Validation of 3D skin imaging for objective repeatable quantification of severity of atrophic acne scarring

Acne scarring-pathophysiology, diagnosis, prevention and education: Part I

Acne scarring is common and can occur even with effective acne management. In addition, patients with acne scarring suffer from significant psychosocial morbidity, including depression and suicidality. Despite the availability and advancement of therapeutic modalities, treatment for acne scarring is not always optimized and often overlooked in patients with acne encounters. Using acne scarring assessment tools and identifying specific acne scar subtypes allows for a tailored therapeutic approach. Part I of this continuing medical education series covers the pathophysiology and morphology of textural and pigmented acne scars, scarring assessment tools, and medical treatment options. The principles reviewed will aid in approaching and initiating acne scar treatment in the outpatient setting.

Artificial intelligence in cosmetic dermatology: An update on current trends

The use of artificial intelligence (AI) will soon be commonplace within the field of cosmetic dermatology. Current uses for AI in the discipline have focused on empowering patients to be more involved in treatment decisions with customizable skin care, augmented-reality applications, and at-home skin analysis tools. AI-driven skin analysis tools are also included in many dermatology practices with the development of three-dimensional facial reconstruction, including models for predicting clinical outcomes. We highlight current and developing applications of AI in cosmetic dermatology and provide insight into future modalities in this field. Dermatologists need to be well-informed about emerging technologies to better educate patients and enhance their clinical practices.

Evaluation of the efficacy of maintenance therapy for acne vulgaris using adapalene 0.1%/benzoyl peroxide 2.5% gel and benzoyl peroxide 2.5% gel for 24 weeks and assessment of atrophic acne scars using three-dimensional image analysis

Maintenance therapy after remission of inflammation is strongly recommended in the guideline for the treatment of acne vulgaris published by the Japanese Dermatological Association. One advantage of continuing maintenance therapy is the alleviation of atrophic scarring. This study investigated the efficacy of maintenance therapy using adapalene 0.1%/benzoyl peroxide 2.5% gel and benzoyl peroxide 2.5% gel, and its effects on atrophic scarring. Overall, 126 patients were randomized to the adapalene/benzoyl peroxide group (n = 40), benzoyl peroxide group (n = 44), and control group (without maintenance treatment drugs; n = 42), and 111 of these completed a trial lasting 24 weeks. As the primary endpoint, the treatment success rate (the percentage of patients in whom the number of inflammatory lesions was maintained at ≤10) was 89.2% in the adapalene/benzoyl peroxide group, 87.5% in the benzoyl peroxide group, and 47.4% in the control group. Compared with the control group, the success rates were significantly higher in the adapalene/benzoyl peroxide and benzoyl peroxide groups (P = 0.0006 for both). As one of the secondary endpoints, the rate of change in the number of atrophic scars showed significant improvement from the baseline in the adapalene/benzoyl peroxide and benzoyl peroxide groups at week 24 (P = 0.0004 and P < 0.0001, respectively). Although the three-dimensional image analysis parameters did not change significantly from the baseline in the adapalene/benzoyl peroxide and benzoyl peroxide groups at week 24, significant worsening was noted in the control group (P = 0.0276 for affected area, P = 0.0445 for volume, and P = 0.0182 for maximum depth). Adverse drug reactions were noted in three patients in the adapalene/benzoyl peroxide group (7.5%) but not in the benzoyl peroxide group. These findings suggest that maintenance therapy using adapalene 0.1%/benzoyl peroxide 2.5% gel and benzoyl peroxide 2.5% gel is effective in preventing the worsening of scars in Japanese patients with acne vulgaris.

Photography and Image Acquisition in Dermatology a Scoping Review: Techniques for High-Quality Photography

BACKGROUND

Clinical photography is essential in dermatology, in particular in the areas of surgical and cosmetic dermatology and has been evolving rapidly. However, many dermatologists desire more training in clinical photography and a comprehensive literature review of photography in dermatology is lacking.

OBJECTIVE

This scoping review aimed to summarize the literature regarding techniques for high-quality photography in dermatology.

MATERIALS AND METHODS

A literature search was conducted using Embase, MEDLINE, PubMed, and Evidence-Based Medicine databases in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.

RESULTS

This review summarizes information from 74 studies. Camera type, resolution, lens choice, camera settings, environment and set-up, standardization, and types of clinical photography are all important factors in acquisition of high-quality photography.

CONCLUSION

Photography in dermatology is continuously evolving with broader applications. Improved practices and innovations will benefit the quality of images.

Assessing Adult Patients with Facial Deformities for Injectable Treatment: Do Current Classification Systems and Methodologies Meet Important Patient Needs?

BACKGROUND

Many individuals are affected by facial deformities. Injectable aesthetic treatments can often be used to improve appearance and/or dynamic function. However, to best meet the needs of these patients, broadly applicable methodologies are required for classifying the deformity, assessing severity, and developing a treatment strategy.

OBJECTIVE

To assess whether any published systems could be used for this purpose.

METHODS

Thirty-eight searches were conducted in PubMed (1999-2019; in English). Forty-two publications were identified describing novel classification systems for adult facial deformity. They were analyzed against a checklist of 10 characteristics defining an "optimal" system-based on appropriate anatomical coverage, wide usability across types of deformity, user-friendliness, applicable underlying methodology, and ability to guide treatment with injectables.

RESULTS

None of the systems met more than 7 of the 10 checklist criteria; none were usable across multiple types of deformity or provided a recommendation for treatment with injectables.

CONCLUSION

There remains a need for a broadly applicable system for classifying adult facial deformities ahead of injectable therapy. The checklist provides a developmental framework. With the increasing popularity and accessibility of injectables, this diverse and complex demographic is at risk of mismanagement without superior methods for devising treatment strategies.

A computational method for the investigation of burn scars topology based on 3D optical scan

Burn scar treatment is a difficult subject to address since the improper therapy can have a significant impact on people's quality of life. The evaluation of medical therapy over time should be based on objective measurement of the severity of burn scars and their progression. Unfortunately, most clinical assessments of scars are still reliant on physicians' subjective exams of patients. A profitable method to overcome the limitations of subjective assessment could be to leverage 3D scanning technologies. These could be used to retrieve the surface topology of burns. Accordingly, the goal of this study is to provide an objective approach for analysing the surface topology of burn scars using 3D scanning and roughness-based evaluation. In particular, two types of ISO-compliant profile and surface filters (Gaussian and Wavelet) derived from the analysis of roughness in the mechanical sector are implemented to discriminate form from roughness of scars. Once retrieved, the roughness surface is processed to derive a set of statistical parameters describing the scar surface topology. Three case studies were used to derive these parameters (a synthetic surface, an ostrich-skin surface and a set of scars). After the surface's roughness was determined, a comparison between healthy and unhealthy skin could be established. The devised methods prove their effectiveness in correctly retrieving the main surface characteristics of a burn scar. Therefore, by using the proposed method it will be possible to evaluate the effectiveness of medical therapy by comparing the healthy and scarred skin of a single subject.

A stereoscopic optical system for objective quantification of the change in cumulative acne scar depth following various treatment interventions

BACKGROUND

Current approaches for assessment of acne scars are subjective, including counting scar subtypes, subjective self-assessment, or scoring global acne scar severity.

AIMS

We aimed to validate accuracy and present initial data of a new, simple, non-contact, high-resolution 3D stereoscopic optical imaging system in the setting of acne scarring.

PATIENTS/METHODS

Ten patients treated for acne scars in the dermo-esthetic outpatient clinics in our institution from July to December 2019 were recruited from medical files and completed by telephone interview. Each patient was assessed by the 3D imaging system, the Qualitative Scarring Grading Score (QSGS), and the patient's questionnaire for Self-assessment of Clinical Acne-Related Scars (SCARS) before and 4 weeks after a single intervention.

RESULTS

Scar depth measured by the imaging system correlated significantly with the actual depth of printed surface depressions and the 3D optical imaging assessments. The changes in SCARS and 3D optical imaging assessments correlated significantly, but there were no correlations between changes in QSGS and 3D optical assessment measures, or between the QSGS and SCARS results.

CONCLUSION

The new stereoscopic optical system is a reliable and practical objective method for assessing the cumulative depth of atrophic acne scars and monitoring treatment response. It is more sensitive, accurate, and informative than subjective scales.

Skin Quality - A Holistic 360° View: Consensus Results

Introduction

Skin quality is an important component of human attractiveness. To date, there are no standardized criteria for good skin quality. To establish a consensus for good skin quality parameters and measurement and treatment options, a virtual skin quality advisory board consisting of a global panel of highly experienced aesthetic dermatologists/aesthetic physicians was convened.

Methods

A total of 10 dermatologists/aesthetic physicians served on the advisory board. A modified version of the Delphi method was used to arrive at consensus. Members accessed an online platform to review statements on skin quality criteria from their peers, including treatment and measurement options, and voted to indicate whether they agreed or disagreed. Statements that did not have agreement were modified and the members voted again. Consensus was defined as: strong consensus = greater than 95% agreement; consensus = 75% to 95% agreement; majority consent = 50% to 75% agreement; no consensus = less than 50% agreement.

Results

There was strong consensus that good skin quality is defined as healthy, youthful in appearance (appearing younger than a person's chronological age), undamaged skin and that skin quality can be described across all ethnicities by four emergent perceptual categories (EPCs): skin tone evenness, skin surface evenness, skin firmness, and skin glow. The EPCs can be affected by multiple tissue layers (ie, skin surface quality can stem from and be impacted by deep structures or tissues). This means that topical approaches may not be sufficient. Instead, improving skin quality EPCs can require a multilayer treatment strategy.

Conclusion

This global advisory board established strong consensus that skin quality can be described by four EPCs, which can help clinicians determine the appropriate treatment option(s) and the tissue or skin layer(s) to address. Skin quality is important to human health and wellbeing and patients' perception for the need for aesthetic treatment.

Objective and Long-Term Evaluation of the Efficacy and Safety of a 1064-nm Picosecond Laser With Fractionated Microlens Array for the Treatment of Atrophic Acne Scar in Asians

BACKGROUND AND OBJECTIVE

Fractional 1064-nm picosecond-domain laser has recently been utilized for the treatment of atrophic acne scars and showed promising results. However, data on the safety and efficacy of this procedure in dark-skinned patients are limited. This prospective, self-controlled study was conducted to objectively evaluate the safety and efficacy of a 1064-nm picosecond laser coupled with a microlens array (MLA) for the treatment of atrophic acne scars on Asian skin.

STUDY DESIGN/MATERIALS AND METHODS

Twenty-six subjects of Fitzpatrick skin types (FSTs) III and IV with atrophic acne scars were enrolled. All subjects were treated with a 1064-nm picosecond laser (spot size of 8 mm, fluence of 1.0 J/cm² , a repetition rate of 10 Hz) in combination with the MLA handpiece for an average of three passes, for 6 monthly sessions. Objective (measurement of scar volume using three-dimensional (3D) photography and skin roughness analysis using ultraviolet A-light video camera) and subjective (clinical evaluation by two blinded dermatologists) assessments were obtained at baseline and at 1, 3, and 6 months after the final treatment.

RESULTS

Statistically significant reduction of the scar volume from baseline at 1, 3, and 6 months after the final treatment were observed by 3D photography and ultraviolet A-light video camera. At the 6-month follow-up, 50% (13 of 26) of the subjects were rated as having at least 50% improvement of the scars. The rate of improvement significantly increased from the 1-month follow-up to the 6-month follow-up (P = 0.013). Similarly, at the 6-month follow-up, the scar volume (P = 0.024) and skin roughness (P = 0.001) also significantly improved, in comparison with the baseline. Mild postinflammatory hyperpigmentation (PIH) was observed to develop in approximately 18% of all the treatment sessions. All cases of PIH were temporary and resolved within 4 weeks on average.

CONCLUSIONS

The 1064-nm picosecond laser with MLA is a safe therapeutic alternative for the treatment of atrophic acne scars in dark-skinned individuals. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

The role of artificial intelligence in cosmetic dermatology-Current, upcoming, and future trends

Within the field of cosmetic dermatology, several promising developments utilize artificial intelligence to better patient care. While many new treatments in cosmetic dermatology feature components of artificial intelligence, there is a knowledge gap within the field regarding the current and developing products featuring AI. We aim to highlight current and developing applications of artificial intelligence in cosmetic dermatology and provide insight into future modalities in this field. Methods include literature review, including peer-reviewed journal articles as well as product websites. In an age of medical and technological advancement, the utility of artificial intelligence models continues to grow.There are many new facets of artificial intelligence in cosmetic dermatology, marketed to both the consumer and the physician. With the development of customizable skin care, augmented reality applications, and at-home skin analysis tools, patients are empowered to be the masters of their cosmetic care. Artificial intelligence is utilized by physicians in new ways in their practices, with the advent of models for prediction of clinical outcome to treatments and tools for in-depth analysis of the patient's skin. Further research is required in the development of automated energy-based treatment devices and robotic-assisted treatments. Models for AI in cosmetic dermatology serve to increase patient involvement in their skin care decisions and have the ability to enhance the patient-physician experience. Dermatologists should be well-informed of the emerging technologies to better educate patients and enhance their clinical practice.

Diagnostics of skin features through 3D skin mapping based on electro-controlled deposition of conducting polymers onto metal-sebum modified surfaces and their possible applications in skin treatment

Analytical diagnostics of skin features was developed through application of portable and fast skin mapping based on electro-controlled deposition of conducting polymers onto metal-sebum modified surfaces. In this analytical diagnostic technique, the development of skin pattern is based on electropolymerization of conducting polymers within insulating barriers in skin stamp provided by natural sebum to monitor the 3D nature of various skin features. The recorded skin maps reach a μm-level resolution and are proved to be capable of recognition, enhancement, and reproduction of surface outlines of various skin topographies, subsequently assisting dermatological diagnosis. The technique can precisely record skin surface morphology and reflect the vertical dimension information within 10 min and is aimed to assist dermatologists working with patients suffering from skin diseases via recording or monitoring the skin surface conditions. Additionally, successful trials of loading and electro-controlled release of Cu²⁺ into/from the developed skin patterns reveals its potential to be also utilized for treatment of pathological skin conditions. Based on the developed analytical diagnostic technique, a well-designed 3D printed portable prototype device based on electrosynthesis of the conducting polymer powered by an ordinary battery (1.5 V) was tested and was found to have excellent performance in onsite 3D skin pattern reproduction from live human skin.

Acne in the first three decades of life: An update of a disorder with profound implications for all decades of life

Acne vulgaris is a chronic, inflammatory, skin condition that involves the pilosebaceous follicles and is influenced by a variety of factors including genetics, androgen-stimulation of sebaceous glands with abnormal keratinization, colonization with Cutibacterium acnes (previously called Propionibacterium acnes), and pathological immune response to inflammation. Acne can occur at all ages and this discussion focuses on the first three decades of life. Conditions that are part of the differential diagnosis and/or are co-morbid with acne vulgaris are also considered. Acne in the first year of life includes neonatal acne (acne neonatorum) that presents in the first four weeks of life and infantile acne that usually presents between 3 and 6 months of the first year of life with a range of 3 to 16 months after birth. Acne rosacea is a chronic, inflammatory, skin condition that is distinct from acne vulgaris, typically presents in adults, and has four main types: erythemato-telangiectatic, papulopustular, phymatous and ocular. Treatment options for acne vulgaris include topical retinoids, topical benzoyl peroxide, antibiotics (topical, oral), oral contraceptive pills, isotretinoin, and others. Management must consider the increasing impact of antibiotic resistance in the 21st century. Psychological impact of acne can be quite severe and treatment of acne includes awareness of the potential emotional toll this disease may bring to the person with acne as well as assiduous attention to known side effects of various anti-acne medications (topical and systemic). Efforts should be directed at preventing acne-caused scars and depigmentation on the skin as well as emotional scars within the person suffering from acne.