Ultra-High Frequency UltraSound (UHFUS) Assessment of Barrier Function in Moderate-to-Severe Atopic Dermatitis during Dupilumab Treatment

Atopic dermatitis (AD) is a chronic multifactorial inflammatory disease characterized by intense itching and inflammatory eczematous lesions. Biological disease-modifying drugs, such as dupilumab are recommended for patients with moderate-to-severe AD, refractory to systemic immunosuppressive therapies. Disease monitoring is performed by clinical scores. Since 1970, however, the use of ultrasound and particularly high-frequency ultrasound (HFUS), has identified alterations in dermal echogenicity, called the subepidermal low-echogenic band (SLEB), that correlates with disease severity and response to treatment. We enrolled 18 patients with moderate-to-severe AD, divided into two groups: twelve patients in the dupilumab treatment (Group A) and six patients in standard treatment, from February 2019 to November 2019. We performed ultra-high frequency ultrasound (UHFUS) evaluation of lesional and non-lesional skin, focusing on SLEB average thicknesses measurement, epidermal thickness, and vascular signal in correlation with objective disease scores (EASI, IGA), patient's reported scores (Sleep Quality NRS and Itch NRS), and TEWL and corneometry at baseline (T0), after 1 month (T1) and 2 months (T2). The SLEB average thickness measurement, vascular signal, and epidermal thickness showed a statistically significant reduction in lesional skin of the biological treatment group and no significant reduction in non-lesional skin in both groups. In the lesional skin of the standard treatment group, only epidermal thickness showed a statistically significant reduction. Our study demonstrates that SLEB measurement, vascular signals, and epidermal thickness could be used as objective parameters in monitoring the AD treatment response, while the presence of SLEB in non-lesional skin could be used as a marker of subclinical inflammation and could predict development of clinical lesions, suggesting a pro-active therapy. Further follow-up and research are needed to clarify the association of SLEB decrease/disappearance with a reduction of flares/prolongment of the disease remission time.

Deep learning approach to skin layers segmentation in inflammatory dermatoses

Monitoring skin layers with medical imaging is critical to diagnosing and treating patients with chronic inflammatory skin diseases. The high-frequency ultrasound (HFUS) makes it possible to monitor skin condition in different dermatoses. Accurate and reliable segmentation of skin layers in patients with atopic dermatitis or psoriasis enables the assessment of the treatment effect by the layer thickness measurements. The epidermis and the subepidermal low echogenic band (SLEB) are the most important for further diagnosis since their appearance is an indicator of different skin problems. In medical practice, the analysis, including segmentation, is usually performed manually by the physician with all drawbacks of such an approach, e.g., extensive time consumption and lack of repeatability. Recently, HFUS becomes common in dermatological practice, yet it is barely supported by the development of automated analysis tools. To meet the need for skin layer segmentation and measurement, we developed an automated segmentation method of both epidermis and SLEB layers. It consists of a fuzzy c-means clustering-based preprocessing step followed by a U-shaped convolutional neural network. The network employs batch normalization layers adjusting and scaling the activation to make the segmentation more robust. The obtained segmentation results are verified and compared to the current state-of-the-art methods addressing the skin layer segmentation. The obtained Dice coefficient equal to 0.87 and 0.83 for the epidermis and SLEB, respectively, proves the developed framework's efficiency, outperforming the other approaches.

High-frequency ultrasonography-New non-invasive method in assessment of skin lymphomas

BACKGROUND

Mycosis fingoides (MF) is the most common subtype of primary cutaneous T-cell lymphomas. Current evaluation of disease extent and severity is based on mSWAT scoring system, which seems to be relatively subjective. The aim of this subject was to present the usefulness of 20 MHz in objective 5-year long monitoring of response to therapy in MF patients.

MATERIALS AND METHODS

The 5-years long follow-up based on 19 skin USG images of patients diagnosed as early stages of MF was studied. The assessed USG parameter was the mean diameter of subepidermal low echogenic band (SLEB).

RESULTS

In every MF patient during exacerbation within lesional skin we could observe SLEB, which thinning or complete disappearance was detected after finishing the therapy. Lack of complete absence of SLEB was related to the lack of complete remission assessed by mSWAT.

CONCLUSION

We present for the first time the possibility of monitoring patients' clinical state on the base of non-invasive USG imaging. We recommend additional use of 20 MHz USG to reduce intra-observer variability and to assess residual disease. USG imaging can complement evaluation of skin lesions in MF and can support clinical judgement.

A Study Comparing the Efficacy of Monopolar Radiofrequency and Glycolic Acid Peels in Facial Rejuvenation of Aging Skin Using Histopathology and Ultrabiomicroscopic Sonography (UBM) - An Evidence Based Study

BACKGROUND

Radio frequency (RF) and chemical peels have been used for nonablative skin rejuvenation. Both of these cause collagen remodeling in the dermis and neo-collagen formation resulting in facial rejuvenation. There is limited literature on the evaluation of collagen remodeling by objective methods.

OBJECTIVE

To compare the benefits of monopolar radiofrequency and glycolic acid peels in facial rejuvenation with regards to histopathology and Ultrabiomicroscopic sonography (UBM).

METHODOLOGY

In this study, forty patients with mild to moderate photoaging received four treatments with 3 weeks interval of monopolar radiofrequency on one side of face and glycolic acid peels in increasing concentrations (NeostrataR) on the other side. Pre and post treatment, 2 mm biopsies were taken from both preauricular areas and Ultrasonography using a 35 MHz probe was done from outer canthus of eye and nasolabial folds from both sides of face. A blinded assessment was done to measure the increase in the grenz zone and dermal thickness.

RESULTS

In 35/40 patients there was a significant increase in the grenz zone on histopathology and decrease in subepidermal low-echogenic band (SLEB) on UBM of the nasolabial folds on both sides of the face (p < 0.05).

CONCLUSION

Radiofrequency and chemical peels showed equal efficacy in the treatment of facial rejuvenation.