Comparison of two skin imaging analysis instruments: The VISIA® from Canfield vs the ANTERA 3D® CS from Miravex

Does Linear or Spot Injection Technique Matter in Upper Face Botulinum Toxin Type A Application? A Split-Face Randomized Trial

BACKGROUND

Although the efficacy of botulinum toxin type A (BoNTA) has been shown to vary depending on injection layer, reconstitution volume, and BoNTA formulation, the effect of injection pattern has rarely been mentioned. The authors compared the therapeutic effects in patients treated with BoNTA with retrograde linear and traditional spot injection techniques.

METHODS

Twenty-eight participants were enrolled in a split-face, patient-blinded randomized clinical trial. Each patient received BoNTA injected with linear injection technique on one side and with spot injection technique on the other side. Outcomes included wrinkle improvement rates (WIRs) of the 2 injection techniques determined by wrinkle scores derived from an Antera 3-dimensional camera, muscle activity assessed by ultrasound, and patient-reported pain rating on a numeric rating scale.

RESULTS

All participants completed the study. For forehead wrinkles, WIR on the linear side was significantly larger than that on the spot side at 1 week and 1 month ( P < 0.02). For glabellar wrinkles, WIR on the linear injection side was significantly larger than that on the spot side at 1 week ( P = 0.04). However, for periorbital wrinkles, WIR on the spot side was significantly larger than that on the linear side at 1 week ( P < 0.03). No significant difference was observed between the injection patterns in terms of muscle contraction and numeric rating scale pain scores.

CONCLUSIONS

Compared with the traditional spot injection, retrograde linear injection was superior in reducing forehead lines and glabellar lines, but less effective in reducing periorbital lines when identical dosages were injected.

CLINICAL QUESTION/LEVEL OF EVIDENCE

Therapeutic, II.

Advances in the Application of Noninvasive Skin Imaging Techniques in Acne Scars

Acne scarring is a common sequela of acne vulgaris, which seriously affects facial esthetics. The treatment options for acne scars vary depending on the development stage, color, type, and location of scarring. The objective and precise assessment of acne scars is a prerequisite for treatment, and it is also an important means of monitoring the treatment effect. The traditional methods to evaluate the types and severity grade of acne scars are primarily based on subjective assessment by physicians, which lacks objectivity and accuracy. Novel noninvasive skin imaging techniques, such as skin surface imaging analysis systems, dermoscopy, reflectance confocal microscopy (RCM), high-frequency ultrasound (HFUS), optical coherence tomography (OCT), and multiphoton tomography (MPT), provide new tools for the rapid and objective assessment of acne scars. This article reviews the progress of skin imaging techniques in the diagnosis, classification, and efficacy evaluation of acne scars.

A survey of skin tone assessment in prospective research

Increasing evidence supports reduced accuracy of noninvasive assessment tools, such as pulse oximetry, temperature probes, and AI skin diagnosis benchmarks, in patients with darker skin tones. The FDA is exploring potential strategies for device regulation to improve performance across diverse skin tones by including skin tone criteria. However, there is no consensus about how prospective studies should perform skin tone assessment in order to take this bias into account. There are several tools available to conduct skin tone assessments including administered visual scales (e.g., Fitzpatrick Skin Type, Pantone, Monk Skin Tone) and color measurement tools (e.g., reflectance colorimeters, reflectance spectrophotometers, cameras), although none are consistently used or validated across multiple medical domains. Accurate and consistent skin tone measurement depends on many factors including standardized environments, lighting, body parts assessed, patient conditions, and choice of skin tone assessment tool(s). As race and ethnicity are inadequate proxies for skin tone, these considerations can be helpful in standardizing the effect of skin tone on studies such as AI dermatology diagnoses, pulse oximetry, and temporal thermometers. Skin tone bias in medical devices is likely due to systemic factors that lead to inadequate validation across diverse skin tones. There is an opportunity for researchers to use skin tone assessment methods with standardized considerations in prospective studies of noninvasive tools that may be affected by skin tone. We propose considerations that researchers must take in order to improve device robustness to skin tone bias.

Evaluation of 755-nm Picosecond Alexandrite Laser With a Focus Lens Array for the Treatment of Enlarged Facial Pores

OBJECTIVES

This study aims to evaluate the use of 755-nm picosecond alexandrite laser with a focus lens array to treat facial pores.

METHODS

Laser treatment was performed on 129 patients between January 2021 and October 2022. VISIA imaging system was used for photographic assessments, the total average number and pore index was calculated, the physicians' assessment score and patient satisfaction score were collected, and the incidence of disadvantage effects was also documented.

RESULTS

The mean patient age was 35.2±6.4 years (21-45 y). The total average number of facial pores was 1614.1±412.8, and the total average number decreased to 1262.6±356.2 three months after the last treatment. The pretreatment baseline of pore index was 26.1±4.5, while the pore index was 21.3±3.7 three months after the last treatment. The physicians' assessment score was 2.7 on the 0-to-4 scale, and patient satisfaction score was 3.5 on the 1-to-5 scale. There were no adverse events, such as hyperkeratosis, scarring, and hypo-or hyperpigmentation.

CONCLUSIONS

755-nm picosecond alexandrite laser with a focus lens array was safe and effective in the treatment of facial pores with relatively few unanticipated adverse events.

LEVEL OF EVIDENCE

Level IV-observational study without controls.

A comparative study of an advanced skin imaging system in diagnosing facial pigmentary and inflammatory conditions

Visual assessment, while the primary method for pigmentation and erythema evaluation in clinical practice, is subjective, time-consuming, and may lead to variability in observations among clinicians. Objective and quantitative techniques are required for a precise evaluation of the disease's severity and the treatment's efficacy. This research examines the precision and utility of a newly developed skin imaging system in assessing pigmentation and erythema. Sixty participants were recruited, and their facial images were analyzed with the new OBSERV 520 x skin imaging system, compared to DERMACATCH for regional analysis and VISIA for full-face examination. The degree of skin pigmentation was clinically graded using the MASI scores evaluated by dermatologists. The data revealed positive correlations between the novel skin imaging system and the two conventional instruments in quantifying pigmentation and erythema, whether in regional or full-face analysis. Furthermore, the new skin imaging system positively correlated with the clinical MASI scores (r = 0.4314, P < 0.01). In contrast, our study found no significant correlation between the traditional system and clinical assessment, indicating a more substantial capacity for hyperpigmentation assessment in the new system. Our study validates the innovative skin imaging system's accuracy in evaluating pigmentation and erythema, demonstrating its feasibility for quantitative evaluation in both clinical and research purposes.

Double-blind, vehicle-controlled clinical investigation of peptide OS-01 for skin rejuvenation

INTRODUCTION

Senescent cells contribute to age-related tissue deterioration, including the skin, which plays important roles in overall health and social interactions. This study aimed to assess the effects of the senotherapeutic peptide, OS-01 (a.k.a. Pep 14), on skin.

METHODS

A 12-week split-face, double-blinded, vehicle-controlled study involving 22 participants was conducted. The OS-01-containing formulation was applied to one side of the face, while the other side received an identical control formulation lacking the peptide. Skin characteristics were assessed using instrumental measurements, expert clinical grading, and subjective questionnaires.

RESULTS

Results showed that the OS-01 formulation significantly improved one aspect of skin barrier function, as evidenced by reduced trans-epidermal water loss compared to both baseline and vehicle control. Expert grading and Antera 3D image analysis revealed a reduction in wrinkle appearance and indentation in the periorbital area, and improved skin texture and radiance on both sides of the face, with the OS-01-containing formulation demonstrating superior results. Participants also perceived improvements in skin hydration, smoothness, radiance, and overall appearance.

CONCLUSION

The findings suggest that the OS-01 formulation promotes skin health by strengthening the skin barrier, protecting against dehydration, reducing the appearance of wrinkles, and improving skin texture and radiance. These effects are likely attributed to the senotherapeutic properties of OS-01 in reducing cellular senescence and its associated detrimental effects.

Spectrophotometric evaluation of postmortem lividity: a proposal of a model for negroid ethnic race

The interpretation of tanatochronological data is a fundamental aspect of the medico legal diagnosis, because it allows to trace back the interval of death. Traditionally, the evaluation of the hypostasis plays a relevant role in the interpretation of such information, despite its well-known limits and fallacies. In order to evaluate the degree of hypostatic area discoloration, the methodology currently used is highly subjective and influenced by several variables. The hypostasis pattern in individuals with V-VI phototype is useless because their post-mortem lividity is not estimable due to the color of the skin. This makes much harder to estimate the interval between the death and the detection of the tanatochronological data. This study is aimed at defining a highly accurate procedure to develop an objective method to estimate the hypostasis' degree of fixation with scientific accuracy on people with darker skin. The technology used is spectrophotometry Antera3D: this device is able to analyse the hypostasis by measuring the mean hemoglobin quantitative level in the skin either before and after a standardized compression, thus obtaining a numerical value that is directly related to the time of death. The method here presented allows analysing the hemoglobin amount in the skin of a dead body, without the influence of the melanin pigment in the definition of the hypostatic area color, therefore enabling us to overcome the objective limits of the direct and empiric estimation of the hypostasis decoloration. By creating a standardized method it's possible to reduce the operator-dependent error and to introduce a valid and applicable procedure in order to estimate the post-mortem interval.

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.

New Regenerative and Anti-Aging Medicine Approach Based on Single-Stranded Alpha-1 Collagen for Neo-Collagenesis Induction: Clinical and Instrumental Experience of a New Injective Polycomponent Formulation for Dermal Regeneration

This study explores the efficacy of a novel polycomponent formulation (KARISMA Rh Collagen® FACE, Taumedika Srl, Rome, Italy), containing 200 mg/mL of non-crosslinked high-molecular-weight hyaluronic acid (HMW-HA), 200 μg/mL of a human recombinant polypeptide of collagen-1 alpha chain, and 40 mg/mL of carboxymethyl cellulose (CMC) as a regenerative medicine for skin regeneration and rejuvenation. This formulation combines non-crosslinked high-molecular-weight hyaluronic acid, human recombinant polypeptide of collagen-1 alpha chain, and carboxymethyl cellulose to stimulate collagen type I production and enhance skin hydration. This study involved 100 subjects with varying skin conditions, divided into three groups based on skin aging, smoking history, and facial scarring, to evaluate the product's effectiveness in skin regeneration and aesthetic improvement. The methodology included two injections of Karisma (2 mL for each injection) one month apart, with evaluations conducted using FACE-Q questionnaires, the SGAIS Questionnaire, and Antera 3D skin scanner measurements at baseline, 30 days, and 60 days post-treatment. The results demonstrated a significant reduction in skin roughness and an improvement in skin quality across all the groups, with no correlation between the outcomes and the patient's age. The subjective assessments also indicated high satisfaction with the treatment's aesthetic results. The analyzed data allow us to conclude that the single-stranded collagen with hyaluronic acid and carboxymethyl-cellulose formulation is able to stimulate the skin's regenerative response, yielding significant results both in vitro and, through our study, also in vivo. This new polycomponent formulation effectively stimulates skin regeneration, improving skin quality and texture, with significant aesthetic benefits perceived by patients, and a low incidence of adverse events, marking a promising advancement in regenerative medicine.

Safety and efficacy evaluation of botulinum toxin an injection by FITTER® microneedle to treat medial lower eyelid wrinkles

BACKGROUND

Treatment for medial lower eyelid wrinkles is in great demand now. However, conventional injection of botulinum toxin A (BTX-A) often leads to serious complications.

AIMS

We aim to evaluate the safety and efficacy of BTX-A injection with microneedle to treat medial lower eyelid wrinkles.

METHODS

We collected clinical data of 16 patients to treat dynamic wrinkles on the medial aspect of the lower eyelid. Adverse effects at each stage of the treatment were recorded. We used VISIA to compare the static and dynamic wrinkles of the medial lower eyelid before and after treatment. Furthermore, patients and physicians evaluated the wrinkles with Kappa scores.

RESULTS

All 16 patients completed the study. The objective evaluation indicator (the Ra variable given by VISIA) progressively and significantly decreased at 1 month and 3 months after treatment. The kappa scores given by patients and by surgeons were both significantly reduced after treatment. No adverse reactions, such as pouch prolapse, diplopia, and canthal tendon laxity, occurred at 1 week, 1 month, or 3 months after the treatment.

CONCLUSION

BTX-A treatment of medial lower eyelid wrinkles with microneedle injection allows better control of the injection depth and reduces both the amount of BTX-A needed and the incidence of complications while maintaining the natural dynamic expression.

Assessment of the reproducibility and accuracy of the Visia® Complexion Analysis Camera System for objective skin analysis of facial wrinkles and skin age

Objective

This study aimed to investigate the reproducibility and accuracy of the Visia® Complexion Analysis Camera System by Canfield Scientific for objective skin analysis.

Methods

Nineteen participants underwent facial capture with the Visia® camera following a standardised protocol. During the first session, the participants sat down and positioned their faces in a capture rig, closed their eyes and had their faces captured from the left, front and right sides, with threefold repetition of the captures from the front side. After 4 weeks, the participants underwent recapture in a similar manner. Based on the frontal views, data for two measurement methods of the Visia® camera system, the absolute scores and the percentiles, were obtained with regard to the skin criterion wrinkles via automated software calculation. Means and standard deviations were evaluated. Based on the side views, the data for the Truskin Ages® were calculated by the Visia® camera system and compared with the calendrical ages, which served as the gold standard for comparison.

Results

In the assessment of the reproducibility of the data of the capture system the standard deviation from the frontal captures among all participants was about 3% when the absolute scores of the wrinkles were compared with each other; specifically, the average deviation was 3.36% during the first capture session and 3.4% during the second capture session. Meanwhile, the standard deviation of the measurements was about 9% when the percentiles were compared; specifically, the average deviation was 8.2% during the first capture session and 10.7% during the second capture session. In the assessment of the accuracy the correlation between the calendrical age and the calculated Truskin Age® for both facial sides was very high at a correlation coefficient rho value of >0.8 (right side: r=0.896; left side: r=0.827) and statistically significant at a p-value of <0.001. The average calendrical age and Truskin Age® deviated only slightly from each other and did not differ significantly (right side: p=0.174; left side: p=0.190). The Truskin Age® was slightly higher than the calendrical age by a mean value of 1.37 years for both facial sides. The analysis of the absolute differences revealed that in 50% of the cases, there was a maximum difference of 3 years, and in 75% of the cases, there were maximum differences of 4.5 years for the right side and 5.5 years for the left side.

Conclusion

The assessment of the reproducibility and accuracy of the objective measurement method, the Visia® camera system, contributed to the validation of the system. The evaluation of the reproducibility revealed a satisfactory precision of the repeated captures when investigating facial wrinkles. Absolute scores should be preferred over percentiles owing to their better precision. The calculation of the accuracy of the Truskin Age® data from the Visia® camera system revealed only a slight deviation from the true calendrical ages. The correlation between both data groups was highly significant.

Detecting Skin Reactions in Epicutaneous Patch Testing with Deep Learning: An Evaluation of Pre-Processing and Modality Performance

Epicutaneous patch testing is a well-established diagnostic method for identifying substances that may cause Allergic Contact Dermatitis (ACD), a common skin condition caused by exposure to environmental allergens. While the patch test remains the gold standard for identifying allergens, it is prone to observer bias and consumes valuable human resources. Deep learning models can be employed to address this challenge. In this study, we collected a dataset of 1579 multi-modal skin images from 200 patients using the Antera 3D® camera. We then investigated the feasibility of using a deep learning classifier for automating the identification of the allergens causing ACD. We propose a deep learning approach that utilizes a context-retaining pre-processing technique to improve the accuracy of the classifier. In addition, we find promise in the combination of the color image and false-color map of hemoglobin concentration to improve diagnostic accuracy. Our results showed that this approach can potentially achieve more than 86% recall and 94% specificity in identifying skin reactions, and contribute to faster and more accurate diagnosis while reducing clinician workload.

Temporal and periorbital depressions identified by 3D images are correlated with malnutrition phenotypes in cancer patients: A pilot study

Background

Prompt diagnosis of malnutrition and appropriate interventions can substantially improve the prognosis of patients with cancer; however, it is difficult to unify the tools for screening malnutrition risk. 3D imaging technology has been emerging as an approach to assisting in the diagnosis of diseases, and we designed this study to explore its application value in identifying the malnutrition phenotype and evaluating nutrition status.

Methods

Hospitalized patients treating with maintenance chemotherapy for advanced malignant tumor of digestive system were recruited from the Department of Oncology, whose NRS 2002 score &gt; 3. Physical examination and body composition data of patients at risk for malnutrition were analyzed by physicians trained to complete a subjective global assessment. The facial depression index was recognized using the Antera 3D® system, temporal and periorbital depression indexes were acquired using the companion software Antera Pro. This software captures quantitative data of depression volume, affected area, and maximum depth of temporal and periorbital concave areas.

Results

A total of 53 inpatients with malnutrition-related indicators were included. The volume of temporal depression was significantly negatively correlated with upper arm circumference (r = −0.293, p = 0.033) and calf circumference (r = −0.285, p = 0.038). The volume and affected area of periorbital depression were significantly negatively correlated with fat mass index (r = −0.273, p = 0.048 and r = −0.304, p = 0.026, respectively) and percent body fat (r = −0.317, p = 0.021 and r = −0.364, p = 0.007, respectively). The volume and affected area of temporal depression in patients with muscle loss phenotype (low arm circumference/low calf circumference/low handgrip strength/low fat-free mass index) were significantly higher than those in patients without muscle loss. Moreover, patients with fat mass loss phenotype (low fat mass index) showed a significant increase in the volume and affected area of periorbital depression.

Conclusion

The facial temporal region, and periorbital depression indicators extracted by 3D image recognition technology were significantly associated with the phenotype of malnutrition-related muscle and fat loss and showed a trend of grade changes in the population of different subjective global assessment nutritional classifications.

Efficacy and safety of innovative acne scar serum in Indian patients (ESTEEM India study)

BACKGROUND

Scarring is a common and undesirable outcome of acne vulgaris. There are limited effective topical formulations for acne scar treatment. The investigational product, acne scar serum (HEXILAK® Acne Scar Serum) is latest topical formulation developed for treatment of acne scar with unique ingredients, Kollaren and Exo-T.

OBJECTIVE

Evaluate safety and efficacy of latest acne scar serum on the reduction of acne scars in Indian population.

MATERIALS AND METHODS

Subjects, diagnosed clinically with acne scars with or without hyperpigmentation, of either gender in the age group of 15 to 45 years were enrolled in the study. The investigational acne scar serum was applied twice daily for 3 months with monthly follow for outcome evaluation.

RESULTS

Out of 72 subjects enrolled, 67 completed the study. Most of the subjects, 79.1% showed improvement in acne scar at Day 90. Significant reduction of mean total post-acne hyperpigmentation index (PAHI) was seen at all follow up visits compared with baseline. Significant improvement in mean acne scar depth, mean acne scar volume, and mean L value using 3D imaging were observed at all visits compared with baseline. All side effects reported were mild and overall, it was well tolerated by all subjects.

CONCLUSION

We found that there was a significant reduction in acne scar and post-acne pigmentation with new acne scar serum as a monotherapy, this needs further confirmation in larger randomized controlled studies. Therefore, topical acne scar serum with unique ingredients Kollaren and Exo-T can be a safe, effective, and new option in the armamentarium of acne scar management.

Unparallel improvement patterns of dynamic wrinkles and skin quality after botulinum toxin type A treatment on the upper face

BACKGROUND

Botulinum toxin type A (BoNT-A) can not only reduce the dynamic wrinkles but also improve the skin quality. This study aims to quantitaively and comprehensively assess the improvement of dynamic wrinkles and skin quality following BoNT-A treatment on the upper face.

METHODS

Patients were recruited to receive BoNT-A treatment of the glabellar, frontal, and lateral periorbital wrinkles. Antera 3D camera was used to evaluate the skin quality and dynamic wrinkle severity. Follow-up visits were at 1 week, 1 month, 3 months, and 6 months after treatment. Different filters were utilized to quantitatively detect the severity of fine wrinkles (FWS), the volume of pores (PV), the roughness of skin texture (STR), and the severity of dynamic wrinkles (DWS).

RESULTS

Twenty-four participants (average 30.5 ± 7.2 years) were recruited. The significant improvement of PV, FWS, and STR in different areas usually maintained from 1 to 6 months after injections but of DWS only existed within 3 months. For each area, the improvement rates of FWS, PV, and STR peaked at 3 months or 6 months after treatment while the maximal improvement of DWS was observed at 1 month posttreatment.

CONCLUSION

After BoNT-A treatment for dynamic wrinkles on the upper face, the skin quality of target regions can also be ameliorated. The improvement of skin quality and dynamic wrinkles presented unparallel patterns. The former is with a slower onset but longer duration while the latter exhibits a more rapid onset but shorter duration.

Feasibility and Safety of Using Combined Light-Emitting Diodes Versus Intense Pulsed Light Technology for the Improvement of Facial Hypervascularization in Adult Patients

Background: Superficial facial vascular lesions can be an aesthetic problem and a symptom of different skin diseases. Objective: It was to compare the efficacy and safety profiles of Dermalux^® Tri-Wave MD, based on three combined light-emitting diodes (LEDs) technology and intense pulsed light (IPL) for reducing the excess of facial vascularization due to superficial cutaneous vascular lesions. Materials and methods: The study had a single-center, proof-of-concept, open-label, and prospective design. Two groups of adult patients were treated for facial hypervascularization, LED-Group with an LED device combining 633 and 830 nm and IPL-Group with an IPL (555-950 and 530-750 nm). Variables assessed were hemoglobin hyperconcentration (HH), hemoglobin-affected area (HAA) through Antera 3D^®, and pain using the Numeric Pain Rating Scale. Results: Twenty subjects were included, 10 by group (50% female). LED-Group: Mean age 32.1 years (range, 21-46). IPL-Group: Mean age 34.5 years (range, 25-49). HH: LED-Group 100% had a moderate improvement; in the IPL-Group, 10% was moderate, and 90% was marked. HAA: LED-Group 10% had a slight improvement, 70% moderate, and 20% marked; in the IPL-Group, 100%, the improvement was marked. Seventy percent of LED-Group patients reported no pain, 30% mild; in the IPL-Group, 100% of patients reported severe pain. Conclusions: Treatment with combined red and near-infrared LEDs effectively reduced the excess of facial vascularization with moderate outcomes compared with IPL, but without secondary effects and no pain. This treatment could represent an effective, safe, and well-tolerated approach for facial vascular lesions.

Effectiveness of combination therapy of broadband light and intradermal injection of tranexamic acid in the treatment of chloasma

OBJECTIVE

To investigate the efficacy and safety of broadband light (BBL) combined with intradermal injection of tranexamic acid for treating melasma.

METHODS

120 women with melasma admitted to our hospital from January 2021 to April 2022 were randomly categorized into the following groups: control group, treated with 250 mg tranexamic acid given orally twice daily, except during menstruation; group I, treated with BBL (Sciton, Inc., USA) monthly; group II, received intradermal injections of tranexamic acid monthly; and group III, treated with BBL with intradermal injection of tranexamic acid monthly. Treatment in each group lasted three months. The MASI (Melasma Area Severity Index) and VISIA (Canfield VISIA Complexion Analysis) were used for evaluation.

RESULTS

After treatment course, MASI scores and VISIA brown spot and red zone ranking improved in all four groups (p < 0.05). The decrease in MASI scores and improvement rates of VISIA brown spot and red zone rankings were not significantly different among the control group, group I, and group II; however, the decreased MASI scores and improvement rates of VISIA brown spot and red zone rankings were significantly higher in group III than in the other three groups (p < 0.05).

CONCLUSION

The effect of BBL combined with the intradermal injection of TA in the treatment of melasma is remarkable. This combination therapy can be an alternative and effective treatment for managing melasma.

Comparison of two devices for facial skin analysis

BACKGROUND

The use of quantitative measures to assess patients' skin has turned the subjective nature of dermatology into an objective one. These measures allow for more accurate diagnosis and improved monitoring of diseases. While there are many skin analysis devices available, they often require specific equipment to function and can be costly, limiting their clinical use.

AIMS

The aim of our study was to compare a new skin analysis device that is easy to incorporate into dermatologic practice to a standard validated device.

METHODS

We recruited 50 patients from dermatology clinics and analyzed their skin with two facial analysis systems: an online application that can be downloaded on either an iPad or iPhone, and a computer-based analysis system that utilizes a facial imaging photobooth. Scores were recorded and compared between the two devices for the following five skin characteristics; "spots," "wrinkles," "redness," "texture," and "pores."

RESULTS

The tablet and the computer analysis system had an agreement rate of 67.7%. The highest agreement was in assessing texture (72.0%) and pores (68.2%). The lowest agreeance was in assessing redness (64%) and wrinkles (67%). When assessing the relationship between patients' raw score for wrinkles and their age, there was a strong correlation with the tablet (r = 0.79, p < 0.0001) compared with the computer system (r = 0.26, p < 0.06).

CONCLUSIONS

The application utilized in our study may serve as a cost-effective and clinic friendly tool to assess patients' skin. It produces similar results to other skin analysis devices and may be more sensitive in detecting and quantifying wrinkles.

Novel neural network model for predicting susceptibility of facial post-inflammatory hyperpigmentation

BACKGROUND

To construct a neural network model (ATBP) for predicting susceptibility to Post-inflammatory hyperpigmentation (PIH), which is a rapid, objective, and reliable decision-support method before physical and chemical interventions in dermatology clinics for pigment disorders.

MATERIAL AND METHODS

A dataset was established based on the VISIA Skin Analysis System detection results of 1953 patients with pigment disorders including 93,477 labeled data under 8 indicators. A novel Post-inflammatory hyperpigmentation susceptibility prediction model incorporating Multi-head self-attention mechanism and Back-propagation neural network is proposed to capture the patterns of skin detection data to predict PIH susceptibility.

RESULTS

The results of comparison experiments indicate that Attentive BP (Back Propagation Neural Network) has a significant superiority in prediction accuracy (0.8604) compared with other machine learning models. The ablation experiments prove that the Multi-head self-attention mechanism substantially improves the accuracy and the stability of prediction. The results of the 10-fold cross-validation experiment prove that ATBP is robust and avoids turbulence in predicting.

CONCLUSION

Leveraging Multi-head self-attention mechanism and the architecture advantage of BPNN, the proposed model ATBP obtains the robust and efficient prediction performance in predicting PIH susceptibility via processing large-scale and hi-dimension data, i.e., considering comprehensive skin conditions of individual patient. It can be proved from the experimental results that the proposed model is reliable for decision-support work of PIH susceptibility.

Artificial Intelligence in Dermatology Image Analysis: Current Developments and Future Trends

BACKGROUND

Thanks to the rapid development of computer-based systems and deep-learning-based algorithms, artificial intelligence (AI) has long been integrated into the healthcare field. AI is also particularly helpful in image recognition, surgical assistance and basic research. Due to the unique nature of dermatology, AI-aided dermatological diagnosis based on image recognition has become a modern focus and future trend. Key scientific concepts of review: The use of 3D imaging systems allows clinicians to screen and label skin pigmented lesions and distributed disorders, which can provide an objective assessment and image documentation of lesion sites. Dermatoscopes combined with intelligent software help the dermatologist to easily correlate each close-up image with the corresponding marked lesion in the 3D body map. In addition, AI in the field of prosthetics can assist in the rehabilitation of patients and help to restore limb function after amputation in patients with skin tumors.

THE AIM OF THE STUDY

For the benefit of patients, dermatologists have an obligation to explore the opportunities, risks and limitations of AI applications. This study focuses on the application of emerging AI in dermatology to aid clinical diagnosis and treatment, analyzes the current state of the field and summarizes its future trends and prospects so as to help dermatologists realize the impact of new technological innovations on traditional practices so that they can embrace and use AI-based medical approaches more quickly.

Quantitative evaluation of sensitive skin by ANTERA 3D ® combined with GPSkin Barrier ®

BACKGROUND

At present, there are many different evaluation methods for sensitive skin, including subjective, semisubjective, and objective evaluation. Various objective tests focus on assessing changes in barrier functions. It is anticipated that the ANTERA 3D®, in combination with GPSkin Barrier®, will provide better evaluation of sensitive skin.

METHODS

A total of 20 subjects with sensitive skin and 20 healthy participants were recruited. Sensitive skin subjects were treated with an anti-sensitive moisturizing tolerance-extreme cream which has anti-inflammatory and moisturizing effects, twice daily on the whole face for 28 days. VISIA^® Skin Detector was used to record clinical images and red area. GPSkin Barrier^® was used to measure TEWL and SCH. Texture, hemoglobin, and influenced area (mm² ) were recorded using ANTERA 3D^® . Subjects underwent skin tests and recorded changes at D0 and D28. Data were only collected from healthy participants who did not receive treatment as controls.

RESULTS

TEWL, texture, hemoglobin, and affected area in sensitive skin group were significantly higher than those in healthy group, while SCH was significantly lower than that in healthy group (p all<0.05). After anti-inflammatory and moisturizing treatment, the texture, hemoglobin, and affected area of sensitive skin decreased, TEWL decreased while SCH increased (p all<0.05).

CONCLUSIONS

Based on the results, the combination of the ANTERA 3D^® with GPSkin Barrier^® could be used as a new kind of quantitative evaluation method for the detection and diagnosis of sensitive skin.

Spectrophotometric analysis of post-mortem lividity: A new objective measure to define time of death

The correct definition of time of death often represents a key to solving judicial cases. One of the methods for determination of the time interval since death is at present the quantitative and qualitative characteristics of hypostases. However, the simple observation of the degree and fixation of hypostases is based on nonobjective parameters, and is therefore characterized by an intrinsic variability that can compromise their reliability. The purpose of the present study was to define an objective and standardizable method that allows estimation of time since death with good approximation. To achieve this, the instrument used was based on spectrophotometry, to analyze only the hemoglobin contribution to skin color, while excluding the role of melanin. This made it possible to analyze a hypostatic area, with a numerical value defined as a measure of the hemoglobin content before and after application of standardized pressure for a defined time interval. The study was conducted on 100 cadavers in various wards. The variables considered in the study were: Hb-pre (mean hemoglobin measure before weight force application); Hb-post (mean hemoglobin measure after weight force application), ΔHb (change in mean hemoglobin measures from before to after weight force application); and red% Hb (percentage reduction in hemoglobin after weight force application, compared to the mean measure of hemoglobin before weight force application). The analysis showed statistically significant correlations between red% Hb in the skin area analyzed and time from death to examination. This provided a mathematical formula to estimate time since death with good reliability ( ± 4 h, 50 min).

Photothermal therapy using gold nanoparticles and a long-pulsed 755-nm alexandrite laser to treat facial photoaging in Asian skin: A prospective clinical trial

BACKGROUND AND OBJECTIVES

Transdermally delivered gold nanoparticles (AuNPs) irradiated with near-infrared laser energy can create a photothermal effect within the sebaceous glands (SGs). Photothermal therapy (PTT) can be used clinically to reverse photoaging in SG-rich areas of the skin. Improvements in wrinkles and enlarged pores in Asian skin were assessed following AuNP-mediated PTT with a long-pulsed 755-nm alexandrite laser.

STUDY DESIGN/MATERIALS AND METHODS

A single-arm, prospective trial was designed. Twenty Korean patients underwent three gold PTT interventions performed 4 weeks apart at laser hair-removal settings without cooling. At Week 20, changes in the wrinkle index (WI) and pore index (PI), size, and count were calculated using three-dimensional camera analyses. Overall improvements in wrinkles and pores (0-4 scale) were assessed by blinded investigators using standardized photographic comparisons. The subjects scored their satisfaction (0-10 scale) and treatment discomfort (0-10 scale). Safety data were also collected.

RESULTS

There were significant reductions in the WI (8.3%, p < 0.01), pore size (23.1%, p = 0.035), and PI (19.9%, p = 0.034) in the periorbital areas at week 20 compared with baseline. The mean reductions in the size (22.5%, p = 0.027), count (16.5%, p = 0.048), and index (22.4%, p = 0.023) of the cheek pores were also significant. Investigators reported average scores of 3.2 ± 0.6 for improved wrinkle appearance, and 3.1 ± 0.7 for improvement in visible pores. Participants were moderately satisfied with the overall results (7.6 ± 1.8). Subjects felt moderate discomfort during treatment (4.7 ± 2.6). No serious or persistent adverse events occurred.

CONCLUSIONS

AuNP-mediated PTT showed noticeable efficacy and tolerability in treating wrinkles and pores in Asian skin over a 12 week-follow-up. Further studies with a longer follow-up are needed to confirm the reduction in SG activity at the parameters used.

Forearm porphyrin levels evaluated by digital imaging system are increased in patients with systemic sclerosis compared with patients in pre-clinical stage

We hypothesized that changes in skin characteristics on the forearm could be useful for early diagnosis of systemic sclerosis (SSc). We used VISIA digital imaging system to investigate this possibility for the first time. Twenty-eight Japanese patients who were diagnosed with typical or very early diagnosis of SSc (VEDOSS) were enrolled in this study, and ten age- and gender-matched patients with other disorders were included as a control group. Eight skin characteristics were analyzed. Our method of evaluating forearm skin characteristics was shown to be reproducible. The scores of WRINKLES, TEXTURE, PORES, and PORPHYRINS were higher in SSc subjects with sclerotic forearm skin (SSc forearm+; 11.004, 5.116, 3.230, and 0.084, respectively) and those without (SSc forearm-: 11.915, 4.898, 2.624, 0.0616, respectively) than in the non-SSc control subjects (10.075, 4.496, 2.459, 0.0223, respectively). Also, the scores of SPOTS, TEXTURE, PORES, UV SPOTS, BROWN SPOTS, and PORPHYRINS were elevated in SSc forearm+ (3.182, 5.116, 3.230, 5.761, 6.704, 0.084, respectively) and SSc forearm- patients (2.391, 4.898, 2.624, 9.835, 5.798, 0.0616, respectively) compared with those with VEDOSS (2.362, 4.738, 2.234, 5.999, 4.898, 0.0169, respectively). We found statistical significance in the difference in score of PORPHYRINS between SSc forearm- and VEDOSS groups (p = 0.044), and between SSc forearm+ and VEDOSS groups (p = 0.012). Therefore, they can be used to differentiate VEDOSS from early or mild SSc cases, which is sometimes clinically problematic. Our study also suggests that the porphyrin research will lead to a better understanding of SSc pathogenesis.

Efficacy and safety of plasma gel versus platelet-rich plasma in periorbital rejuvenation: a comparative split-face clinical and Antera 3D camera study

BACKGROUND

Periorbital skin is the thinnest. That is why, it is the easiest to wrinkle and the most challenging to rejuvenate. Platelet-rich plasma (PRP) as well as plasma gel have been used for skin rejuvenation and considered relatively safe and effective.

METHODS

This split-face study was conducted on forty female patients seeking periorbital rejuvenation where PRP was injected in the right (Rt) side and plasma gel in the left (Lt) side, two treatment sessions 4 weeks apart (week 0 and week 4). Patients were followed up 2 weeks after each treatment session (week 2 and week 6) as well as 12 weeks after the last session (week 16) using both subjective [physician assessment through Global Aesthetic Improvement score (GAIS) and patient's satisfaction (Likert scale)] and objective [Antera 3D camera] assessment methods.

RESULTS

Both modalities yielded a significant improvement of periorbital wrinkles after the 2nd session, with significantly better results on the plasma gel injected side; however, the improvement achieved through both modalities could not be maintained for the following 3 months. Besides, objective assessment could not prove any improvement in periorbital hyperpigmentation.

CONCLUSION

Two sessions of both PRP and plasma gel are effective for periorbital rejuvenation, with plasma gel showing significantly better results. However, improvement was not maintained for 3 months.

Technique for analyzing the transfer of colored cosmetics onto face masks

BACKGROUND

With the rapid spread of COVID-19, the makeup trend in the cosmetics market is changing as mask-wearing has become a common practice. This study was conducted to establish an objective and reliable method for analyzing the transfer of colored cosmetics onto face masks.

METHODS

A total of 24 women participated in this test. The participants were requested to wear Korean Filter 94 masks after having applied colored cosmetics on their faces and lips. VISIA-CR was used to photograph the face, and a camera was used to photograph the mask, which had smeared the cosmetics. Each image was analyzed using the Image-pro^® 10 image analysis software.

RESULTS

Immediately after applying the cosmetics, the intensity of the face decreased and the redness of the lips increased when compared with the results 30 minutes after washing the face. After wearing a mask, the intensity increased and the redness decreased when compared with immediately after applying the cosmetics. The area before and after the colored cosmetics smeared onto the mask was increased.

CONCLUSION

It is expected that this study could be used as a reference for further experiments on analysis of methods for preventing mask stains.

Helium plasma dermal resurfacing: VISIA CR assessment of facial spots, pores, and wrinkles-Preliminary findings

Objectives

Effects of low energy, single‐pass helium plasma dermal resurfacing (PDR) treatment on brown spots, enlarged pores, and wrinkles—preliminary findings.

Methods

Twenty two subjects (64.6 ± 6.6 years) with Fitzpatrick Wrinkle and Elastosis Scale score (FWS) of ≤2 and seeking improvement of facial appearance were included in this subanalysis. All subjects received a single, one‐pass, full face, and low power helium PDR treatment. Standard digital images were collected using the VISIA‐CR (Canfield Scientific Inc.) at baseline and 3 months after treatment with images assessed for improvement in FWS and for improvements in brown spots, enlarged pores, and wrinkles by proprietary automated image processing algorithms.

Results

Nearly all subjects demonstrated ≥1‐point improvement in FWS and also reported improvement per modified Global Aesthetic Improvement Scale query. The numbers of brown spots and enlarged pores decreased by 45.1% and 28.3%, respectively. Stratification of brown spots data by presence or absence of post‐inflammatory hyperpigmentation revealed paradoxically conflicting data. The improvement detected in wrinkle area and mean wrinkle thickness was less pronounced with overall reductions of 13.4% and 4.8%, respectively. 37 Non‐serious adverse events (AEs) in 22 subjects were reported with most resolving within 14 days or less, and no serious AEs were observed.

Conclusions

While longer‐term follow‐up is needed, these early study results show that one single‐pass, low energy helium PDR treatment improves facial skin appearance both qualitatively and quantitatively. Studies evaluating higher energy levels and multiple treatment passes are ongoing.

Facial UV photo imaging for skin pigmentation assessment using conditional generative adversarial networks

Skin pigmentation is associated with skin damages and skin cancers, and ultraviolet (UV) photography is used as a minimally invasive mean for the assessment of pigmentation. Since UV photography equipment is not usually available in general practice, technologies emphasizing pigmentation in color photo images are desired for daily care. We propose a new method using conditional generative adversarial networks, named UV-photo Net, to generate synthetic UV images from color photo images. Evaluations using color and UV photo image pairs taken by a UV photography system demonstrated that pigment spots were well reproduced in synthetic UV images by UV-photo Net, and some of the reproduced pigment spots were difficult to be recognized in color photo images. In the pigment spot detection analysis, the rate of pigment spot areas in cheek regions for synthetic UV images was highly correlated with the rate for UV photo images (Pearson's correlation coefficient 0.92). We also demonstrated that UV-photo Net was effective for floating up pigment spots for photo images taken by a smartphone camera. UV-photo Net enables an easy assessment of pigmentation from color photo images and will promote self-care of skin damages and early signs of skin cancers for preventive medicine.

A prospective comparative study of radiotherapy effect upon scar quality

INTRODUCTION

The effect of radiation on uncomplicated postoperative scars is unclear. This study aimed to analyze irradiated and non-irradiated scars in patients with unilateral breast cancer, who underwent oncoplastic breast reduction surgery and radiation therapy (RT), to identify how postoperative scar changes with radiation.

METHODS

Twenty breast scars in 10 patients were analyzed after unilateral breast-conserving surgery, oncoplastic breast reduction, and RT. Scars were assessed using the Vancouver scar scale (VSS) by two independent blinded observers and three-dimensional scar analysis camera. Paired t-test between irradiated and non-irradiated scars in each patient and correlation of scar score differences with potential contributing factors were analyzed.

RESULTS

The VSS was significantly lower for the irradiated scar than that for the non-irradiated contralateral scar (1.40 vs. 4.05, p = 0.001), although time interval from the last radiation to scar assessment had a negative correlation with paired differences of VSS (Spearman's correlation coefficient: -0.637, p = 0.048). Compared with the non-irradiated scar, the irradiated scar showed a significantly high level of hemoglobin (1.04 vs. 1.26, p = 0.017) and melanin (0.55 vs. 0.63, p = 0.03).

CONCLUSIONS

Postoperative scars with radiation showed better results in objective and subjective assessments than scars without radiation. These findings suggest that radiation has a positive effect on general scar maturation.

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.

Instrumental diagnosis of facial skin-A necessity or a pretreatment recommendation in esthetic medicine

Background

This paper presents the possibilities of pretreatment instrumental diagnosis for assessing the condition of various facial skin areas.

Aim

Tests which aimed at determining the firmness and elasticity of facial skin were conducted.

Methods

Analysis of skin parameters in selected facial areas in adults over a wide age range was performed using the Cutometer Dual MPA 580 probe. Parameters R0, R2, R5, R7, R8, and R9 were analyzed.

Results

The following results were obtained: R0 (0.20‐0.33) mm; R2 (0.66‐0.82) a.u.; R5 (0.60‐0.92) a.u.; R7 (0.37‐0.52) a.u.; R8 (0.10‐0.27) mm; and R9 (0.03‐0.05) mm. The R0 parameter showed no statistically significant correlation between skin firmness and age. On the basis of the other parameters, it can be concluded that skin elasticity and an ability to return to its original shape around the eyes, on the cheeks and around the lips, are greater in younger patients than in older groups. There were no statistically significant differences within each age group between the right and left sides of the face.

Conclusion

Skin firmness described by the R0 parameter is constant in the studied groups and independent of age. Skin elasticity, and an ability to return to its original shape around the eyes, on the cheeks and around the lips, is greater in younger patients. The aging process simultaneously affects the entire facial skin.

Combined therapy with Endoret-Gel and plasma rich in growth factors vs Endoret-Gel alone in the management of facial rejuvenation: A comparative study

BACKGROUND

Skin suffers progressive decrement. An endogenous regenerative technology has been developed that has the versatility to provide an autologous injectable gel (Endoret-Gel) or a liquid plasma rich in growth factors (PRGF) based on the patient´s own platelet-rich plasma.

AIMS

To compare the efficacy of the combined therapy with Endoret-Gel and PRGF versus Endoret-Gel alone in the management of facial rejuvenation.

METHODS

Twenty clinically diagnosed patients with aged skin received either Endoret-Gel monotherapy or Endoret-Gel + PRGF combined therapy. Patients underwent three sessions at one-month intervals and were clinically assessed for six months. Corneometry, sebumetry, and high-resolution topographic analysis were carried out. Patient self-assessment questionnaires and clinical improvement scores were also performed.

RESULTS

The combined therapy showed to promote a higher hydration index. These results were also significant for spot improvement at three months, while conversely, monotherapy with Endoret-Gel demonstrated higher UV spot improvement. A significant decrease of sebum production and wrinkle development was observed for both treatment groups. Red areas also improved in a similar way at the end of the follow-up period. After Endoret-Gel or Endoret-Gel + PRGF therapy, 30% and 70% of patients referred to be very satisfied, respectively. Accordingly, 40% and 80% showed a "very improved" esthetic performance. None of the patients reported a negative change and no adverse events were recorded.

CONCLUSION

Both Endoret-Gel monotherapy and the combined treatment with PRGF were shown to promote facial rejuvenation and to palliate the age-related cutaneous atrophy. The combined therapy may exert a synergistic effect that addresses both skin quality improvement and soft tissue restoration in a shorter period.

Comparative analysis of skin characteristics evaluation by a dermatologist and the Janus-III measurement system

BACKGROUND

The Janus-III measurement system evaluates the overall skin characteristics such as skin pore, wrinkle, sebum, porphyrin, skin pigmentation, and skin color using high-resolution facial images. The values are measured from five different facial areas, namely, the forehead, nose, corner of/skin below the eyes, and cheeks. Owing to its convenience and diverse measuring characteristics, Janus-III has been widely used in skin research and the cosmetic industry in Korea. In our previous study, we revealed the consistency and reliability of the system with repeatedly measured values. Its measuring performance was investigated statistically, but to make it more reliable for academic skin research, additional verification by a professional dermatologist is needed.

MATERIALS AND METHODS

In this study, we conducted comparative analysis of three skin characteristics (pigmented spot, skin color, and eye wrinkle) by a dermatologist and the Janus-III measurement system. We utilized 330 image data that were cropped from the whole facial images of 330 different participants to avoid correlation among the three measuring items. Pearson's correlation coefficient exhibited similar patterns between the system and the dermatologist's findings.

RESULTS

The main finding of our study was that the measured value of skin characteristics by the Janus-III system showed clear correlation with the values evaluated by a dermatologist, especially in a pigmented spot.

CONCLUSION

Therefore, it would be a plausible idea to consider the Janus-III system for specialized research of skin characteristics even with a small sample size.

A new method for skin aging evaluation of Chinese women

BACKGROUND

With the development of cosmetic industry in China, an aging evaluation method of Chinese women is in great need.

AIMS

The aim of this study is to establish a skin aging assessment method using convenient portable machine Antera 3D.

METHODS

The quantitative approach was developed by capturing 11 areas of the face, and overall, 48 parameters were extracted for aging evaluation. Later, 297 subjects were recruited to take facial image and life style questionnaire. Evaluation of age was accomplished by establishing prediction method with detected skin traits.

RESULTS

The age prediction model was built by using the evaluated facial traits, and a R square of 0.6 is achieved by comparing to the chronological age. The crow's feet, cheek skin pigmentation, forehead skin tone, and wrinkles around the month are critical factors in evaluating Chinese women skin aging. In addition, we also explored life styles associated with important skin aging traits.

CONCLUSION

The method developed in this research provides reliable alternative in aging study of Chinese women.

Analysis of facial redness by comparing VISIA® from Canfield and CSKIN® from Yanyun Technology

BACKGROUND

Redness is the most common symptom among many facial dermatoses. With the rapid development of optical instruments, spectral imaging, and image processing technology, there appear varieties of skin color analysis methods and instruments. The aim of this study is to reveal the differences and correlations in measuring the facial redness between CSKIN^® and VISIA^® , as well as the relevance between the instrument parameters and clinical evaluation.

MATERIALS & METHODS

Forty-three Chinese patients were enrolled. Images were taken and analyzed by VISIA^® from Canfield and CSKIN^® from Yanyun Technology, and the facial erythema was graded by the dermatologists.

RESULTS

Feature counts within the red areas measured by VISIA^® were found to have significantly positive correlations with red pixels and percent which were measured by CSKIN^® on both sides of the face (r = .45 ~ .566, P < .01). The parameters analyzed by CSKIN^® and VISIA^® feature counts were correlated with visual scores graded by the dermatologists, VISIA^® presented with a weak correlation (r = .213, P < .05), while CSKIN^® had a moderate correlation with the visual scores (r = .472 ~ .492, P < .001).

CONCLUSION

CSKIN^® may be another alternative option when encountering with measurement and follow-up of facial erythema.

Skin Quality Improvement With VYC-12, a New Injectable Hyaluronic Acid: Objective Results Using Digital Analysis

BACKGROUND

VYC-12 is a novel hyaluronic acid-based dermal filler designed to treat fine lines and improve skin quality. A specialist digital camera and proprietary Digital Analysis of the Cutaneous Surface (DACS) software have previously been used to objectively measure changes in skin features.

OBJECTIVE

To assess the effect of facial treatment with VYC-12 on skin texture using the specialist camera.

MATERIALS AND METHODS

This was a prospective, open-label, 2-center study of 40 women aged 35 to 60 years treated with multiple, microdepot intradermal injections of VYC-12 (2 mL in the face; 1 mL in the neck if required). Eight patients (20.0%) required a touch-up at Day 45. Images were acquired using the specialist camera at baseline and 45 days and 6 months after treatment, and were analyzed by DACS. Clinical improvements were also assessed subjectively using the Global Aesthetic Improvement Scale (GAIS).

RESULTS

VYC-12 improved skin texture from baseline after 45 days (mean improvement: 25.9% ± 9.2%) and 6 months (mean improvement: 30.7% ± 18.2%). Improvements were also evident using the GAIS. There were no major adverse events.

CONCLUSIONS

VYC-12 improves skin quality, as measured using an objective, fast, and reproducible measuring tool. VYC-12 represents a valuable addition to the treatment armamentarium.

Hyperspectral imaging enabled by an unmodified smartphone for analyzing skin morphological features and monitoring hemodynamics

We propose a novel method and system that utilizes a popular smartphone to realize hyperspectral imaging for analyzing skin morphological features and monitoring hemodynamics. The imaging system works based on a built-in RGB camera and flashlight on the smartphone. We apply Wiener estimation to transform the acquired RGB-mode images into "pseudo"-hyperspectral images with 16 wavebands, covering a visible range from 470nm to 620nm. The processing method uses weighted subtractions between wavebands to extract absorption information caused by specific chromophores within skin tissue, mainly including hemoglobin and melanin. Based on the extracted absorption information of hemoglobin, we conduct real-time monitoring experiments in the skin to measure heart rate and to observe skin activities during a vascular occlusion event. Compared with expensive hyperspectral imaging systems, the smartphone-based system delivers similar results but with very-high imaging resolution. Besides, it is easy to operate, very cost-effective and has a wider customer base. The use of an unmodified smartphone to realize hyperspectral imaging promises a possibility to bring a hyperspectral analysis of skin out from laboratory and clinical wards to daily life, which may also impact on healthcare in low resource settings and rural areas.

An Open-Label Single-Arm, Monocentric Study Assessing the Efficacy and Safety of Natural Pterostilbene (Pterocarpus marsupium) for Skin Brightening and Antiaging Effects

BACKGROUND

Both intrinsic and environmental factors play a role in premature ageing of the skin. Natural extracts have been extensively used to reduce the signs of ageing in recent years. Pterostilbene is a natural analog of resveratrol with therapeutic properties against numerous diseases mainly due to its ability to reduce reactive oxygen species.

METHODS

We studied the anti-aging and skin brightening effect of a 0.4% formulation of natural pterostilbene in healthy volunteers (N=38) in an open-label, single-arm, monocentric study for 8 weeks. The melanogenesis inhibitory, anti-tyrosinase and anti-collagenase and anti-elastase properties of pterostilbene were evaluated in vitro.

RESULTS

Natural pterostilbene showed significant inhibition of melanogenesis in vitro. Pterostilbene cream (0.4%) was highly effective in reducing markers of aging and induces even skin tone. The product was effective in reducing wrinkles and fine lines, improved skin hydration elasticity and showed no adverse effects.

CONCLUSION

Our results suggest that natural pterostilbene is a safe and effective ingredient for use in cosmetic preparation to reduce the markers of skin ageing and brighten the skin tone.

TRIAL REGISTRATION

Clinical Trial Registration India Identifier CTRI/2019/01/017160 [Registered on 18/01/2019].

An image-based mapping of significance and relevance of facial skin colour changes of females living in Thailand

Objective

There are methods to evaluate skin colour on defined areas over the face but no approach automatically and accurately evaluates skin colour variations on large facial areas, comparing subjects, treatments and/or time points. We propose such an image‐based approach to visualize quickly the outcome of clinical studies on colour variations.

Methods

Among 54 Asian women, one group applied a vehicle twice daily, during 28 days, and the other group an anti‐ageing emulsion, taking facial images at baseline and after treatment. Changes in L*a*b* values were studied on four pre‐selected facial regions. We also reconstructed average facial images from which the L*a*b* parameters were extracted for every pixel, computing relevance (ΔE) and significance data. Using colour gradients, we mapped these results onto the average facial images.

Results

After treatment, L*a*b* parameters show no statistically relevant colour changes in the vehicle group. In the ‘active’ group, skin was lighter at the upper cheek and, overall, redness decreased. Relevance and significance maps confirmed no visible colour changes in the vehicle group. In the ‘active’ group, the mapping approach revealed colour changes and their location. Skin became lighter below the eye, cheek and forehead. It was less red below the eyes, on the cheek, jawline and forehead, and generally more yellow.

Conclusion

Our image‐based mapping approach proves to be powerful. It enables us to identify precise facial regions of relevant and statistically significant colour changes after a topical treatment, regions that would have otherwise been undetected.

Repeated measurements of facial skin characteristics using the Janus-Ⅲ measurement system

BACKGROUND

For personalized skin care, noninvasive quantitative methods to evaluate facial skin characteristics are important. Janus-III is one of the most widely used imaging analysis devices in the skin care industry in Korea. Janus-III generates values for a range of skin characteristics. Due to the convenience of obtaining results for a variety of skin characteristics in a single measurement, the use of Janus-III in cosmetic stores and research institutes has been recently increasing. However, the consistency of skin measurements of Janus-III has not been elucidated yet.

MATERIALS AND METHODS

In this study, we repeated skin measurements three times for 70 different subjects and compared each numerical value in order to assess the consistency of the Janus-III. For this purpose, we compared between-sample distances and within-sample distances.

RESULTS

We found important patterns for future analyses in terms of consistency. First, the average values of skin measurement categories were more reliable than individual part values of facial segments. Second, center part values such as forehead and nose were more reliable than side part values such as left and right part segments.

CONCLUSION

If researchers who use Janus-III for studies of facial characteristics analyze average and center part values first, they can obtain relatively reliable patterns of facial skin characteristics.

The efficacy and safety of microneedle monopolar radiofrequency for the treatment of periorbital wrinkles

BACKGROUND

Treatment of periorbital wrinkles is a challenging task because of its anatomical significance and delicate nature.

OBJECTIVE

The aim of this study was to evaluate the efficacy and safety of a microneedle monopolar radiofrequency (RF) device for treating periorbital wrinkles.

METHODS AND MATERIALS

This retrospective study involved 21 patients who were treated for periorbital wrinkles using a RF device. The type of microneedle used, clinical photography, VISIA wrinkle score, and adverse events were collected from the medical chart. Two independent dermatologists assessed the photographs.

RESULTS

There were 18 female and 3 male patients with a mean age of 50.24 years. The severity of wrinkle was improved according to photographic assessment and VISIA wrinkle score at 6-month post-treatment. When 21 sites treated with a long microneedle (LMN, 1.5 mm) and the other 21 sites treated with a short microneedle (SMN, 0.8 mm) were compared, significant improvement in the VISIA wrinkle score was observed only in those treated with the LMN. No serious adverse events, including scarring and postinflammatory hyperpigmentation, occurred.

CONCLUSIONS

We demonstrated the efficacy and safety of the microneedle monopolar RF device in treating periorbital wrinkles. The LMN was superior to the SMN in reducing VISIA wrinkle score.

A dose-ranging, parallel group, split-face, single-blind phase II study of light emitting diode-red light (LED-RL) for skin scarring prevention: study protocol for a randomized controlled trial

BACKGROUND

Skin fibrosis is a significant global health problem that affects over 100 million people annually and has a profoundly negative impact on quality of life. Characterized by excessive fibroblast proliferation and collagen deposition, skin fibrosis underlies a wide spectrum of dermatologic conditions ranging from pathologic scars secondary to injury (e.g., burns, surgery, trauma) to immune-mediated diseases. Effective anti-scarring therapeutics remain an unmet need, underscoring the importance of developing novel approaches to treat and prevent skin fibrosis. Our in vitro data show that light emitting diode-red light (LED-RL) can modulate key cellular and molecular processes involved in skin fibrosis. In two phase I clinical trials (STARS 1 and STARS 2), we demonstrated the safety and tolerability of LED-RL at fluences of 160 J/cm² up to 480 J/cm² on normal human skin.

METHODS/DESIGN

CURES (Cutaneous Understanding of Red-light Efficacy on Scarring) is a dose-ranging, randomized, parallel group, split-face, single-blind, mock-controlled phase II study to evaluate the efficacy of LED-RL to limit post-surgical skin fibrosis in subjects undergoing elective mini-facelift surgery. Thirty subjects will be randomly allocated to three treatment groups to receive LED-RL phototherapy or temperature-matched mock irradiation (control) to either periauricular incision site at fluences of 160 J/cm², 320 J/cm², or 480 J/cm². Starting one week post-surgery (postoperative days 4-8), treatments will be administered three times weekly for three consecutive weeks, followed by efficacy assessments at 30 days, 3 months, and 6 months. The primary endpoint is the difference in scar pliability between LED-RL-treated and control sites as determined by skin elasticity and induration measurements. Secondary outcomes include clinical and photographic evaluations of scars, 3D skin imaging analysis, histological and molecular analyses, and adverse events.

DISCUSSION

LED-RL is a therapeutic modality of increasing importance in dermatology, and has the potential to limit skin fibrosis clinically by decreasing dermal fibroblast activity and collagen production. The administration of LED-RL phototherapy in the early postoperative period may optimize wound healing and prevent excessive scarring. The results from this study may change the current treatment paradigm for fibrotic skin diseases and help to pioneer LED-RL as a safe, non-invasive, cost-effective, portable, at-home therapy for scars.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03795116 . Registered on 20 December 2018.

3D Mammometric Changes in the Treatment of Idiopathic Gynecomastia

BACKGROUND

Three-dimensional surface imaging (3DSI) has shown promise for plastic surgeons to objectively assess changes in body contour and breast volume.

OBJECTIVES

To assess the surgical outcome after bilateral subcutaneous mastectomy (BSM) and water jet-assisted liposuction (WAL) as treatment for idiopathic gynecomastia, using 3DSI to document changes regarding nipple-areolar complex (NAC) and breast volume.

METHODS

Thirty male patients (Simon II A to B) receiving BSM and WAL were enrolled. Eight subjects received additional mastopexy and NAC reduction. Use of a Vectra 3D Imaging System^® before and 6 months after surgery provided data regarding changes of NAC placement and NAC and breast dimensions. The sum volume of intraoperatively approximated lipoaspirate before and after centrifugation and mastectomy specimens quantified using water displacement were compared with 3D-assessed differences in volume.

RESULTS

When compared to the NAC dimensions defined during surgery, patients receiving NAC reductions showed nonsignificant postoperative changes in NAC dimensions. Patients without additional mastopexy showed a significant (p < 0.001) vertical (15.7 ± 14.3%) and horizontal (17.1 ± 15.0%) reduction in NAC diameter. 3D volume changes (92.8 ± 26.4 mL) showed significant differences (p < 0.001) 6 months after surgery compared to the intraoperatively measured lipoaspirate before (182 ± 54.5 mL) and after (120 ± 34.6 mL) centrifugation.

CONCLUSION

Although it is clear that patient satisfaction must remain the prime focus of surgical body contouring, 3DSI has proven valuable to objectively demonstrate both the anticipated outcome and further findings regarding treatment of idiopathic gynecomastia.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Anti-Wrinkle Efficacy of Cross-Linked Hyaluronic Acid-Based Microneedle Patch with Acetyl Hexapeptide-8 and Epidermal Growth Factor on Korean Skin

Background

Hyaluronic acid (HA)-based microneedle patch has recently been studied for wrinkle improvement. Cross-linked HA (CLHA) is widely used in dermal fillers. Acetyl hexapeptide-8 (AHP-8) and epidermal growth factor (EGF) are used for cosmetic ingredients.

Objective

This study aimed to verify the efficacy of the CLHA/HA-based patch with microstructure (microneedle patch) containing AHP-8 or EGF.

Methods

A total of 52 Korean females were enrolled in a double-blind, randomized, controlled, split-face trial. The subjects were divided into 3 groups: (1) microneedle patch alone, (2) microneedle patch/AHP-8, and (3) microneedle patch/EGF. The treatment was applied on the periorbital and nasolabial fold area for 4 hours to completely dissolve the microstructures once per week for 29 days. Evaluations, including photodamage scoring, image analysis with Antera 3D® (Miravex, Ireland), skin hydration measurement, and adverse effect assessments, were performed at each visit.

Results

Fifty subjects (96.2%) completed this clinical study. On day 29 after application, statistically significant improvements in wrinkle and skin hydration were observed in all groups (p<0.01). Treatment with microneedle patch/AHP-8 and microneedle patch/EGF showed statistically significant improvements in wrinkle compared with microneedle patch alone (p<0.05). No serious adverse effects were noted.

Conclusion

Combination of CLHA-based microneedle patch and functional cosmetic ingredients can improve wrinkle with minimal discomfort.