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Hussein FA, Manan HA, Mustapha AWMM, Sidek K, Yahya N. Ultrasonographic Evaluation of Skin Toxicity Following Radiotherapy of Breast Cancer: A Systematic Review. Int J Environ Res Public Health 2022; 19:13439. [PMID: 36294025 PMCID: PMC9603505 DOI: 10.3390/ijerph192013439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
The present review aimed to systematically review skin toxicity changes following breast cancer radiotherapy (RT) using ultrasound (US). PubMed and Scopus databases were searched according to PRISMA guidelines. The characteristics of the selected studies, measured parameters, US skin findings, and their association with clinical assessments were extracted. Seventeen studies were included with a median sample size of 29 (range 11-166). There were significant US skin changes in the irradiated skin compared to the nonirradiated skin or baseline measurements. The most observed change is skin thickening secondary to radiation-induced oedema, except one study found skin thinning after pure postmastectomy RT. However, eight studies reported skin thickening predated RT attributed to axillary surgery. Four studies used US radiofrequency (RF) signals and found a decrease in the hypodermis's Pearson correlation coefficient (PCC). Three studies reported decreased dermal echogenicity and poor visibility of the dermis-subcutaneous fat boundary (statistically analysed by one report). The present review revealed significant ultrasonographic skin toxicity changes in the irradiated skin most commonly skin thickening. However, further studies with large cohorts, appropriate US protocol, and baseline evaluation are needed. Measuring other US skin parameters and statistically evaluating the degree of the association with clinical assessments are also encouraged.
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Affiliation(s)
- Fatimah Alaa Hussein
- Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, University Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Hanani Abdul Manan
- Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, University Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
- Department of Radiology and Intervensi, Hospital Pakar Kanak-Kanak (Children Specialist Hospital), Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Aida W. M. Mohd Mustapha
- Department of Radiology, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Khairiyah Sidek
- Department of Radiotherapy, University Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Kuala Lumpur 56000, Malaysia
| | - Noorazrul Yahya
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, School of Diagnostic & Applied Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia
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Fodor D, Rodriguez-Garcia SC, Cantisani V, Hammer HB, Hartung W, Klauser A, Martinoli C, Terslev L, Alfageme F, Bong D, Bueno A, Collado P, D'Agostino MA, de la Fuente J, Iohom G, Kessler J, Lenghel M, Malattia C, Mandl P, Mendoza-Cembranos D, Micu M, Möller I, Najm A, Özçakar L, Picasso R, Plagou A, Sala-Blanch X, Sconfienza LM, Serban O, Simoni P, Sudoł-Szopińska I, Tesch C, Todorov P, Uson J, Vlad V, Zaottini F, Bilous D, Gutiu R, Pelea M, Marian A, Naredo E. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part I: Extraarticular Pathologies. Ultraschall Med 2022; 43:34-57. [PMID: 34479372 DOI: 10.1055/a-1562-1455] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The first part of the guidelines and recommendations for musculoskeletal ultrasound, produced under the auspices of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB), provides information about the use of musculoskeletal ultrasound for assessing extraarticular structures (muscles, tendons, entheses, ligaments, bones, bursae, fasciae, nerves, skin, subcutaneous tissues, and nails) and their pathologies. Clinical applications, practical points, limitations, and artifacts are described and discussed for every structure. After an extensive literature review, the recommendations have been developed according to the Oxford Centre for Evidence-based Medicine and GRADE criteria and the consensus level was established through a Delphi process. The document is intended to guide clinical users in their daily practice.
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Affiliation(s)
- Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Maria Antonietta D'Agostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | | | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
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Katakam BK, Munisamy M, Rao TN, Chiramel MJ, Panda M, Gupta S, Pss R, Seetharam KA. Recommendations for Management of Childhood Psoriasis. Indian Dermatol Online J 2021; 12:S71-S85. [PMID: 34976883 PMCID: PMC8664175 DOI: 10.4103/idoj.idoj_965_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/09/2021] [Accepted: 05/22/2021] [Indexed: 12/17/2022] Open
Abstract
Childhood psoriasis is recognized as a potential multisystem disorder and hence it is imperative to optimize disease management to arrest progression, minimize psychological burden and evolution of metabolic syndrome. Clinical practice recommendations are necessary to assist practitioners in appropriate decision making based on available evidence. Owing to the lack of Indian recommendations on childhood psoriasis, the SIG Pediatric Dermatology under IADVL Academy undertook an evidence-based approach based on published literature on the topic, between January 2000 and July 2020 to frame the recommendations.
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Affiliation(s)
- Bhumesh Kumar Katakam
- Dermatology, Venereology and Leprology, Gandhi Medical College, Secunderabad, Telangana, India
| | - Malathi Munisamy
- Dermatology and STD, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | | | | | - Maitreyee Panda
- Dermatology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Sandeep Gupta
- Consultant Dermatologist, Balaji Skin Clinic, New Delhi, India
| | - Ranugha Pss
- Dermatology, JSS Medical College and Hospital, JSSAHER, Mysore, Karnataka, India
| | - K A Seetharam
- Dermatology, GSL Medical College, Rajahmundry, India
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Pérez M, Zuccaro J, Mohanta A, Tijerin M, Laxer R, Pope E, Doria AS. Feasibility of Using Elastography Ultrasound in Pediatric Localized Scleroderma (Morphea). Ultrasound Med Biol 2020; 46:3218-3227. [PMID: 32951932 DOI: 10.1016/j.ultrasmedbio.2020.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 06/11/2023]
Abstract
Assessment and monitoring of inflammation and tissue damage is crucial in localized scleroderma (LS), but validated diagnostic tools are lacking. We aimed to determine the feasibility of using acoustic radiation force imaging ultrasound elastography in the assessment of pediatric-onset LS lesions. Conventional ultrasound and shear-wave elastography (SWE) imaging were used to characterize changes in pre-assigned LS lesions in 13 prospectively recruited participants. Contralateral sites were used as controls. Mean SWE values were compared. LS lesions were significantly stiffer than control sites in the dermis and the hypodermis using both parametric and non-parametric tests, before and after skin-thickness normalization. We show that SWE imaging is a feasible way to discriminate between normal skin and LS lesions in the pediatric population.
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Affiliation(s)
- Manuela Pérez
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
| | - Jennifer Zuccaro
- Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arun Mohanta
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marta Tijerin
- Radiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ronald Laxer
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elena Pope
- Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada; Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Ontario, Canada
| | - Andrea S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
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5
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Guazzaroni M, Ferrari D, Lamacchia F, Marisi V, Tatulli D, Marsico S, Orlacchio A, Floris R, Bianchi L, Dattola A. Shear wave elastography and microvascular ultrasound in response evaluation to calcipotriol+betamethasone foam in plaque psoriasis. Postgrad Med J 2020; 97:16-22. [PMID: 32646970 DOI: 10.1136/postgradmedj-2020-138150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/10/2020] [Accepted: 06/13/2020] [Indexed: 11/03/2022]
Abstract
Psoriasis (PsO) is a chronic skin disease. This study aims to evaluate clinical and subclinical response to calcipotriol+betamethasone foam, in patients with PsO, comparing, for the first time, data from microvascular ultrasound (MicroV) and shear wave elastography (SWE) with Psoriasis Area and Severity Index (PASI). METHODS Between November 2018 and April 2019 in Tor Vergata Hospital (Roma, Italy), we enrolled 26 patients with PsO who were ageds 20-75 years, with PASI score ≥4, candidated for calcipotriol+betamethasone foam treatment. They underwent MicroV and SWE evaluation at baseline (T0) and after 4 weeks of treatment (T4). Clinical follow-up was carried on at T4, T8 and T12. Student's t-test (p values<0.05 statistically significant) was used to compare SWE and PASI values. RESULTS At T0, SWE stiffness values of target plaques (61.5% on elbows, 23% knees, 7.7% sacrum,7.7% legs) were significantly higher than values under healthy skin. At T4, all patients showed a significant reduction of PASI; MicroV showed reduction in vascularisation of responsive plaques in 85% of cases, only in 15%, the vascularisation degree remained stable; and SWE values of target plaques were significantly lower compared with T0. Only in 7.7%, there was a relapse at T12. CONCLUSIONS Calcipotriol+betamethasone foam is a very effective topical treatment in a short-medium term follow-up in patients with PsO. MicroV and SWE evaluate response to treatment (in term of plaque vascularisation and stiffness), so they could represent promising early indicators of therapeutic response and help the physician to establish a better clinical-therapeutic management of patients with PsO.
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Affiliation(s)
- Manlio Guazzaroni
- Department of Surgical Science, University of Rome Tor Vergata, Roma, Italy
| | - Donatella Ferrari
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome Tor Vergata, Roma, Italy
| | - Feliciana Lamacchia
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome Tor Vergata, Roma, Italy
| | - Vanessa Marisi
- Department of Dermatology, University of Rome Tor Vergata, Roma, Italy
| | - Doriana Tatulli
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome Tor Vergata, Roma, Italy
| | - Salvatore Marsico
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome Tor Vergata, Roma, Italy
| | - Antonio Orlacchio
- Department of Surgical Science, University of Rome Tor Vergata, Roma, Italy
| | - Roberto Floris
- Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome Tor Vergata, Roma, Italy
| | - Luca Bianchi
- Department of Dermatology, University of Rome Tor Vergata, Roma, Italy
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Șomlea MC, Boca AN, Pop AD, Ilieș RF, Vesa SC, Buzoianu AD, Tătaru A. High-frequency ultrasonography of psoriatic skin: A non-invasive technique in the evaluation of the entire skin of patients with psoriasis: A pilot study. Exp Ther Med 2019; 18:4981-4986. [PMID: 31798719 DOI: 10.3892/etm.2019.8140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 03/06/2019] [Indexed: 12/17/2022] Open
Abstract
Psoriasis is a chronic, systemic, inflammatory disorder which accelerates the life process of skin cells, based on a genetically induced deviant immune response. High-frequency ultrasonography (HF-USG) is a painless, non-invasive imaging technique that can be performed and repeated whenever the need arises. We evaluated lesional and non-lesional skin of psoriatic patients with the use of HF-USG, focusing on the immune-induced inflammation and skin thickness. Previous studies suggested that HF-USG, being a non-invasive technique, is useful as an aid to clinical evaluation of the severity of psoriatic plaques. Our goal was to determine whether the skin of psoriatic patients is influenced by the background or habits of the patients. The study included a total of 27 patients affected by psoriasis vulgaris. The thickness of the epidermis and dermis and the skin echogenicity were documented for the active plaques, as well as for the non-affected skin of all the patients included in the study, using a high-frequency ultrasonographic system. The patient's local background, sex, family history of psoriasis, smoking habits and sun exposure were analyzed. HF-USG of the psoriatic plaques exposes a three-band structure that is easily distinguished from the surrounding unaffected skin, due to a hypoechoic band in the upper dermis. Although not specific for psoriasis, it is a strong marker of inflammation. The obtained results confirm that, indeed, skin thickness is greater in lesional skin compared to non-lesional skin, by a mean of 1,180 µm (±340 µm). We consider that skin HF-USG should be used as a quantitative method in the clinical evaluation of the patients with psoriasis and may help as an objective means of assessing inflammation in lesional skin.
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Affiliation(s)
- Mihaela Cristina Șomlea
- Department of Dermatology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Andreea Nicoleta Boca
- Department of Pharmacology, Toxicology and Clinical Pharmacology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
| | - Alexandra Dana Pop
- Department of Physiology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Roxana Flavia Ilieș
- Department of Medical Genetics, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400212 Cluj-Napoca, Romania
| | - Stefan Cristian Vesa
- Department of Pharmacology, Toxicology and Clinical Pharmacology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
| | - Anca Dana Buzoianu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400337 Cluj-Napoca, Romania
| | - Alexandru Tătaru
- Department of Dermatology, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
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Abstract
OBJECTIVE Psoriasis is a chronic inflammatory disease that affects the skin, joints, and nails. To investigate the efficacy of sonoelastographic evaluation for assessing nail involvement and severity in psoriasis. MATERIALS AND METHODS Thirty-one psoriasis patients and 31 healthy control subjects were included in the study. The nail thickness and nail bed thickness of the thumbs of all cases were measured by gray scale ultrasonography. In addition, the values of strain elastography were measured by sonoelastography. RESULTS Of the participants, 38 were male and 24 were female; the ratio of males and females was equal in both groups. There was no significant difference between the patient and control group in terms of gender and age. In the patient group, the mean duration of illness was 13.87 ± 9.8 years, mean PASI score was 5.53 ± 2.38, and mean NAPSI score was 33.97 ± 37.99. The nail plate thickness and elastography strain ratios were found to be statistically higher in the psoriasis group compared to the control group. There was also significant correlation between elastography strain ratios and nail thickness (P = .014), nail bed thickness (P < .001) and NAPSI scores (P = .01). CONCLUSION Due to the superiority of ultrasound in real-time imaging of the nail structure and the compatibility of sonographic elastography with clinical scores in the assessment of the nail bed, we believe that it can be used as a complementary method.
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Affiliation(s)
| | - Mahizer Yaldiz
- Departmant of Dermatology, Sakarya University Training and Research Hospital, Sakarya, Turkey
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Grajdeanu IA, Statescu L, Vata D, Popescu IA, Porumb-Andrese E, Patrascu AI, Taranu T, Crisan M, Solovastru LG. Imaging techniques in the diagnosis and monitoring of psoriasis. Exp Ther Med 2019; 18:4974-4980. [PMID: 31819765 PMCID: PMC6895776 DOI: 10.3892/etm.2019.7957] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/09/2019] [Indexed: 12/23/2022] Open
Abstract
Plaque psoriasis is a chronic, immune-mediated disease, which has a multifactorial etiopathogenesis. Practical non-invasive techniques to monitor plaque psoriasis progression and treatment are necessary. Imaging techniques available for psoriasis assessment may vary in terms of resolution, depth of penetration and visual representation. This review summarizes the current developments in the field of psoriasis non-invasive imaging techniques, such as dermoscopy, conventional ultrasound and high frequency ultrasonography (HFUS), videocapillaroscopy (VC), reflectance confocal microscopy (RCM), optical microangiography (OMAG), laser Doppler imaging (LDI), multiphoton tomography (MPT) and optical coherence tomography (OCT). The aim was to collect and analyze data concerning types, indications, advantages and disadvantages of modern imaging techniques for in vivo psoriasis assessment. We focused on two main methods, videodermoscopy and HFUS, which can be included in daily dermatologists' practice and which may assist in establishing diagnosis, as well as monitoring response to topical and/or systemic therapy of psoriasis. Dermoscopy may be useful for a first evaluation and may offer an understanding of the type and distribution of blood vessels, as well as the color of the scale and the background of the lesion. Videodermoscopy allows magnification and offers a detailed evaluation of the vessel type. The utility of HFUS consists mainly in monitoring therapy response. These methods may be comparable with virtual histopathology.
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Affiliation(s)
- Ioana-Alina Grajdeanu
- Dermatology Department, Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Laura Statescu
- Dermatology Department, Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Dermatology Clinic, 'St. Spiridon' County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Dan Vata
- Dermatology Department, Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Dermatology Clinic, 'St. Spiridon' County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Ioana Adriana Popescu
- Dermatology Department, Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Dermatology Clinic, 'St. Spiridon' County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Elena Porumb-Andrese
- Dermatology Department, Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Dermatology Clinic, 'St. Spiridon' County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Adriana Ionela Patrascu
- Dermatology Department, Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Dermatology Clinic, 'St. Spiridon' County Emergency Clinical Hospital, 700111 Iasi, Romania
| | - Tatiana Taranu
- Dermatology Department, Faculty of Dental Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Dermatology Clinic, CF Iasi Hospital, 700506 Iasi, Romania
| | - Maria Crisan
- Dermatology Department, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania
| | - Laura Gheuca Solovastru
- Dermatology Department, Faculty of Medicine, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania.,Dermatology Clinic, 'St. Spiridon' County Emergency Clinical Hospital, 700111 Iasi, Romania
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9
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Kaya İslamoğlu ZG, Uysal E, Demirbaş A, İslamoğlu N. Evaluating nail thickness and stiffness with shear‐wave elastography in nail psoriasis: A preliminary study. Skin Res Technol 2019; 26:45-49. [DOI: 10.1111/srt.12762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/27/2019] [Indexed: 02/04/2023]
Affiliation(s)
| | - Emine Uysal
- Department of Radiology, Faculty of Medicine Selcuk University Konya Turkey
| | - Abdullah Demirbaş
- Department of Dermatology, Faculty of Medicine Selcuk University Konya Turkey
| | - Necat İslamoğlu
- Department of Radiology Van research and Education Hospital Van Turkey
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10
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Martins-Rocha T, Azzolin I, Serban T, Massazza G, Iagnocco A. New applications of sonoelastography in rheumatology: where are we now? Rheumatology (Oxford) 2019; 58:765-769. [PMID: 30281087 DOI: 10.1093/rheumatology/key296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 08/22/2018] [Indexed: 12/19/2022] Open
Abstract
Ultrasound elastography (UE) is a non-invasive imaging method that allows the assessment of tissue elastic property. Different UE techniques are currently available (i.e. strain UE and acoustic radiation force impulse UE), with several potential clinical applications. Recent studies investigated the role of UE in two systemic rheumatic diseases and psoriasis. This research added interesting information to the already known applications of UE in the assessment of tendinopathies. In SS, acoustic radiation force impulse UE has shown a potential role in the diagnosis of the disease, with lower sensitivity than and similar specificity to salivary gland histology. In SSc, a potential use of UE in screening pre-clinical disease has been reported. In psoriasis, the use of strain UE in evaluating treatment response has been highlighted. UE is a promising tool in rheumatology, with a potential role in the evaluation of various tissues and pathologies.
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Affiliation(s)
| | - Irene Azzolin
- Division of Physical Medicine and Rehabilitation, MFRU - Università degli Studi di Torino
| | - Teodora Serban
- Academic Rheumatology Center, Division of Physical Medicine and Rehabilitation and Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy
| | - Giuseppe Massazza
- Division of Physical Medicine and Rehabilitation, MFRU - Università degli Studi di Torino
| | - Annamaria Iagnocco
- Academic Rheumatology Center, Division of Physical Medicine and Rehabilitation and Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy
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Ambroziak M, Pietruski P, Noszczyk B, Paluch Ł. Ultrasonographic elastography in the evaluation of normal and pathological skin - a review. Postepy Dermatol Alergol 2019; 36:667-72. [PMID: 31997992 DOI: 10.5114/ada.2018.77069] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 06/19/2018] [Indexed: 11/17/2022] Open
Abstract
The aim of this review article is to discuss the role of ultrasonographic elastography, a technique used to quantify tissue stiffness, in the evaluation of normal and pathological skin. A growing body of evidence suggests that elastography may be used for the diagnosis and monitoring of skin pathologies, in particular tumors, and fibrotic and sclerotic processes. Our knowledge about the elastographic parameters of normal skin is sparse, which together with the lack of reference values for cutaneous stiffness constitutes a serious limitation to the use of elastography in some medical disciplines, including aesthetic medicine.
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Halani S, Foster FS, Breslavets M, Shear NH. Ultrasound and Infrared-Based Imaging Modalities for Diagnosis and Management of Cutaneous Diseases. Front Med (Lausanne) 2018; 5:115. [PMID: 29922650 PMCID: PMC5996893 DOI: 10.3389/fmed.2018.00115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 04/06/2018] [Indexed: 12/16/2022] Open
Abstract
Non-invasive bedside imaging tools are becoming more prevalent for assessing cutaneous lesions. Ultrasound used at specific frequencies allows us to assess margins of lesions to minimize the extent of the biopsy that is performed and improve cosmetic outcomes. Vascularity, seen on Doppler ultrasound and contrast-enhanced ultrasound, and stiffness, assessed on tissue elastography, can help differentiate between benign and malignant lesions for clinicians to be more judicious in deciding whether to biopsy. Moreover, research has shown the efficacy in using ultrasound in monitoring flares of hidradenitis suppurativa, a disease affecting apocrine gland-rich areas of the body, for which the current gold standard involves examining and scoring inflammatory lesions with the naked eye. Infrared-based modalities have also been on the uptrend to aid in clinical decision-making regarding suspiciousness of lesions. Reflectance confocal microscopy has lateral resolution that is comparable to histopathology and it has been shown to be an appropriate adjunctive tool to dermoscopy, specifically when evaluating melanomas. Optical coherence tomography has utility in determining lesion thickness because of its depth penetration, and spectrophotometric intracutaneous analysis is becoming more popular as a tool that can be used by general practitioners to know when to refer to dermatology regarding worrisome pigmented lesions. Strides have been made to incorporate electrical impedance spectroscopy alongside dermoscopy in decision-making regarding excision, although the evidence for its use in the clincial setting remains inconclusive. This paper reviews the efficacy and drawbacks of these techniques in the field of dermatology and suggests future directions.
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Affiliation(s)
- Sheliza Halani
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - F Stuart Foster
- Medical Biophysics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Neil H Shear
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Dermatology, University of Toronto, Toronto, ON, Canada
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Dattola A, Altobelli S, Marsico S, Plastina D, Nistico SP, Cavallo A, Floris R, Bianchi L, Guazzaroni M. Hypodermal Adipose Tissue Sonoelastography for Monitoring Treatment Response in Patients with Plaque Psoriasis. Photomed Laser Surg 2017; 35:484-491. [PMID: 28445107 DOI: 10.1089/pho.2016.4261] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Psoriasis (PsO) is a multifactorial chronic and relapsing skin disease that affects about 125 million people in the world. Several studies have demonstrated the link between adipose tissue, inflammation, and PsO. The purpose of our study is to evaluate hypodermal adipose tissue inflammation underneath PsO plaques quantifying tissue elasticity with sonoelastography before and after treatment. The study was conducted at the Department of Dermatology of the University of "Rome Tor Vergata" and Department of Radiology of the University of "Rome Tor Vergata." METHODS We enrolled 60 patients with plaque PsO and a PASI score of ≥5 divided in three groups of treatment: biologic drugs therapy (Group A), systemic therapy with DMARDS (Group B), and topic therapy (Group C). Each Patient underwent sonoelastography examination (TE: transient elastography) at baseline (T0) and after 1 month (T1) of treatment. The region of interest (ROI) 5 × 5 mm area and the strain ratio was obtained dividing muscular elasticity (referral tissue) by hypodermal elasticity. RESULTS The difference between T0 and T1 was referred as Δ strain. Sonoelastography is able to identify hypodermal adipose tissue involvement in plaque PsO and on the basis of our experience it could represent a valid method to assess early therapy response in patient with plaque PsO. CONCLUSIONS This is the first report regarding the use of sonoelastography in psoriatic patients. Sonoelastography is easy to use, rapid, and is a portable technique that does not use ionizing radiation. The result showed the mean lesional strain ratio significantly higher than the nonlesional one at baseline examination. In the future, the role of ultrasound sonoelastography is likely to be complementary to conventional imaging techniques in providing an additional tool.
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Affiliation(s)
- Annunziata Dattola
- 1 Department of Dermatology, University of Rome "Tor Vergata ," Rome, Italy
| | - Simone Altobelli
- 2 Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome "Tor Vergata ," Rome, Italy
| | - Salvatore Marsico
- 2 Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome "Tor Vergata ," Rome, Italy
| | - Domenico Plastina
- 1 Department of Dermatology, University of Rome "Tor Vergata ," Rome, Italy
| | - Steven P Nistico
- 3 Department of Health Sciences, University "Magna Graecia" Catanzaro , Catanzaro, Italy
| | - Armando Cavallo
- 2 Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome "Tor Vergata ," Rome, Italy
| | - Roberto Floris
- 2 Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome "Tor Vergata ," Rome, Italy
| | - Luca Bianchi
- 1 Department of Dermatology, University of Rome "Tor Vergata ," Rome, Italy
| | - Manlio Guazzaroni
- 2 Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University of Rome "Tor Vergata ," Rome, Italy
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Wigger-Alberti W, Williams R, von Mackensen YL, Hoffman-Wecker M, Grossmann U, Staedtler G, Nkulikiyinka R, Shakery K. Comparison of Occlusive and Open Application in a Psoriasis Plaque Test Design, Exemplarily Using Investigations of Mapracorat 0.1% Ointment versus Vehicle and Reference Drugs. Skin Pharmacol Physiol 2017; 30:102-114. [PMID: 28407625 DOI: 10.1159/000458415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 01/26/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Psoriasis plaque tests (PPTs) are important tools in the early phases of antipsoriatic drug development. Two distinct PPT design variants (open vs. occluded drug application) are commonly used, but no previous work has aimed to directly compare and contrast their performance. METHODS We compared the antipsoriatic efficacy of mapracorat 0.1% ointment and reference drugs reported in 2 separate studies, representing open and occluded PPT designs. The drug effect size was measured by sonography (mean change in echo-poor band thickness), chromametry, and standardized clinical assessment. RESULTS Antipsoriatic effects were detectable for the study drugs in both occluded and open PPTs. Differences between the potency of antipsoriatic drugs and vehicle were observable. The total antipsoriatic effect size appeared to be higher in the occluded PPT than the open PPT, despite the shorter treatment duration (2 vs. 4 weeks). Effect dynamics over time revealed greater differences between some study drugs in the open PPT compared to the occluded PPT. CONCLUSION Taking the higher technical challenges for the open PPT into account, we recommend the occluded PPT as a standard screening setting in early drug development. In special cases, considering certain drug aspects or study objectives that would require procedural adaptations, an open PPT could be the better-suited design. Finally, both PPT models show clear advantages: classification as phase I studies, small number of psoriatic subjects, relatively short study duration, excellent discrimination between compounds and concentrations, parallel measurement of treatment response, and go/no go decisions very early in clinical development.
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Alfageme Roldán F. Elastografía en dermatología. Actas Dermo-Sifiliográficas 2016; 107:652-60. [DOI: 10.1016/j.ad.2016.05.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 04/11/2016] [Accepted: 05/01/2016] [Indexed: 10/21/2022] Open
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Alfageme Roldán F. Elastography in Dermatology. Actas Dermo-Sifiliográficas (English Edition) 2016; 107:652-660. [DOI: 10.1016/j.adengl.2016.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Gutierrez M, Okano T, Reginato AM, Cazenave T, Ventura-rios L, Bertolazzi C, Pineda C. New Ultrasound Modalities in Rheumatology: . J Clin Rheumatol 2015; 21:427-34. [DOI: 10.1097/rhu.0000000000000319] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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