiligo trials. The Facial Vitiligo Area Scoring Index (F-VASI) score is often chosen as the primary outcome measure to assess the efficacy of treatments for facial vitiligo. Although useful, this scoring system remains subjective and has several limitations. OBJECTIVES To assess the agreement and reliability of an algorithmic method to measure the percentage depigmentation of vitiligo on the face. METHODS We developed a dedicated algorithm called Vitil-IA® to assess depigmentation on standardized facial ultraviolet (UV) pictures. We then conducted a cross-sectional study using the framework of the ERASE trial (NCT04843059) in 22 consecutive patients attending a tertiary care centre for vitiligo. Depigmentation was analysed before any treatment and, for 7 of them, after 3 and 6 months of narrowband UVB treatment combined with 16 mg methylprednisolone, both used twice weekly. Interoperator and interacquisition repeatability measures were assessed for the algorithm. The results of the algorithmic measurement were then compared with the F-VASI and the percentage of depigmented skin scores assessed by 13 raters, including 7 experts in the grading of vitiligo lesions. RESULTS Thirty-one sets of pictures were analysed with the algorithmic method. Internal validation showed excellent reproducibility, with a variation of < 3%. The percentage of depigmentation assessed by the system showed high agreement with the percentage of depigmentation assessed by raters [mean error (ME) -11.94 and mean absolute error (MAE) 12.71 for the nonexpert group; ME 0.43 and MAE 5.57 for the expert group]. The intraclass correlation coefficient (ICC) for F-VASI was 0.45 [95% confidence interval (CI) 0.29-0.62] and 0.52 (95% CI 0.37-0.68) for nonexperts and experts, respectively. When the results were analysed separately for homogeneous and heterogeneous depigmentation, the ICC for homogeneous depigmentation was 0.47 (95% CI 0.31-0.77) and 0.85 (95% CI 0.72-0.94) for nonexperts and experts, respectively. When grading heterogeneous depigmentation, the ICC was 0.19 (95% CI 0.05-0.43) and 0.38 (95% CI 0.20-0.62) for nonexperts and experts, respectively. CONCLUSIONS We demonstrated that the Vitil-IA algorithm provides a reliable assessment of facial involvement in vitiligo. The study underlines the limitations of the F-VASI score when performed by nonexperts for homogeneous vitiligo depigmentation, and in all raters when depigmentation is heterogeneous.
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Affiliation(s)
| | - Clémence Bertold
- Université Côte d'Azur, CHU Nice, Department of Dermatology, Nice, France
| | - Khaled Ezzedine
- Department of Dermatology, AP-HP, Henri Mondor University Hospital, Créteil, France
- Université Paris Est (UPEC), EpiDermE Research Unit, Paris, France
| | - Amit G Pandya
- Palo Alto Foundation Medical Group, Sunnyvale, CA, USA
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marie Cherel
- Newtone Technologies, Research and Development, Lyon, France
| | | | | | - Marwa Abdallah
- Department of Dermatology, Andrology and Venereology, Ain Shams University, Cairo, Egypt
| | - Jung Min Bae
- Department of Dermatology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Markus Böhm
- Department of Dermatology, University of Münster, Münster, Germany
| | - Davinder Parsad
- Department of Dermatology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - David Rosmarin
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Albert Wolkerstorfer
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Philippe Bahadoran
- Université Côte d'Azur, CHU Nice, Department of Dermatology, Nice, France
| | - Manon Blaise
- Université Côte d'Azur, CHU Nice, Department of Dermatology, Nice, France
| | | | - Valérie Philippo
- Université Côte d'Azur, CHU Nice, Department of Dermatology, Nice, France
| | | | - Thierry Passeron
- Université Côte d'Azur, CHU Nice, Department of Dermatology, Nice, France
- Université Côte d'Azur, INSERM, U1065, C3M, Nice, France
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