MAL Daylight Photodynamic Therapy for Actinic Keratosis: Clinical and Imaging Evaluation by 3D Camera

An Actinic Keratosis Auxiliary Diagnosis Method Based on an Enhanced MobileNet Model

Actinic keratosis (AK) is a common precancerous skin lesion with significant harm, and it is often confused with non-actinic keratoses (NAK). At present, the diagnosis of AK mainly depends on clinical experience and histopathology. Due to the high difficulty of diagnosis and easy confusion with other diseases, this article aims to develop a convolutional neural network that can efficiently, accurately, and automatically diagnose AK. This article improves the MobileNet model and uses the AK and NAK images in the HAM10000 dataset for training and testing after data preprocessing, and we performed external independent testing using a separate dataset to validate our preprocessing approach and to demonstrate the performance and generalization capability of our model. It further compares common deep learning models in the field of skin diseases (including the original MobileNet, ResNet, GoogleNet, EfficientNet, and Xception). The results show that the improved MobileNet has achieved 0.9265 in accuracy and 0.97 in Area Under the ROC Curve (AUC), which is the best among the comparison models. At the same time, it has the shortest training time, and the total time of five-fold cross-validation on local devices only takes 821.7 s. Local experiments show that the method proposed in this article has high accuracy and stability in diagnosing AK. Our method will help doctors diagnose AK more efficiently and accurately, allowing patients to receive timely diagnosis and treatment.

Fractional carbon dioxide laser versus combined fractional CO2 laser and platelet rich plasma in treatment of facial wrinkles: A comparative split face study

BACKGROUND

Wrinkles are the most visible sign in skin aging and for which many people seek different aesthetic procedures. Treatment options varies from invasive to non-invasive procedures. Combining platelet rich plasma and fractional carbon dioxide laser (CO₂ ) has been used frequently for showing promising results in treating photoaged skin generally and wrinkles specifically since the microscopic thermal zones created by the fractional laser facilitates the delivery of the plasma into the dermis which aids the process of collagen induction and skin rejuvenation.

AIM OF THE WORK

To compare and assess the clinical efficacy of fractional CO₂ laser alone versus combined fractional CO₂ laser and platelet rich plasma in treatment of facial rhytides (in terms of size, depth, and overall appearance).

SUBJECTS AND METHODS

Twenty-six female patients were selected and each face was split into 2 halves a control side (Laser + saline) and an experimental side (Laser + platelet rich plasma). Treatment plan was 1 laser session per month for a total of 4 sessions. Clinical objective evaluation was done by the Antera camera in addition to assessment by two blinded dermatologists.

RESULTS

The combined treatment was as effective in improving wrinkles as fractional CO₂ laser alone. Antera camera scores showed statistical significance in overall wrinkles measurements on each side equally.

CONCLUSION

Both treatment modalities gave optimum cosmetic results with no significant difference noticed when compared with each other, although overall satisfaction with wrinkles and skin were statistically greater than the initial satisfaction scores.

The objective evaluation of triamcinolone acetonide efficacy in keloids management using Antera3D® imaging system

Background

Keloids are pathological scars characterized by nodular fibrous tissue that extends beyond the border of initial damage. These lesions do not spontaneously regress and can cause cosmetic disfigurements and functional disabilities. IntraLesional Injection of Triamcinolone Acetonide (ILITA), alone or in combination with other therapy, is one of the first-line treatment modalities. In this study the authors evaluated the objective efficacy of ILITA treatment in keloids management using this new imaging system.

Materials and Methods

37 patients with 45 keloid scars were treated with intralesional injection of triamcinolone acetonide (TAC) 20 mg/ml at an interval of three weeks. Antera3D® camera took the images and dates of the treated area in each patient, before the treatment (T0) and at three weeks after the last injection (T1). The system processed the levels of color, elevations, melanin and hemoglobin expression. All the scars were also evaluated, at the same times, by validated Vancouver Scar Scale (VSS). Comparison of the variables was performed using a Wilcoxon signed-rank test with a p < 0.05.

Results

At T0, mean VSS score was 8.67 ± 1.35 which reduced to 3.62 ± 1.72 at final follow up. Antera3D® scores were statistically significant differences in color (8.14 ± 2.41 vs 9.54 ± 1.81), protrusion (381.3 ± 15.6 vs 198.6 ± 21.3), melanin (0.53 ± 0.02 vs 0.62 ± 0.2) and hemoglobin (1.26 ± 0.41 vs 2.21 ± 0.41) expression levels after the treatment.

Conclusions

In our clinical trial, the data results demonstrated that ILITA seems to be effective in reducing keloid dimensions and symptoms such as itching and pain, even if the treatment has local minimal adverse effects such as pain, telangiectasias and atrophy.

Lay Summary

Keloids are pathological scars characterized by nodular fibrous tissue that extends beyond the border of initial damage. Large keloids can cause cosmetic disfigurements and functional disabilities that affect quality of life. In literature, several treatment approaches have been described but, to date, no single method is considered superior. The International Advisory Panel on Scar Management recommended the use of intralesional steroid injections for keloids treatment. The efficacy of treatment may be evaluated with subjective scale; as no one can guarantee an objective evaluation. To eliminate the observer and/or patient factors, and to obtain a reliable, consistent, feasible, valid and objective evaluation a skin analysis camera system called Antera3D® (Miravex, Dublin, Ireland) can be used.In this study the authors evaluated the objective efficacy of triamcinolone acetonide treatment in keloids management using this imaging system. In this series, for Antera3D® scores there were statistically significant differences in color, protrusion, melanin and hemoglobin expression levels before and after treatment. The device directly shows the treatment changes, measured objectively and accurately, without bias of traditional evaluation scoring scale.Antera3D® system guarantees an objective evaluation of effectiveness of scar treatment enabling clinicians to modulate the therapy according to the scores registered.

Evaluation of the effectiveness of the use of Postacnetin gel in the therapy of the postacne symptom complex using the device ANTERA 3D

Background. The postacne symptom complex occurs in the outcome of vulgar acne in 40% of cases. Recently, there has been a tendency to grow up acne. Currently, there are many methods in the arsenal of a dermatologist and a cosmetologist for correcting post-acne elements, but most of the procedures for correcting postacne elements have age restrictions, some of the procedures are accompanied by severe pain and the presence of a rehabilitation period, and the economic component of these procedures is also of great importance. Therefore, for the treatment of the post-acne symptom complex, there should be methods that are highly effective and accessible to patients. In most cases, the assessment of the clinical effectiveness of treatment is subjective, both for the doctor and for the patient. Photo documentation is also not in all cases a reliable way to represent the quality and effectiveness of treatment. Consequently, the use of hardware methods for quantifying the severity of disease indicators to confirm the effectiveness of treatment increases the patient's compliance. Aims. Evaluation of the effectiveness of Postacnetin gel in the treatment of postacne symptom complex, using the ANTERA 3D device. Materials and methods. 12 patients aged 18 to 28 years with the presence of postacne symptoms were under observation. The study was conducted on the basis of the Department of Dermatovenereology of SibSMU and the medical center Estetik in Tomsk. During the entire study period, patients applied Postacnetin gel to one half of the face. Treatment regimen: Postaknetin gel was applied in a thin layer, point-by-point on the postakne elements 2 times a day. The duration of treatment was 28 days. To assess the clinical effectiveness, photo documentation, three-dimensional analysis of the skin surface on the ANTERA 3D device and statistical analysis were performed. Results. The average level of redness in 12 patients on the side of using Postacnetin gel before the study was 117.200 0.424, 1 month after using the gel, there was a significant decrease in the level of the indicator to 95.900 0.849 (р 0.05). The average value of the pigmentation level before using the Postacnetin gel and 1 month after use was 56.950 0.919 and 46.600 0.424, respectively (р 0.05). This indicates a significant decrease in the level of pigmentation. The average value of the volume index before the study was 9.350 0.212, after 28 days the volume index decreased to 6.750 0.071, respectively (р 0.05). Conclusions. As a result of the conducted research, it was established with the help of the ANTERA 3D device that the use of Postacne gel for 28 days leads to a regression of the indicators of postacne elements.

Non-Invasive Analysis of Actinic Keratosis before and after Topical Treatment Using a Cold Stimulation and Near-Infrared Spectroscopy

Background and objectives: The possible evolution of actinic keratoses (AKs) into invasive squamous cell carcinomas (SCC) makes their treatment and monitoring essential. AKs are typically monitored before and after treatment only through a visual analysis, lacking a quantitative measure to determine treatment effectiveness. Near-infrared spectroscopy (NIRS) is a non-invasive measure of the relative change of oxy-hemoglobin and deoxy-hemoglobin (O₂Hb and HHb) in tissues. The aim of our study is to determine if a time and frequency analysis of the NIRS signals acquired from the skin lesion before and after a topical treatment can highlight quantitative differences between the AK skin lesion area. Materials and Methods: The NIRS signals were acquired from the skin lesions of twenty-two patients, with the same acquisition protocol: baseline signals, application of an ice pack near the lesion, removal of ice pack and acquisition of vascular recovery. We calculated 18 features from the NIRS signals, and we applied multivariate analysis of variance (MANOVA) to compare differences between the NIRS signals acquired before and after the therapy. Results: The MANOVA showed that the features computed on the NIRS signals before and after treatment could be considered as two statistically separate groups, after the ice pack removal. Conclusions: Overall, the NIRS technique with the cold stimulation may be useful to support non-invasive and quantitative lesion analysis and regression after a treatment. The results provide a baseline from which to further study skin lesions and the effects of various treatments.

AK-DL: A Shallow Neural Network Model for Diagnosing Actinic Keratosis with Better Performance Than Deep Neural Networks

Actinic keratosis (AK) is one of the most common precancerous skin lesions, which is easily confused with benign keratosis (BK). At present, the diagnosis of AK mainly depends on histopathological examination, and ignorance can easily occur in the early stage, thus missing the opportunity for treatment. In this study, we designed a shallow convolutional neural network (CNN) named actinic keratosis deep learning (AK-DL) and further developed an intelligent diagnostic system for AK based on the iOS platform. After data preprocessing, the AK-DL model was trained and tested with AK and BK images from dataset HAM10000. We further compared it with mainstream deep CNN models, such as AlexNet, GoogLeNet, and ResNet, as well as traditional medical image processing algorithms. Our results showed that the performance of AK-DL was better than the mainstream deep CNN models and traditional medical image processing algorithms based on the AK dataset. The recognition accuracy of AK-DL was 0.925, the area under the receiver operating characteristic curve (AUC) was 0.887, and the training time was only 123.0 s. An iOS app of intelligent diagnostic system was developed based on the AK-DL model for accurate and automatic diagnosis of AK. Our results indicate that it is better to employ a shallow CNN in the recognition of AK.

Resurfacing with Ablation of Periorbital Skin Technique: Indications, Efficacy, Safety, and 3D Assessment from a Pilot Study

OBJECTIVES AND BACKGROUND

Nowadays, several approaches for skin rejuvenation of the lower eyelid are available. We present a new technique of resurfacing with ablation of periorbital skin (RAP) performed in a single session.

METHODS

This is a retrospective study involving 20 patients showing skin elastosis with or without evidence of the nasojugal fold and atrophic and dyschromic skin or needing a combined approach of transconjuntival lower blepharoplasty for fat bag removal. RAP technique is assessed in terms of efficacy, safety, and 3D evaluation of results at 6 months' follow-up.

RESULTS

Global Assessment Improvement Scale results highlighted an improvement in all cases, for both physicians (blinded to treatment) and individual subjects. Only minor adverse events (edema, erythema, and discoloration) were reported in almost all patients, lasting 2-3 weeks after treatment, and were resolved without intervention. A 3D imaging tool revealed the reduction of medium protrusions and depressions and an improved texture at 2 months. Skin recovery was inversely correlated with hemoglobin reduction.

CONCLUSIONS

RAP seems to offer expert dermatologists a safe and clinically effective technique for skin rejuvenation of lower eyelids, without significant adverse events. Further studies will be performed to confirm our results.

Photodynamic therapy for actinic keratosis: Is the European consensus protocol for daylight PDT superior to conventional protocol for Aktilite CL 128 PDT?

BACKGROUND

Topical photodynamic therapy (PDT) is an established treatment modality for various dermato-oncologic conditions. In Europe, initially requiring irradiation with red light, PDT of actinic keratosis (AK) can now also be carried out with exposure to daylight that has been clinically proven to be as effective as and less painful than red light.

OBJECTIVES

In this paper, we propose a comparison between the conventional protocol for Aktilite CL 128 (red light source) PDT and the European consensus protocol for daylight PDT - with the exposure is assumed to be performed during either a clear sunny day or an overcast day - in the treatment of AK with methyl aminolevulinate through a mathematical modeling.

METHOD

This already published modeling that is based on an iterative procedure alternating determination of the local fluence rate and updating of the local optical properties enables to estimate the local damage induced by the therapy.

RESULTS

The European consensus protocol for daylight PDT during a sunny day and an overcast day provides, on average, 6.50 and 1.79 times higher PDT local damages at the end of the treatment than those obtained using the conventional protocol for Aktilite CL 128 PDT, respectively.

CONCLUSIONS

Results analysis shows that, even performed during an overcast day, the European consensus protocol for daylight PDT leads to higher PDT local damages than the efficient conventional protocol for Aktilite CL 128.

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

BACKGROUND

The skin imaging analysis instruments are widely used to record and measure the surface and subsurface skin conditions. The main aim of this study is to reveal the differences and correlations in measuring wrinkle, skin texture, coloration/evenness, vascular features, and pore between two commercially available instruments.

METHODS

Twenty-eight subjects were enrolled in the study. A 2*2 cm cardboard was used to make sure the two instruments analyze the same area. Pictures were taken and analyzed by the VISIA^® from Canfield and the ANTERA 3D^® CS from Miravex, in sequence.

RESULTS

The spot, ultraviolet spot, brown spot, red area, texture values measured with VISIA^® were positively correlated with age, while the pore and wrinkle values showed no significance. The wrinkle, texture, melanin, hemoglobin, pore index, pore volume values measured with ANTERA 3D^® had a significantly positive correlation with age. The spot, brown spot values from VISIA^® were positively correlated with the melanin value from ANTERA 3D^® . Texture value measured with the two instruments revealed positive linear correlation. Strong correlation was found between the red area value from VISIA^® and the hemoglobin value from ANTERA 3D^® . Ultraviolet spot from VISIA^® showed no linear correlation with the melanin value from ANTERA 3D^® . Neither of the wrinkle and pore measured with the two instruments showed linear correlation.

CONCLUSIONS

ANTERA 3D^® relies on multidirectional illumination obtained by LEDs of different wavelengths from different directions which make it advanced at the qualitative evaluation of various dermatologic conditions. Compared with VISIA^® , ANTERA 3D^® is more sensitive in the assessment of wrinkle and it may also be available to evaluate the aging-related enlarged pore.