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Lee KC, Dretzke J, Grover L, Logan A, Moiemen N. A systematic review of objective burn scar measurements. BURNS & TRAUMA 2016; 4:14. [PMID: 27574684 PMCID: PMC4964074 DOI: 10.1186/s41038-016-0036-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/29/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Problematic scarring remains a challenging aspect to address in the treatment of burns and can significantly affect the quality of life of the burn survivor. At present, there are few treatments available in the clinic to control adverse scarring, but experimental pharmacological anti-scarring strategies are now beginning to emerge. Their comparative success must be based on objective measurements of scarring, yet currently the clinical assessment of scars is not carried out systematically and is mostly based on subjective review of patients. However, several techniques and devices are being introduced that allow objective analysis of the burn scar. The aim of this article is to evaluate various objective measurement tools currently available and recommend a useful panel that is suitable for use in clinical trials of anti-scarring therapies. METHODS A systematic literature search was done using the Web of Science, PubMed and Cochrane databases. The identified devices were then classified and grouped according to the parameters they measured. The tools were then compared and assessed in terms of inter- and intra-rater reproducibility, ease of use and cost. RESULTS After duplicates were removed, 5062 articles were obtained in the search. After further screening, 157 articles which utilised objective burn scar measurement systems or tools were obtained. The scar measurement devices can be broadly classified into those measuring colour, metric variables, texture, biomechanical properties and pathophysiological disturbances. CONCLUSIONS Objective scar measurement tools allow the accurate and reproducible evaluation of scars, which is important for both clinical and scientific use. However, studies to evaluate their relative performance and merits of these tools are scarce, and there remain factors, such as itch and pain, which cannot be measured objectively. On reviewing the available evidence, a panel of devices for objective scar measurement is recommended consisting of the 3D cameras (Eykona/Lifeviz/Vectra H1) for surface area and volume, DSM II colorimeter for colour, Dermascan high-frequency ultrasound for scar thickness and Cutometer for skin elasticity and pliability.
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Affiliation(s)
- Kwang Chear Lee
- The Healing Foundation Burn Research Centre, University Hospital Birmingham Foundation Trust, Birmingham, B15 2TH UK
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Janine Dretzke
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Liam Grover
- School of Chemical Engineering, University of Birmingham, Birmingham, B15 2TT UK
| | - Ann Logan
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Naiem Moiemen
- The Healing Foundation Burn Research Centre, University Hospital Birmingham Foundation Trust, Birmingham, B15 2TH UK
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Trojahn C, Dobos G, Schario M, Ludriksone L, Blume-Peytavi U, Kottner J. Relation between skin micro-topography, roughness, and skin age. Skin Res Technol 2014; 21:69-75. [PMID: 24889351 DOI: 10.1111/srt.12158] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND The topography of the skin surface consists of lines, wrinkles, and scales. Primary and secondary lines form a network like structure that may be identified as polygons. Skin surface roughness measurements are widely applied in dermatological research and practice but the relation between roughness parameters and their anatomical equivalents are unclear. This study aimed to investigate whether the number of closed polygons (NCP) per measurement field can be used as a reliable parameter to measure skin surface topography. For this purpose, we analysed the relation between skin surface roughness parameters and NCP in different age groups. METHODS Images of the volar forearm skin of 38 subjects (14 children, 12 younger, and 12 older adults) were obtained with the VisioScan VC98. The NCP was counted by three independent researchers and selected roughness parameters were measured. Interrater reliability of counting the number of closed polygons and correlations between NCP, roughness parameters, and age were calculated. RESULTS The mean NCP/mm² in children was 3.1 (SD 1.1), in younger adults 1.0 (SD 0.7), and in older adults 1.0 (SD 0.9). The interrater reliability was 0.9. A negative correlation of NCP/mm² with age was observed, whereas measured roughness parameters were positively associated with age. NCP/mm² was weakly related to skin roughness. CONCLUSION The NCP/mm² is a reproducible parameter for characterizing the skin surface topography. It is proposed as an additional parameter in dermatological research and practice because it represents distinct aspects of the cutaneous profile not covered by established roughness parameters.
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Affiliation(s)
- C Trojahn
- Department of Dermatology and Allergy, Clinical Research Center for Hair and Skin Science, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Harmon CB. The efficacy of stereoimage optical topometry to evaluate depressed acne scar treatment using cultured autologous fibroblast injection. Dermatol Surg 2012; 37:1314-5. [PMID: 22988991 DOI: 10.1111/j.1524-4725.2011.02117.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Elsner P, Fluhr JW, Gehring W, Kerscher MJ, Krutmann J, Lademann J, Makrantonaki E, Wilhelm KP, Zouboulis CC. Anti-Aging Data and Support Claims - Consensus Statement. J Dtsch Dermatol Ges 2011; 9 Suppl 3:S1-32. [DOI: 10.1111/j.1610-0379.2011.07746.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Scars may lead to an array of cosmetic, psychological, and functional problems. Different scar features can be distinguished (i.e., color, thickness, relief, pliability, and surface area) that are clinically relevant and contribute to the quality and judgment of a scar. Today, objective evaluation of these scar features is indispensable for practicing evidence-based medicine (e.g., to evaluate the outcome of clinical trials). In this review, an overview and update are given on the most relevant noninvasive objective measurement tools for scar evaluation. METHODS A PubMed literature search was performed. Articles evaluating the clinimetric properties of noninvasive scar assessment tools were included. The selected objective measurement tools were then critically reviewed with respect to the clinimetric properties of reliability, validity, and feasibility. RESULTS In total, 75 articles were selected and 23 different noninvasive measurement methods were evaluated. CONCLUSION Based on the scar features color, thickness, relief, pliability, and surface area, the best measurement tools that are currently available were recommended.
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Bloemen MC, van Gerven MS, van der Wal MB, Verhaegen PD, Middelkoop E. An objective device for measuring surface roughness of skin and scars. J Am Acad Dermatol 2011; 64:706-15. [DOI: 10.1016/j.jaad.2010.03.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2009] [Revised: 01/29/2010] [Accepted: 03/14/2010] [Indexed: 10/18/2022]
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Lammers G, Verhaegen PD, Ulrich MM, Schalkwijk J, Middelkoop E, Weiland D, Nillesen ST, Van Kuppevelt TH, Daamen WF. An Overview of Methods for the In Vivo Evaluation of Tissue-Engineered Skin Constructs. TISSUE ENGINEERING PART B-REVIEWS 2011; 17:33-55. [DOI: 10.1089/ten.teb.2010.0473] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Gerwen Lammers
- Department of Biochemistry, Nijmegen Centre for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Pauline D.H.M. Verhaegen
- Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, The Netherlands
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Centre, Amsterdam, The Netherlands
| | - Magda M.W. Ulrich
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Centre, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - Joost Schalkwijk
- Department of Dermatology, Nijmegen Centre for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Esther Middelkoop
- Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - Daniela Weiland
- Department of Biochemistry, Nijmegen Centre for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Suzan T.M. Nillesen
- Department of Biochemistry, Nijmegen Centre for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Toin H. Van Kuppevelt
- Department of Biochemistry, Nijmegen Centre for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Willeke F. Daamen
- Department of Biochemistry, Nijmegen Centre for Molecular Life Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Sakai S, Nakagawa N, Yamanari M, Miyazawa A, Yasuno Y, Matsumoto M. Relationship between dermal birefringence and the skin surface roughness of photoaged human skin. JOURNAL OF BIOMEDICAL OPTICS 2009; 14:044032. [PMID: 19725743 DOI: 10.1117/1.3207142] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The dermal degeneration accompanying photoaging is considered to promote skin roughness features such as wrinkles. Our previous study demonstrated that polarization-sensitive spectral domain optical coherence tomography (PS-SD-OCT) enabled noninvasive three-dimensional evaluation of the dermal degeneration of photoaged skin as a change in dermal birefringence, mainly due to collagenous structures. Our purpose is to examine the relationship between dermal birefringence and elasticity and the skin morphology in the eye corner area using PS-SD-OCT. Nineteen healthy male subjects in their seventees were recruited as subjects. A transverse dermal birefringence map, automatically produced by the algorithm, did not show localized changes in the dermal birefringence in the part of the main horizontal wrinkle. The averaged upper dermal birefringence, however, showed depth-dependent correlation with the parameters of skin roughness significantly, suggesting that solar elastosis is a major factor for the progress of wrinkles. Age-dependent parameters of skin elasticity measured with Cutometer did not correlate with the parameters. These results suggest that the analysis of dermal birefringence using PS-SD-OCT enables the evaluation of photoaging-dependent upper dermal degeneration related to the change of skin roughness.
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Affiliation(s)
- Shingo Sakai
- Kanebo Cosmetics, Inc., Basic Research Laboratory, 5-3-28, Kotobuki, Odawara, Kanagawa 250-0002, Japan.
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Park SH, Hong YM, Choi YJ, Choi JH, Kim BK. Antiwrinkle Effects of Mugwort (Artemisia vulgaris) Extracts on UVB-Irradiated Hairless Mouse Skin. ACTA ACUST UNITED AC 2008. [DOI: 10.3746/jkfn.2008.37.9.1136] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Fujimura T, Haketa K, Hotta M, Kitahara T. Global and systematic demonstration for the practical usage of a direct in vivo measurement system to evaluate wrinkles. Int J Cosmet Sci 2007; 29:423-36. [DOI: 10.1111/j.1468-2494.2007.00399.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kautzky F, Dahm MW, Köhler LD, Drosner M, Vogt HJ, Borelli S. Intra- and interindividual variations of direct profilometry of different skin areas. J Eur Acad Dermatol Venereol 2006. [DOI: 10.1111/j.1468-3083.1997.tb00460.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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