Effectiveness of VISIA system in evaluating the severity of rosacea

Analysis of the use of digital technologies in the preliminary diagnosis of dermatological diseases: a systematic review

Dermatological diseases are a significant global health concern, and advanced technologies have demonstrated considerable potential to improve the diagnosis and treatment of these conditions. The overall objective of this systematic review is to analyze and evaluate the use of preliminary digital diagnostic technologies in the field of dermatological diseases. The PRISMA methodology was used to collect approximately 50 products to support the article. The results obtained reveal several key findings. First, we investigate for which dermatological diseases these specialized technologies are used, finding that conditions such as skin cancer, rosacea and acne are the most diagnosed using advanced tools. Second, the technologies used to improve preliminary diagnosis are explored, with neural networks standing out, contributing to more accurate and efficient diagnosis. Third, the benefits of these technologies are evaluated, highlighting diagnostic accuracy, early detection and improved quality of patient care. In conclusion, this review highlights the crucial role of technologies in dermatology, not only improving diagnostic accuracy and treatment efficiency, but also optimizing resources and improving the patient experience.

Different Pathways of Skin Aging: Objective Instrumental Evaluation

Background/Objectives: Hypertrophic and atrophic skin aging represent two distinct phenotypes: hypertrophic aging is marked by deep wrinkles and a leathery texture, whereas atrophic aging is characterized by overall skin thinning, increased vascularity, and a higher risk of non-melanoma skin cancers. This study aims to elucidate the characteristics and differences between hypertrophic and atrophic facial aging subtypes using two non-invasive imaging devices: VISIA® and dynamic optical coherence tomography (D-OCT). Methods: We retrospectively evaluated patients who had presented to the outpatient dermatological clinic at Policlinico Umberto I hospital in Rome, Italy for a non-invasive facial imaging check-up. We included 40 patients aged 60-75 who were imaged with VISIA® and dynamic optical coherence tomography (D-OCT). Based on the number of UV spots and amount of red found on VISIA®, subjects were grouped into four subgroups (PIGM, RED, CONTROL, PIGM + RED), and trends among them were analyzed. Results: We found a strong correlation between VISIA® red area scores and D-OCT vascular density at 300 µm depth, confirming VISIA®'s effectiveness for assessing facial vascularity. Wrinkle count was highest in areas with UV spots, particularly in the PIGM and PIGM + RED groups. Conversely, low attenuation coefficients and dermal density were observed in regions with low UV spots but high red areas. Intermediate subgroups (CONTROL and PIGM + RED) displayed varying parameters. Conclusions: Non-invasive imaging devices are effective in evaluating facial aging and distinguishing between aging subtypes. This study identified two intermediate aging types in addition to the hypertrophic and atrophic subtypes.

Pilot Study: Single-depth Superficial Ultrasound with Subdermal Injections of Diluted Calcium Hydroxylapatite for Improving Lower Face Skin Quality

Background

The lower face can be challenging to treat. We assessed the effectiveness of combining single-depth superficial microfocused ultrasound with visualization (MFU-V, Ultherapy; Merz North America, Inc. Raleigh, N.C.) and subdermal injections of diluted calcium hydroxylapatite (CaHA, Radiesse; Merz North America, Inc. Raleigh, N.C.) in a single session for improving skin quality in the lower face.

Methods

This study enrolled women with moderate-to-severe fine lines and skin unevenness on the lower face who desired nonsurgical intervention. Single-depth MFU-V treatment (10 MHz/1.5 mm) was followed by subdermal injections of diluted (1:1) CaHA. Subjects were followed up for 24 weeks posttreatment. Objective skin quality assessments (Rv: wrinkle depth; R3z: skin unevenness) were performed using LifeViz Micro (QuantifiCare, Sophia Antipolis, France). Subjective assessments included the modified Fitzpatrick Wrinkle Scale visual analog scale, Global Aesthetic Improvement Scale, and global satisfaction scale.

Results

Twelve subjects completed the study. The mean Rv value, mean R3z value, and mean modified Fitzpatrick Wrinkle Scale visual analog scale score improved significantly from baseline to week 24 (mean differences: -0.0321 mm, -0.0684 mm, -1.1667; all P < 0.001). All subjects were rated by the investigators as having demonstrated improvement in their overall aesthetic appearance as early as week 4. All subjects were "very satisfied" or "satisfied" with their treatment from week 12 onwards. No unexpected adverse events were reported.

Conclusions

Combination treatment with single-depth superficial MFU-V and diluted CaHA in a single session significantly improved lower facial skin quality, as assessed by both objective and subjective outcome measures.

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.

The mechanism and application of computer-assisted full facial skin imaging systems

Computer-assisted full facial imaging systems are currently among the most widely used skin analysis instruments in dermatology and medical cosmetology. These systems offer objective quantitative evaluation of facial skin conditions, and as they are non-invasive, play an important role in assessing dermatological conditions such as pigmentation, inflammation, vascular diseases, skin texture, the severity of ageing, and therapeutic follow-up. Although computer-assisted full facial imaging systems enable quantitative analysis in the scope of medical treatment and cosmetic evaluation, their results may considerably vary because of the influence of environmental and postural factors for improper operation. Furthermore, manual observation is sometimes necessary for experimental work for more accuracy, and familiarity with the imaging principles and application points is necessary to best apply this technique. This report aims to discuss and interpret these systems' imaging mechanisms and explore the primary issues with their application.

Clinical characteristics of the well-defined upper eyelid vascular network pattern in patients with rosacea

BACKGROUND

Rosacea is a chronic inflammatory skin disease. The diagnosis is based on the symptoms and physical signs, which still lacks objective laboratory tests or imaging tests.

OBJECTIVES

To propose and evaluate the upper eyelid network pattern in rosacea.

METHODS

Participants included patients diagnosed with rosacea, other facial erythematous skin diseases, and normal controls, all of whom underwent full-face imaging utilizing the VISIA® system software. According to these images, researchers evaluated the condition of the upper eyelid vascular network, developed the grading scale and then compared the difference of distribution in the three groups.

RESULTS

The occurrence rate of upper eyelid vascular network in rosacea was significantly higher than that in other facial erythematous skin diseases (84.3 vs. 32.0%, P < 0.001) and normal controls (84.3 vs. 28.0%, P < 0.001). The upper eyelid vascular network pattern was proposed (none [no clearly reticular vessels], mild [10-50% area of reticular vessels], moderate-to-severe [>50% area of reticular vessels]). Moderate-to-severe grade was defined as well-defined upper eyelid vascular network pattern, which was specific to patients with rosacea (rosacea vs. other facial erythematous skin diseases, adjusted odds ratio [aOR] = 5.814, 95% confidence interval [CI]: 3.899-8.670) (rosacea vs. heathy controls, aOR = 12.628, 95% CI: 8.334-19.112). The severity of the well-defined pattern had no significant association with age, duration, and phenotypes of rosacea (P > 0.05).

CONCLUSION

The well-defined upper eyelid vascular network pattern specifically appeared in patients with rosacea, which could be a possible clue to the diagnosis of rosacea.

The clinical efficacy of a new emulsion for acne and conspicuous facial pore amelioration

BACKGROUND

Oily skin is a common concern in the field of dermatology due to its association with excessive sebum production, acne, blackheads, and enlarged facial pores. Therefore, it is in great demand to develop effective cosmetics to manage oily skin.

OBJECTIVES

To evaluate the clinical efficacy of a novel emulsion containing niacinamide, lens esculenta seed extract, and white willow bark extract for oily skin.

METHODS

The efficacy of a novel emulsion was evaluated through a 56-day clinical trial. The clinical efficacy of the product to ameliorate acne, blackheads, and conspicuous facial pores was assessed on 30 subjects with oily skin by VISIA, PRIMOS, professional dermatologist evaluations, and subject self-assessment.

RESULTS

In the clinical trial, the participants showed high satisfaction with the emulsion's efficacy, reporting significant improvement in skin sebum secretion, acne, facial pores, and blackheads. The efficacy of the novel emulsion was further validated through VISIA and PRIMOS measurements, along with professional dermatologist evaluations.

CONCLUSION

Our results showed that the novel emulsion containing three active ingredients could effectively improve acne, blackheads, and conspicuous facial pores.

Combining protection with skin health: In vivo studies of an innovative gelatin/tannic acid-based hydrogel patch to prevent PPE-related skin lesions

The prolonged use of Personal Protective Equipment (PPE) can lead to skin problems due to persistent pressure, friction, and tension. This issue has prompted the exploration of solutions to protect the skin while maintaining the effectiveness of the PPE. This study aimed to evaluate the in vivo effectiveness of a gelatin/tannic acid-based hydrogel patch positioned beneath a mask to alleviate skin damage resulting from mask-wearing. To understand the pressure exerted by PPE, in vitro tests were conducted to measure the tensile strength of three types of facial masks. The FFP2 masks exhibited the highest tensile strength and were selected for subsequent in vivo biometric investigations. Biometric parameters were evaluated using the Flir E50bx® thermographic camera, Corneometer®, MoistureMap®, Sebumeter®, Tewameter®, and VISIA® systems. The results showed that when the hydrogel patch was used under the mask, there were no significant differences in facial skin temperature, sebum levels, or TEWL values (p > 0.05). However, a statistically significant increase in skin hydration and a decrease in frontal redness (p < 0.05) were observed. Consumer acceptance was assessed through sensory analysis questionnaires. In summary, the observed attenuation of physiological changes in the facial area and the positive consumer feedback suggest that this polymeric film-forming system is a simple yet effective solution to prevent PPE use-related skin issues.

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.

Deep learning-based optical approach for skin analysis of melanin and hemoglobin distribution

SIGNIFICANCE

Melanin and hemoglobin have been measured as important diagnostic indicators of facial skin conditions for aesthetic and diagnostic purposes. Commercial clinical equipment provides reliable analysis results, but it has several drawbacks: exclusive to the acquisition system, expensive, and computationally intensive.

AIM

We propose an approach to alleviate those drawbacks using a deep learning model trained to solve the forward problem of light-tissue interactions. The model is structurally extensible for various light sources and cameras and maintains the input image resolution for medical applications.

APPROACH

A facial image is divided into multiple patches and decomposed into melanin, hemoglobin, shading, and specular maps. The outputs are reconstructed into a facial image by solving the forward problem over skin areas. As learning progresses, the difference between the reconstructed image and input image is reduced, resulting in the melanin and hemoglobin maps becoming closer to their distribution of the input image.

RESULTS

The proposed approach was evaluated on 30 subjects using the professional clinical system, VISIA VAESTRO. The correlation coefficients for melanin and hemoglobin were found to be 0.932 and 0.857, respectively. Additionally, this approach was applied to simulated images with varying amounts of melanin and hemoglobin.

CONCLUSION

The proposed approach showed high correlation with the clinical system for analyzing melanin and hemoglobin distribution, indicating its potential for accurate diagnosis. Further calibration studies using clinical equipment can enhance its diagnostic ability. The structurally extensible model makes it a promising tool for various image acquisition conditions.

Objectively quantifying facial erythema in rosacea aided by the ImageJ analysis of VISIA red images

BACKGROUND

Facial erythema, a prominent characteristic of rosacea, causes concern to both the patient and doctor. In clinical practice, commonly used erythema severity subjective assessment tools lack objectivity and are less comprehensive. Even with images taken by the VISIA^® system, diffused erythema is difficult to segment and evaluate fully due to the automatic threshold segmentation method. This study aimed to explore a more objective and scientific erythema quantification tool with the aid of the ImageJ software analysis of the red area images taken by the VISIA^® system.

MATERIALS AND METHODS

Patients with rosacea were enrolled and assessed for the clinical severity of their illness using various stools-the standard grading systems (SGS) for rosacea, investigator's global assessment (IGA), and clinician's erythema assessment (CEA). Facial images in the red area mode of the VISIA^® system were further analyzed by the ImageJ for the relative intensity of redness and percentage of erythema area; the correlation with the scores of the subjective grading systems was evaluated.

RESULTS

This study included 201 patients (195 females and 6 males). The relative intensity of redness was positively correlated to the SGS, IGA, and CEA scores (0.688, 0.725, and 0.718, respectively) (p < 0.001). The percentage of erythema area was positively correlated to the SGS, IGA, and CEA scores (0.615, 0.666, and 0.656, respectively) (p < 0.001).

CONCLUSION

We demonstrated a more objective and precise method of assessing the severity of facial erythema rosacea, which could comprehensively assess the severity by both the area and intensity of facial erythema.