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Background: Our previous studies have demonstrated that Raman spectroscopy could be used for skin cancer detection with good sensitivity and specificity. The objective of this study is to determine if skin cancer detection can be further improved by combining deep neural networks and Raman spectroscopy. Patients and methods: Raman spectra of 731 skin lesions were included in this study, containing 340 cancerous and precancerous lesions (melanoma, basal cell carcinoma, squamous cell carcinoma and actinic keratosis) and 391 benign lesions (melanocytic nevus and seborrheic keratosis). One-dimensional convolutional neural networks (1D-CNN) were developed for Raman spectral classification. The stratified samples were divided randomly into training (70%), validation (10%) and test set (20%), and were repeated 56 times using parallel computing. Different data augmentation strategies were implemented for the training dataset, including added random noise, spectral shift, spectral combination and artificially synthesized Raman spectra using one-dimensional generative adversarial networks (1D-GAN). The area under the receiver operating characteristic curve (ROC AUC) was used as a measure of the diagnostic performance. Conventional machine learning approaches, including partial least squares for discriminant analysis (PLS-DA), principal component and linear discriminant analysis (PC-LDA), support vector machine (SVM), and logistic regression (LR) were evaluated for comparison with the same data splitting scheme as the 1D-CNN. Results: The ROC AUC of the test dataset based on the original training spectra were 0.886±0.022 (1D-CNN), 0.870±0.028 (PLS-DA), 0.875±0.033 (PC-LDA), 0.864±0.027 (SVM), and 0.525±0.045 (LR), which were improved to 0.909±0.021 (1D-CNN), 0.899±0.022 (PLS-DA), 0.895±0.022 (PC-LDA), 0.901±0.020 (SVM), and 0.897±0.021 (LR) respectively after augmentation of the training dataset (p<0.0001, Wilcoxon test). Paired analyses of 1D-CNN with conventional machine learning approaches showed that 1D-CNN had a 1-3% improvement (p<0.001, Wilcoxon test). Conclusions: Data augmentation not only improved the performance of both deep neural networks and conventional machine learning techniques by 2-4%, but also improved the performance of the models on spectra with higher noise or spectral shifting. Convolutional neural networks slightly outperformed conventional machine learning approaches for skin cancer detection by Raman spectroscopy.
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We developed an automated microregistration method that enables repeated in vivo skin microscopy imaging of the same tissue microlocation and specific cells over a long period of days and weeks with unprecedented precision. Applying this method in conjunction with an in vivo multimodality multiphoton microscope, the behavior of human skin cells such as cell proliferation, melanin upward migration, blood flow dynamics, and epidermal thickness adaptation can be recorded over time, facilitating quantitative cellular dynamics analysis. We demonstrated the usefulness of this method in a skin biology study by successfully monitoring skin cellular responses for a period of two weeks following an acute exposure to ultraviolet light.
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Piel , Humanos , Piel/citología , Piel/diagnóstico por imagen , Rayos Ultravioleta , Rastreo Celular/métodos , Proliferación Celular , Movimiento Celular , Microscopía de Fluorescencia por Excitación Multifotónica/métodos , Microscopía/métodosRESUMEN
A coherent anti-Stokes Raman scattering (CARS)-based multimodality microscopy system was developed using a single Ti:sapphire femtosecond laser source for biological imaging. It provides three complementary and co-registered imaging modalities: CARS, MPM (multiphoton microscopy), and RCM (reflectance confocal microscopy). The imaging speed is about 1 frame-per-second (fps) with a digital resolution of 1024 × 1024 pixels. This microscopy system can provide clear 2-dimensional and 3-dimensional images of ex-vivo biological tissue samples. Its spectral selection initiates vibrational excitation in lipid cells (approximately 2850â cm-1) using two filters on the pump and Stokes beam paths. The excitation can be tuned over a wide spectral range with adjustable spectral filters. The imaging capability of this CARS-based multimodal microscopy system was demonstrated using porcine fat, murine skin, and murine liver tissue samples.
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BACKGROUND: Psoralen + ultraviolet-A (PUVA) is associated with photocarcinogenesis. However, carcinogenic risk with other ultraviolet phototherapies remains unclear. OBJECTIVE: Evaluate whether phototherapy without psoralens increases skin cancer risk. METHODS: Retrospective cohort study of patients treated at a teaching-hospital phototherapy center (1977-2018). Skin cancer records were validated against pathology reports. Age-standardized incidence rates (ASIRs) of skin cancer were evaluated for gender, skin phototype, diagnosis, ultraviolet modality, anatomical site; and compared to provincial population incidence rates (2003). RESULTS: In total, 3506 patients treated with broadband-ultraviolet-B, narrowband-UVB and/or combined UVAB were assessed with a mean follow-up of 7.3 years. Majority of patients had psoriasis (60.9%) or eczema (26.4%). Median number of treatments was 43 (1-3598). Overall, 170 skin cancers (17 melanoma, 33 squamous cell carcinoma and 120 basal cell carcinoma) occurred in 79 patients. Patient-based and tumor-based ASIR of skin cancer was 149 (95% CI: 112-187)/100,000 and 264 (219-309)/100,000 person-years, respectively. There was no significant difference between tumor-based ASIRs for melanoma, squamous cell carcinoma, and basal cell carcinoma compared to the general population; or in phototherapy patients with-psoriasis or eczema; or immunosuppressants. No cumulative dose-response correlation between UVB and skin cancer was seen. LIMITATIONS: Treatment and follow-up duration. CONCLUSION: No increased risk of melanoma and keratinocyte cancer was found with phototherapy.
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Carcinoma Basocelular , Carcinoma de Células Escamosas , Eccema , Furocumarinas , Melanoma , Psoriasis , Neoplasias Cutáneas , Terapia Ultravioleta , Humanos , Incidencia , Melanoma/etiología , Melanoma/complicaciones , Estudios Retrospectivos , Terapia Ultravioleta/efectos adversos , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/etiología , Fototerapia/efectos adversos , Psoriasis/complicaciones , Carcinoma Basocelular/etiología , Carcinoma Basocelular/complicaciones , Carcinoma de Células Escamosas/etiología , Carcinoma de Células Escamosas/complicaciones , Eccema/complicacionesRESUMEN
BACKGROUND: The treatment of vitiligo can be challenging and depends on several factors such as the subtype, disease activity, vitiligo extent, and treatment goals. Vitiligo usually requires a long-term approach. To improve the management of vitiligo worldwide, a clear and up-to-date guide based on international consensus with uniform stepwise recommendations is needed. OBJECTIVES: To reach an international consensus on the nomenclature and to develop a management algorithm for the diagnosis, assessment, and treatment of vitiligo. METHODS: In this consensus statement, a consortium of 42 international vitiligo experts and four patient representatives participated in online and live meetings to develop a consensus management strategy for vitiligo. At least two vitiligo experts summarized the evidence of topics included in the algorithms. A survey was utilized to resolve remaining issues among a core group of eight experts. Subsequently, the unanimous recommendations were finalized and validated based on further input from the entire group during two live meetings. RESULTS: The algorithms highlight the importance of shared decision-making. Dermatologists are encouraged to provide patients with detailed explanations of the prognosis and expected therapeutic outcomes based on clinical examination. The treatment goal should be discussed and clearly emphasized to patients given the different approaches for disease stabilization and repigmentation. The evaluation of disease activity remains a cornerstone in the tailor-made approach to vitiligo patients. CONCLUSIONS: These new treatment algorithms are intended to guide clinical decision-making in clinical practice. Promising novel therapies for vitiligo are on the horizon, further highlighting the need for reliable outcome measurement instruments and greater emphasis on shared decision-making.
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Vitíligo , Humanos , Vitíligo/diagnóstico , Vitíligo/terapia , Consenso , Algoritmos , Toma de Decisiones Clínicas , Encuestas y CuestionariosRESUMEN
BACKGROUND: The treatment of vitiligo can be challenging. Up-to-date agreed consensus recommendations on the use of topical and systemic therapies to facilitate the clinical management of vitiligo are currently lacking. OBJECTIVES: To develop internationally agreed-upon expert-based recommendations for the treatment of vitiligo. METHODS: In this consensus statement, a consortium of 42 international vitiligo experts and four patient representatives participated in different online and live meetings to develop a consensus management strategy for vitiligo. At least two vitiligo experts summarized the evidence for different topics included in the algorithms. A survey was then given to a core group of eight experts to resolve the remaining issues. Subsequently, the recommendations were finalized and validated based on further input from the entire group during two live meetings. RESULTS: The recommendations provided summarize the latest evidence regarding the use of topical therapies (steroids, calcineurin inhibitors and Jak-inhibitors) and systemic therapies, including steroids and other systemic immunomodulating or antioxidant agents. The different modalities of phototherapies (NB-UVB, photochemotherapy, excimer devices and home phototherapy), which are often combined with other therapies, are also summarized. Interventional approaches as well as depigmentation strategies are presented for specific indications. Finally, the status of innovative and targeted therapies under development is discussed. CONCLUSIONS: This international consensus statement culminated in expert-based clinical practice recommendations for the treatment of vitiligo. The development of new therapies is ongoing in vitiligo, and this will likely improve the future management of vitiligo, a disease that still has many unmet needs.
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Fotoquimioterapia , Terapia Ultravioleta , Vitíligo , Humanos , Vitíligo/terapia , Vitíligo/tratamiento farmacológico , Fototerapia , Esteroides/uso terapéutico , Resultado del Tratamiento , Terapia CombinadaRESUMEN
BACKGROUND/PURPOSE: A recent direction in skin disease classification is to develop quantitative diagnostic techniques. Skin relief, colloquially known as roughness, is an important clinical feature. The aim of this study is to demonstrate a novel polarization speckle technique to quantitatively measure roughness on skin lesions in vivo. We then calculate the average roughness of different types of skin lesions to determine the extent to which polarization speckle roughness measurements can be used to identify skin cancer. METHODS: The experimental conditions were set to target the fine relief structure on the order of ten microns within a small field of view of 3 mm. The device was tested in a clinical study on patients with malignant and benign skin lesions that resemble cancer. The cancer group includes 37 malignant melanomas (MM), 43 basal cell carcinomas (BCC), and 26 squamous cell carcinomas (SCC), all categories confirmed by gold standard biopsy. The benign group includes 109 seborrheic keratoses (SK), 79 nevi, and 11 actinic keratoses (AK). Normal skin roughness was obtained for the same patients (301 different body sites proximal to the lesion). RESULTS: The average root mean squared (rms) roughness ± standard error of the mean for MM and nevus was equal to 19 ± 5 µm and 21 ± 3 µm, respectively. Normal skin has rms roughness of 31 ± 3 µm, other lesions have roughness of 35 ± 10 µm (AK), 35 ± 7 µm (SCC), 31 ± 4 µm (SK), and 30 ± 5 µm (BCC). CONCLUSION: An independent-samples Kruskal-Wallis test indicates that MM and nevus can be separated from each of the tested types of lesions, except each other. These results quantify clinical knowledge of lesion roughness and could be useful for optical cancer detection.
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Carcinoma Basocelular , Carcinoma de Células Escamosas , Queratosis Actínica , Melanoma , Nevo , Enfermedades de la Piel , Neoplasias Cutáneas , Humanos , Neoplasias Cutáneas/patología , Carcinoma Basocelular/diagnóstico por imagen , Carcinoma Basocelular/patología , Melanoma/diagnóstico por imagen , Melanoma/patología , Carcinoma de Células Escamosas/diagnóstico por imagenRESUMEN
Non-invasive optical methods for cancer diagnostics, such as microscopy, spectroscopy, and polarimetry, are rapidly advancing. In this respect, finding new and powerful optical metrics is an indispensable task. Here we introduce polarization memory rate (PMR) as a sensitive metric for optical cancer diagnostics. PMR characterizes the preservation of circularly polarized light relative to linearly polarized light as light propagates in a medium. We hypothesize that because of well-known indicators associated with the morphological changes of cancer cells, like an enlarged nucleus size and higher chromatin density, PMR should be greater for cancerous than for the non-cancerous tissues. A thorough literature review reveals how this difference arises from the anomalous depolarization behaviour of many biological tissues. In physical terms, though most biological tissue primarily exhibits Mie scattering, it typically exhibits Rayleigh depolarization. However, in cancerous tissue the Mie depolarization regime becomes more prominent than Rayleigh. Experimental evidence of this metric is found in a preliminary clinical study using a novel Stokes polarimetry probe. We conducted in vivo measurements of 20 benign, 28 malignant and 59 normal skin sites with a 660â nm laser diode. The median PMR values for cancer vs non-cancer are significantly higher for cancer which supports our hypothesis. The reported fundamental differences in depolarization may persist for other types of cancer and create a conceptual basis for further developments in polarimetry applications for cancer detection.
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BACKGROUND: Biases inherent in self-assessment of sun exposure and sun-safe behavior may lead to inaccurate conclusions about the effectiveness of sun-safety educational programs. OBJECTIVES: We aimed to compare self-reports to objective measures of sun exposure, when examining the effectiveness of passive versus active educational interventions. METHODS: From May to June 2018, 73 participants recruited at a dermatology clinic were sequentially assigned to receive sun-safety education through one of 3 modes: interactive online module, video, or no education. A baseline Sun Exposure and Behavior Inventory (SEBI) questionnaire was administered, and spectrophotometric measurements of sun-exposed and sun-protected areas were taken and reported in the CIE L*a*b* color space. Participants were followed 4-8 and 16 weeks after the initial visit where the SEBI was re-administered, and serial measurements of skin color were taken. The change in SEBI scores and L*a*b values, as calculated by the individual typology angle (ITA°), was analyzed. RESULTS: There was a significant increase in skin darkening in all the groups at 4-8 and 16 weeks follow-up. There was no statistically significant difference between the groups in the magnitude of color change. However, subjectively at 4-8 weeks post-intervention, participants in the interactive module and video groups had significantly improved self-reported SEBI scores compared to control (p < .05, Kruskal-Wallis). By 16 weeks, only the interactive module group showed significant improvement in SEBI scores compared to control (p < .05, ANOVA). CONCLUSION: In determining the effectiveness of sun-safety programs, spectrophotometric evaluation of sun-induced skin pigmentation can allow for a more complete evaluation of self-reported sun exposure and sun-protective behavior.
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Conductas Relacionadas con la Salud , Neoplasias Cutáneas , Escolaridad , Conocimientos, Actitudes y Práctica en Salud , Humanos , Neoplasias Cutáneas/tratamiento farmacológico , Pigmentación de la Piel , Protectores Solares/uso terapéutico , Encuestas y CuestionariosRESUMEN
BACKGROUND: Although many hair disorders can be readily diagnosed based on their clinical appearance, their progression and response to treatment are often difficult to monitor, particularly in quantitative terms. We introduce an innovative technique utilizing a smartphone and computerized image analysis to expeditiously and automatically measure and compute hair density and diameter in patients in real time. METHODS: A smartphone equipped with a dermatoscope lens wirelessly transmits trichoscopy images to a computer for image processing. A black-and-white binary mask image representing hair and skin is produced, and the hairs are thinned into single-pixel-thick fiber skeletons. Further analysis based on these fibers allows morphometric characteristics such as hair shaft number and diameters to be computed rapidly. The hair-bearing scalps of fifty participants were imaged to assess the precision of our automated smartphone-based device in comparison with a specialized trichometry device for hair shaft density and diameter measurement. The precision and operation time of our technique relative to manual trichometry, which is commonly used by hair disorder specialists, is determined. RESULTS: An equivalence test, based on two 1-sided t tests, demonstrates statistical equivalence in hair density and diameter values between this automated technique and manual trichometry within a 20% margin. On average, this technique actively required 24 seconds of the clinician's time whereas manual trichometry necessitated 9.2 minutes. CONCLUSION: Automated smartphone-based trichometry is a rapid, precise, and clinically feasible technique which can significantly facilitate the assessment and monitoring of hair loss. Its use could be easily integrated into clinical practice to improve standard trichoscopy.
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Enfermedades del Cabello , Teléfono Inteligente , Alopecia , Cabello , Humanos , Cuero CabelludoRESUMEN
Vitiligo is an acquired depigmentation skin disease caused by immune-mediated death of melanocytes. The most common treatment for vitiligo is narrow band ultraviolet B phototherapy, which often is combined with topical therapies such as tacrolimus. However, patients' responses to these treatments show large variations. To date, the mechanism for this heterogeneity is unknown, and there are no molecular indicators that can predict an individual patient's response to therapy. The goal of this study is to identify clinical parameters and gene expression biomarkers associated with vitiligo response to therapy. Six patients with segmental vitiligo and 30 patients with non-segmental vitiligo underwent transcriptome sequencing of lesional and nonlesional skin at baseline before receiving combined UBUVB and tacrolimus therapy for 6 month, and were separated into good response and bad response groups based on target lesion achieving > 10% repigmentation or not. Our study revealed that treatment-responsive vitiligo lesions had significantly shorter disease duration compared with non-responsive vitiligo lesions (2.5 years vs 11.5 years, p=0.046, t-Test), while showing no significant differences in the age, gender, ethnicity, vitiligo subtype, or disease severity. Transcriptomic analyses identified a panel of 68 genes separating the good response from bad response lesions including upregulation of immune active genes, such as CXCL10, FCRL3, and TCR, Further, compared with vitiligo lesions with long disease duration, the lesions with short duration also have much higher level of expression of immune-active genes, including some (such as FCRL3 and TCR genes) that are associated with favorable therapeutic response. In conclusion, our study has identified clinical parameters such as short disease duration and a panel of immune active and other gene expression biomarkers that are associated with favorable response to immune suppressive NBUVB + tacrolimus therapy. These markers may be useful clinically for individualized therapeutic management of vitiligo patients in the future.
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Biomarcadores , Susceptibilidad a Enfermedades , Vitíligo/diagnóstico , Vitíligo/terapia , Adulto , Anciano , Biopsia , Estudios de Casos y Controles , Terapia Combinada/métodos , Biología Computacional/métodos , Manejo de la Enfermedad , Femenino , Perfilación de la Expresión Génica , Humanos , Masculino , Persona de Mediana Edad , Transcriptoma , Resultado del Tratamiento , Vitíligo/etiologíaRESUMEN
SIGNIFICANCE: Management of skin cancer worldwide is often a challenge of scale, in that the number of potential cases presented outweighs the resources available to detect and treat skin cancer. AIM: This project aims to develop a polarimetry probe to create an accessible skin cancer detection tool. APPROACH: An optical probe was developed to perform bulk tissue Stokes polarimetry, a technique in which a laser of known polarization illuminates a target, and the altered polarization state of the backscattered light is measured. Typically, measuring a polarization state requires four sequential measurements with different orientations of polarization filters; however, this probe contains four spatially separated detectors to take four measurements in one shot. The probe was designed to perform at a lower cost and higher speed than conventional polarimetry methods. The probe uses photodiodes and linear and circular film polarizing filters as detectors, and a low-coherence laser diode as its illumination source. The probe design takes advantage of the statistical uniformity of the polarization speckle field formed at the detection area. RESULTS: Tests of each probe component, and the complete system put together, were performed to evaluate error and confirm the probe's performance despite its low-cost components. This probe's potential is demonstrated in a pilot clinical study on 71 skin lesions. The degree of polarization was found to be a factor by which malignant melanoma could be separated from other types of skin lesions.
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Melanoma , Neoplasias Cutáneas , Humanos , Luz , Melanoma/diagnóstico por imagen , Piel/diagnóstico por imagen , Neoplasias Cutáneas/diagnóstico por imagen , Análisis EspectralRESUMEN
The coronavirus disease 2019 (COVID-19) pandemic and subsequent physical distancing recommendations created major gaps in traditional dermatologic undergraduate and postgraduate medical education delivery. Nevertheless, the educational consequences of various public health restrictions have indirectly set aside the inertia, resistance, and risk averse approach to pedagogical change in medicine. In Canada, rapid collaboration and innovation in dermatologic education has led to novel programs including the implementation of a range of internet-facilitated group learning activities and a dramatic expansion of digital telehealth and virtual care. Going forward, three key issues arising from these developments will need to be addressed: the ongoing assessment of these innovations for efficacy; sustaining the momentum and creativity that has been achieved; and, determining which of these activities are worth maintaining when traditional "tried and true" learning activities can be resumed.
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COVID-19/prevención & control , Prácticas Clínicas/métodos , Dermatología/educación , Internado y Residencia/métodos , Canadá , Humanos , Internet , SARS-CoV-2 , Estudiantes de Medicina , Enseñanza , TelemedicinaRESUMEN
BACKGROUND: Multiphoton microscopy (MPM) offers a feasible approach for the biopsy in clinical medicine, but it has not been used in clinical applications due to the lack of efficient image processing methods, especially the automatic segmentation technology. Segmentation technology is still one of the most challenging assignments of the MPM imaging technique. METHODS: The MPM imaging segmentation model based on deep learning is one of the most effective methods to address this problem. In this paper, the practicability of using a convolutional neural network (CNN) model to segment the MPM image of skin cells in vivo was explored. A set of MPM in vivo skin cells images with a resolution of 128×128 was successfully segmented under the Python environment with TensorFlow. A novel deep-learning segmentation model named Dense-UNet was proposed. The Dense-UNet, which is based on U-net structure, employed the dense concatenation to deepen the depth of the network architecture and achieve feature reuse. This model included four expansion modules (each module consisted of four down-sampling layers) to extract features. RESULTS: Sixty training images were taken from the dorsal forearm using a femtosecond Ti:Sa laser running at 735 nm. The resolution of the images is 128×128 pixels. Experimental results confirmed that the accuracy of Dense-UNet (92.54%) was higher than that of U-Net (88.59%), with a significantly lower loss value of 0.1681. The 90.60% Dice coefficient value of Dense-UNet outperformed U-Net by 11.07%. The F1-Score of Dense-UNet, U-Net, and Seg-Net was 93.35%, 90.02%, and 85.04%, respectively. CONCLUSIONS: The deepened down-sampling path improved the ability of the model to capture cellular fined-detailed boundary features, while the symmetrical up-sampling path provided a more accurate location based on the test result. These results were the first time that the segmentation of MPM in vivo images had been adopted by introducing a deep CNN to bridge this gap in Dense-UNet technology. Dense-UNet has reached ultramodern performance for MPM images, especially for in vivo images with low resolution. This implementation supplies an automatic segmentation model based on deep learning for high-precision segmentation of MPM images in vivo.
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BACKGROUND: Clinical photography is an important component of the initial assessment and follow-up of patients with vitiligo in clinical practice and research settings. Standardization of this photographic process is essential to achieve useful, high-quality, and comparable photographs over time. OBJECTIVE: The aim is to develop an international consensus for a core set of recommendations for standardized vitiligo clinical photography. METHODS: Based an international meeting of vitiligo experts, a standard operating procedure was developed for vitiligo photography in daily practice and research settings. This protocol was subsequently reviewed by 20 vitiligo experts until agreement was reached. RESULTS: The resulting protocol includes a set of 10 and 15 photographs for clinical practice and research purposes, respectively. The photographic series are based on anatomic units included in the Vitiligo Extent Score. Furthermore, graphic representations of standardized positioning and suggestions for guidelines to standardize the process (background color, lighting, position marking, scales, materials, instruments) for both color and ultraviolet photographs are described. CONCLUSIONS: This consensus-based protocol for vitiligo photography will harmonize imaging for both clinical practice, translational research, and clinical trials. It can improve outcome assessment, foster multicenter collaboration, and promote better communication with patients regarding outcomes of treatment.
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Dermatología/normas , Fotograbar/normas , Guías de Práctica Clínica como Asunto , Piel/diagnóstico por imagen , Vitíligo/diagnóstico , Ensayos Clínicos como Asunto/normas , Consenso , Dermatología/métodos , Humanos , Cooperación Internacional , Iluminación/normas , Evaluación de Resultado en la Atención de Salud/métodos , Evaluación de Resultado en la Atención de Salud/normas , Estándares de Referencia , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Investigación Biomédica Traslacional/métodos , Investigación Biomédica Traslacional/normas , Rayos Ultravioleta , Vitíligo/terapiaRESUMEN
BACKGROUND: Studies have shown disparities in the perception of skin disease burden between patients and physicians, with patients often feeling that the severity, emotional impact, and social repercussions of their skin condition are underestimated. Although physician's professional behavior is guided by documents such as the Hippocratic Oath, there are no patient-driven principles to guide healthcare interactions involving skin concerns. OBJECTIVE: To develop a concise and practical charter for patients based on their perceptions of unmet needs with the goals of helping patients express their needs and exercise their rights to accessing and utilizing the healthcare system for conditions, diseases, or traumas involving the skin. METHODS: An initial literature review examined healthcare delivery concerns of patients with skin conditions. Results were used to draft a charter that was reviewed by a Canadian patient focus group representing various skin condition advocacy groups. A revised charter was reviewed by Canadian dermatologists before being formally approved by the Canadian Skin Patient Alliance Board and endorsed by the Canadian Dermatology Association. RESULTS: The Patient Charter comprises 8 principles for providing and receiving professional services for the skin in the healthcare setting. CONCLUSIONS: This Patient Charter provides direct insights into patient priorities and will be used as an educational and advocacy tool in healthcare, occupational, and social settings. The intended goal is for the Patient Charter to empower patients and to educate health professions, government, industry, and society at large. Accordingly, the charter will be disseminated through print materials, informational videos, and social media campaigns.
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Atención a la Salud/normas , Dermatología/normas , Defensa del Paciente/normas , Medición de Resultados Informados por el Paciente , Enfermedades de la Piel , Piel/lesiones , Canadá , Costo de Enfermedad , Necesidades y Demandas de Servicios de Salud/normas , Humanos , Participación del Paciente/métodos , Derechos del Paciente/normasRESUMEN
The recent worldwide rise in idiopathic immune and inflammatory diseases such as multiple sclerosis (MS) and inflammatory bowel diseases (IBD) has been linked to Western society-based changes in lifestyle and environment. These include decreased exposure to sunlight/UVB light and subsequent impairment in the production of vitamin D, as well as dysbiotic changes in the makeup of the gut microbiome. Despite their association, it is unclear if there are any direct links between UVB light and the gut microbiome. In this study we investigated whether exposing the skin to Narrow Band Ultraviolet B (NB-UVB) light to increase serum vitamin D levels would also modulate the makeup of the human intestinal microbiota. The effects of NB-UVB light were studied in a clinical pilot study using a healthy human female cohort (n = 21). Participants were divided into those that took vitamin D supplements throughout the winter prior to the start of the study (VDS+) and those who did not (VDS-). After three NB-UVB light exposures within the same week, the serum 25(OH)D levels of participants increased on average 7.3 nmol/L. The serum response was negatively correlated to the starting 25-hydroxy vitamin D [25(OH)D] serum concentration. Fecal microbiota composition analysis using 16S rRNA sequencing showed that exposure to NB-UVB significantly increased alpha and beta diversity in the VDS- group whereas there were no changes in the VDS+ group. Bacteria from several families were enriched in the VDS- group after the UVB exposures according to a Linear Discriminant Analysis (LDA) prediction, including Lachnospiracheae, Rikenellaceae, Desulfobacteraceae, Clostridiales vadinBB60 group, Clostridia Family XIII, Coriobacteriaceae, Marinifilaceae, and Ruminococcus. The serum 25(OH)D concentrations showed a correlation with the relative abundance of the Lachnospiraceae, specifically members of the Lachnopsira and Fusicatenibacter genera. This is the first study to show that humans with low 25(OH)D serum levels display overt changes in their intestinal microbiome in response to NB-UVB skin exposure and increases in 25(OH)D levels, suggesting the existence of a novel skin-gut axis that could be used to promote intestinal homeostasis and health. Clinical Trial Registration: clinicaltrials.gov, NCT03962673. Registered 23 May 2019 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03962673?term=NCT03962673&rank=1.