A Bayesian network meta-analysis of 14 molecules inhibiting UV daylight-induced pigmentation.

INTRODUCTION: Hyperpigmentation disorders are very frequent, affect the quality of life and may become a psychological burden for afflicted patients. Many anti-pigmenting or depigmenting agents are available with various efficacy and almost no comparative data. 2-mercaptonicotinoyl glycine (2-MNG) was recently proposed as a viable candidate showing safe and effective results on hyperpigmentation control in vitro and in vivo. OBJECTIVES: A Bayesian network meta-analysis (BNMA) was conducted to map and rank the anti-pigmenting and depigmenting efficacy of 2-MNG 0.5% on UV daylight (UVDL)-induced pigmentation together with 13 other reference molecules. A comparison in the kinetics of 2-MNG 0.5% was also performed. METHODOLOGY: Fourteen studies were conducted, for each, on 15-30 women of skin phototype III in Shanghai, China and Paris, France. The products were applied on mini zone, in randomized and blinded protocol, on the back, 5 days a week during 6 weeks, at a dose of 4 mg/cm2 . During the second week, volunteers were exposed under to varying minimum erythemal dose of UVDL during 4 consecutive days-adapted to obtain a similar induction of skin pigmentation regardless of the population. Assessments were performed instrumentally using Chromameter®. Ascorbic acid 7% was used as a positive control for all experiments. A Bayesian network meta-analysis was then established to map and follow the kinetics of 2-MNG 0.5% performance with 13 reference molecules (glutathione 2%, kojic acid 1%, hydroquinone 4%, ascorbyl glucoside 2%, niacinamide 4%, etc.). RESULTS: 2-MNG 0.5% dominated the ranking at all time points with a significant high probability of strong efficacy against UVDL-induced pigmentation. Ascorbic acid 7% ranks second after 4 days of irradiations (D12 ) whereas hydroquinone 4% ranks second 1 month after irradiations (D40 ). In the kinetics, 2-MNG at 0.5% was effective as from the end of irradiations (D12 ) to the study endpoint (D40 ). This suggested an immediate and persistent efficacy across all timepoints evaluated. CONCLUSION: The BNMA revealed a rapid and lasting efficacy of 2-MNG 0.5% on the anti-pigmenting and depigmenting phases of the clinical protocol. 2-MNG 0.5% ranked first, with immediate and lasting effect compared to 13 other references. This study is the first allowing comparison between reference anti-pigmenting and depigmenting agents and will help clinicians for proposing the most effective approach for their patients.

Evaluation of adapted dermocosmetic regimens for perimenopausal and menopausal women using an artificial intelligence-based algorithm and quality of life questionnaires: An open observational study.

BACKGROUND: The decline in estrogen levels from several years before (perimenopause) and during menopause has various negative effects, including skin specific issues, which often receive less attention than other menopausal symptoms despite having a significant negative effect on quality of life (QoL). The objective of this study was to evaluate the effectiveness of anti-aging dermocosmetic products designed for women during the perimenopause and menopause. MATERIALS AND METHODS: An open study of 101 perimenopausal women (no menstruation for 4-12 months or irregular menstruation for <5 years) and 101 menopausal women (no menstruation for >12 months), not taking hormone replacement therapy, was conducted. Adapted dermocosmetic regimens, specific to each group (day cream, night cream and serum), were applied for 56 days. Assessments included automatic artificial intelligence diagnostics of eight clinical facial signs, hydration and transepidermal water loss (TEWL), and a menopause skin QoL questionnaire. RESULTS: Mean age was 50 ± 3.9 years (range 41-57) and 59 ± 3.8 years (range 50-66) for the perimenopause and menopause groups, respectively. Significant improvements in wrinkles and vascular signs, increases in hydration, decreases in TEWL, and a positive impact on QoL were observed after 56 days of application of the respective dermocosmetic regimens for both the perimenopause and menopause groups. CONCLUSION: The anti-aging skin care products designed specifically for perimenopausal and menopausal women increased skin hydration and improved wrinkles with a positive impact on QoL.

Objective and automatic grading system of facial signs from smartphones' pictures in South African men: Validation versus dermatologists and characterization of changes with age.

OBJECTIVE: To evaluate the capacity of the automatic detection system to accurately grade, from selfie pictures, the severity of eight facial signs in South African men. METHODS: Selfie pictures (obtained from frontal and back cameras) of 281 South African men differently aged (20-70 years) were obtained and analyzed by an automatic artificial intelligence (AI)-based automatic grading system. Data were compared with the clinical gradings made by experts and dermatologists. RESULTS: In all facial signs, both series of gradings were found highly correlated with, however, different coefficients (0.59-0.95), those of marionette lines and cheek pores being of lower values. No differences were observed between data obtained by frontal and back cameras. With age, in most cases, gradings show up to the 50-59 year age-class, linear-like changes. When compared to men of other ancestries, South African men present lower wrinkles/texture, pigmentation, and ptosis/sagging scores till 50-59 years, albeit not much different in the cheek pores sign. The early onset (mean age) of visibility of wrinkles/texture for South African men were (i.e., reaching grade >1) 39 and 45 years for ptosis/sagging. CONCLUSION: This study completes and enlarges the previous works conducted on men of other ancestries by showing some South African specificities and slight differences with men of comparable phototypes (Afro American).

Accuracy and clinical relevance of an automated, algorithm-based analysis of facial signs from selfie images of women in the United States of various ages, ancestries and phototypes: A cross-sectional observational study.

BACKGROUND: Real-life validation is necessary to ensure our artificial intelligence (AI) skin diagnostic tool is inclusive across a diverse and representative US population of various ages, ancestries and skin phototypes. OBJECTIVES: To explore the relevance and accuracy of an automated, algorithm-based analysis of facial signs in representative women of different ancestries, ages and phototypes, living in the same country. METHODS: In a cross-sectional study of selfie images of 1041 US women, algorithm-based analyses of seven facial signs were automatically graded by an AI-based algorithm and by 50 US dermatologists of various profiles (age, gender, ancestry, geographical location). For automated analysis and dermatologist assessment, the same referential skin atlas was used to standardize the grading scales. The average values and their variability were compared with respect to age, ancestry and phototype. RESULTS: For five signs, the grading obtained by the automated system were strongly correlated with dermatologists' assessments (r ≥ 0.75); cheek skin pores were moderately correlated (r = 0.63) and pigmentation signs, especially for the darkest skin tones, were weakly correlated (r = 0.40) to the dermatologist assessments. Age and ancestry had no effect on the correlations. In many cases, the automated system performed better than the dermatologist-assessed clinical grading due to 0.3-0.5 grading unit differences among the dermatologist panel that were not related to any individual characteristic (e.g. gender, age, ancestry, location). The use of phototypes, as discontinuous categorical variables, is likely a limiting factor in the assessments of grading, whether obtained by automated analysis or clinical assessment of the images. CONCLUSIONS: The AI-based automatic procedure is accurate and clinically relevant for analysing facial signs in a diverse and inclusive population of US women, as confirmed by a diverse panel of dermatologists, although skin tone requires further improvement.

Objective and automatic grading system of facial signs from selfie pictures of South African women: Characterization of changes with age and sun-exposures.

OBJECTIVE: To evaluate the capacity of the automatic detection system to accurately grade, from smartphones' selfie pictures, the severity of fifteen facial signs in South African women and their changes related to age and sun-exposure habits. METHODS: A two-steps approach was conducted based on self-taken selfie images. At first, to assess on 306 South African women (20-69 years) enrolled in Pretoria area (25.74°S, 28.22°E), age changes on fifteen facial signs measured by an artificial intelligence (AI)-based automatic grading system previously validated by experts/dermatologists. Second, as these South African panelists were recruited according to their usual behavior toward sun-exposure, that is, nonsun-phobic (NSP, N = 151) and sun-phobic (SP, N = 155) and through their regular and early use of a photo-protective product, to characterize the facial photo-damages. RESULTS: (1) The automatic scores showed significant changes with age, by decade, of sagging and wrinkles/texture (p < 0.05) after 20 and 30 years, respectively. Pigmentation cluster scores presented no significant changes with age whereas cheek skin pores enlarged at a low extent with two plateaus at thirties and fifties. (2) After 60 years, a significantly increased severity of wrinkles/texture and sagging was observed in NSP versus SP women (p < 0.05). A trend of an increased pigmentation of the eye contour (p = 0.06) was observed after 50 years. CONCLUSION: This work illustrates specific impacts of aging and sun-exposures on facial signs of South African women, when compared to previous experiments conducted in Europe or East Asia. Results significantly confirm the importance of sun-avoidance coupled with photo-protective measures to avoid long-term skin damages. In inclusive epidemiological studies that aim at investigating large human panels in very different contexts, the AI-based system offers a fast, affordable and confidential approach in the detection and quantification of facial signs and their dependency with ages, environments, and lifestyles.

Structural and functional age-related changes in some facial signs of Chinese men: A pilot study.

OBJECTIVE: The objective of the study was to associate, on the same Chinese male subjects, changes in facial ageing signs with some biomechanical skin properties. METHODS: The severities of 20 facial ageing signs of 219 differently aged Chinese men (20-65 years) were graded in blind by trained experts through standardized photographs, using a referential skin Atlas dedicated to Asian men. On each subject, the mechanical properties were assessed on the cheek area (left or right at random) by the validated suction technique Cutometer®. Finally, the skin colour parameters were assessed on images from VISIA-CR device. RESULTS: Clinically speaking, the severity of almost all facial ageing signs increases from 30 to 65 years, in a linear-like progression, whereas the 20-30 years shows weak increases. Skin colour shows slight but progressive decreases in Luminance and ITA, whereas the yellow and red components slightly increased between 40 and 65 years. At the exception of skin firmness, the skin mechanical properties show a clear decline during the 30-50 years period and plateau beyond. CONCLUSION: The present study suggests that the 20-30 years period, albeit more clinically 'silent' than the other periods of age, seems to be an age range during which early alterations of some dermal elements' onset. Deeper in vivo investigating techniques (Echography, Multiphotonic microscopy) are needed to confirm such hypothesis.

OBJECTIF: Pouvoir associer, sur les mêmes sujets masculins chinois, les modifications des signes de vieillissement faciaux avec certaines propriétés mécaniques du tégument. MÉTHODES: Les sévérités de vingt signes du vieillissement faciaux de 219 hommes chinois de différents âges (de 20 à 65 ans) ont été évalués en aveugle par des experts entraînés sur des photographies standardisées en utilisant des échelles cliniques de référence pour les hommes asiatiques issues des Atlas du vieillissement. Sur chaque sujet les propriétés biomécaniques ont été enregistrées sur la zone de la joue (droite ou gauche suivant un plan de randomization) avec un appareil de succion validé, le Cutometer®. Enfin, les paramètres coloriels ont été mesurés sur des images enregistrées avec le VISIA-CR. RÉSULTATS: D'un point de vue clinique, la sévérité de la plupart des signes étudiés augmentent de manière linéaire de 30 à 65 ans, tandis qu'entre 20 et 30 ans les augmentations sont faibles. La couleur de la peau présente une faible, mais linéaire, chute de la luminance et de l'ITA, tandis que les composantes jaune et rouge augmentent légèrement entre 40 et 65 ans. A exception de la fermeté de la peau, les propriétés mécaniques présentent une chute importante entre 30 et 50 ans et un plateau ensuite. CONCLUSION: Cette étude suggère que la période entre 20 et 30 ans, observée comme "silencieuse" d'un point de vue Clinique contrairement aux autres classes d'âge, semble être un moment charnière durant lequel les premières altérations dermiques s'opèrent. De plus amples investigations in vivo usant de techniques d'imageries structurelles (Microscopie Multi-photonique, Echographie…) seraient nécessaires pour confirmer de tells hypothèses.

The respective weights of facial signs on the perception of age and a tired-look among differently aged Korean men.

OBJECTIVES: To determine the respective weights of certain facial signs on the assessment of the perceived age and a tired-look on Korean men of different ages. MATERIAL AND METHODS: Photographs were taken of the faces of 101 Korean men (20-80 years) under standardized conditions. These photographs allowed to define 16 signs, which were then graded by 15 experts/dermatologists, using standardized scales provided by a referential Skin Aging Atlas. These signs were dispatched into 5 clusters, namely Wrinkles/Texture, Ptosis/Sagging, Cheek pores, Pigmentation, and Vascular signs. A naïve panel of 200 Korean individuals (100 women, 100 men), of similar age range, were asked, when viewing full-face photographs, to (a) attribute on a 0-10 scale their perception of a tired-look and (b) estimate the age of the subject. RESULTS: The severity of all clusters increased with age, although at different rates. The Wrinkles/Texture or Ptosis/Sagging showed a rather regular progression, whereas Vascular presented the weakest changes. Although perceived and real ages were found highly correlated, almost 85% of the subjects were judged older by 1-15 years. The signs/clusters were found significantly correlated with perceived age, highly for Wrinkles/Texture and Ptosis/Sagging, moderate for Pigmentation, and low for Vascular and Cheek pores. The weights in perceived ages of Wrinkles/Texture and Ptosis/Sagging represent 81% and Pigmentation at 19%. Facial tired-look of Korean men was found significantly correlated with perceived age. Although Vascular and Cheek pores were found not impacting, Wrinkles/Texture, Ptosis/Sagging, and Pigmentation presented a clear influence. CONCLUSION: Within facial clusters, Wrinkles/Texture, Ptosis/Sagging, and Pigmentation are major factors in the assessment of perceived age in Korean men. The perception of an increased tired-look is significantly associated with increased perceived age.

Changes in facial signs due to age and their respective weights on the perception of age and skin plumpness among differently aged Korean women.

OBJECTIVE: To determine the respective weights of certain facial signs on the assessment of perceived age and plumpness on Korean women of different ages. MATERIAL AND METHODS: Photographs were taken of the faces of 112 Korean women of different ages (18-80 years) under standardized conditions. These photographs allowed to focus and define 19 facial signs, which were then graded by 15 experts and dermatologists, using standardized scales provided by a reference Skin Aging Atlas. The facial signs were dispatched into 5 clusters, namely Wrinkles/Texture, Ptosis/Sagging, Pigmentation disorders, Vascular disorders, and Cheek skin pores. A naïve panel, composed of 92 Korean women, of similar age range were asked, when viewing full-face photographs, to: (a) attribute on a 0-10 scale their perception of the skin plumpness (ie supple/hydrated/nourished) and (b) estimate the age of the subject. RESULTS: With the exception of Vascular disorders, the severity of all 4 clusters increased with age, although at different rates. The Wrinkles/Texture or Ptosis/Sagging showed a rather regular progression. Although perceived ages and real ages were found highly correlated, half of the subjects were judged older by 2-12 years. The facial signs/clusters were significantly correlated with perceived age, with the exceptions of vascular disorders, size of pigmentary spots and cheek skin pores. The weights in perceived ages of Wrinkles/Texture and Ptosis/Sagging represent 37% each and Pigmentation disorders at 26%. Skin plumpness was logically found significantly anti-correlated with perceived age. If, surprisingly, Vascular disorders were found not impacting the plumpness aspect, Cheek skin pores presented a clear influence. CONCLUSION: Within facial clinical clusters, Wrinkles/Texture, Ptosis/Sagging, and Pigmentation disorders are major factors in the assessment of perceived age in Korean women. The perception of a decreased skin plumpness is significantly associated with increased perceived age.

Skin moisture assessment using Hydration Sensor Patches coupled with smartphones via Near Field Communication (NFC). A pilot study with the first generation of patches that allow self-recordings of skin hydration.

OBJECTIVES: To evaluate the potency of a new skin hydration sensor patch in the fast self-recording of skin hydration. MATERIAL AND METHODS: The Skin Hydration Sensor Patch (SHSP) turns the user's smartphone into a wireless skin moisture measuring device. The SHSP combines a capacitive measurement unit and Near Field Communication technology (NFC) for transmitting data and energy. The probe is fixed onto the back of the smartphone and pressed to the skin for a few seconds where the application immediately calculates the capacitance value. Once recorded, the probe is then immediately taken off from the skin. In a first study, this system was compared to the Corneometer® technique, in vivo, on various skin sites of 23 healthy French women. In a second study, 20 women with moderate dry skin on face and forearm self-recorded, through the SHSP the changes in skin hydration induced by a Xanthan gel containing 3% (w/w) of Glycerol, along 24 hours. A questionnaire based on 5 types of questions was established to be filled by subjects about their perception of the use of this new system. RESULTS: In the first study, the values recorded by the SHSP were found highly correlated with those provided by the Corneometer® . The second study allowed to observe significant differences in skin hydration of both sites at all times, as compared to values obtained before the application of the gel. Differences between both sites were observed, the face being less hydrated than forearm. From a practical aspect, the self-recordings on the face show a higher variability (approx. 10% than those of the forearm). The questionnaire led to positive answers on almost all points. CONCLUSION: This SHSP appears as a promising approach in the field of connected skin-related devices. As such, it opens or enlarges a new paradigm in the relationships between a consumer and a cosmetic product.

Japanese experiment of a complete and objective automatic grading system of facial signs from selfie pictures: Validation with dermatologists and characterization of changes due to age and sun exposures.

OBJECTIVE: To evaluate the capacity of the automatic detection system to accurately grade, from smartphones' selfie pictures, the severity of ten facial signs in Japanese women and their changes due to age and sun exposures. METHODS: A three-step approach was conducted, based on self-taken selfie images. At first, to check on 310 Japanese women (18-69 years) enrolled in the northerner Hokkaido area (latitude 43.2°N), how, on ten facial signs, the A.I-based automatic grading system may correlate with dermatological assessments, taken as reference. Second, to assess and compare age changes in 310 Japanese and 112 Korean women. Third, as these Japanese panelists were recruited according to their usual behavior toward sun exposure, that is, non-sun-phobic (NSP, N = 114) and sun-phobic (SP, N = 196), and through their regular and early use of a photo-protective product, to characterize the facial photo-damages. RESULTS: (a) On the ten facial signs, detected automatically, nine were found significantly (P < .0001) highly correlated with the evaluations made by three Japanese dermatologists (Wrinkles: r = .75; Sagging: r = .80; Pigmentation: r = .75). (b) The automatic scores showed significant changes with age, by decade, of Wrinkles/Texture, Pigmentation, and Ptosis/Sagging (P < .05). (c) After 45 years, a significantly increased severity of Wrinkles/Texture and Pigmentation was observed in NSP vs. SP women (P < .05). A trend of an increased Ptosis/Sagging (P = .09) was observed. CONCLUSION: This work illustrates, for the first time through investigations conducted at home, some impacts of aging and sun exposures on facial signs of Japanese women. Results significantly confirm the importance of sun avoidance coupled with photo-protective measures. In epidemiological studies, the AI-based system offers a fast, affordable, and confidential approach in detection and quantification of facial signs and their dependence with ages, environments and lifestyles.

Comparing the self-perceived effects of a facial anti-aging product to those automatically detected from selfie images of Chinese women of different ages and cities.

OBJECTIVE: To assess the agreement, after 1-month application of a popular and efficient anti-aging product, between self-perceived facial signs of aging and those detected and graded by an automatic A.I-based system, using smartphones' selfie images. MATERIAL AND METHODS: Of 1065 Chinese women, aged 18-60 years, from eight different Chinese cities were recruited. They were asked to apply daily, for 1 month, a referential anti-aging product onto their whole face. Selfie images were taken by all subjects at D0 and D28 and sent to our facilities for being analyzed through 10 different facial signs. At D28 , all subjects were asked to fill a questionnaire on the status of their faces, through six general statements. RESULTS: A global agreement between both approaches is reached, particularly among women older than 40 years where the severity of facial signs is already more pronounced or among younger women who present at least facial signs scored above one grading units. This limit becomes, therefore, a prerequisite in the recruitment of Chinese subjects in the case of anti-aging applied studies and possible automatically based on automatic grading system. When respecting such conditions, the positive effects of the product on most facial signs can be demonstrated after 28 days of successive applications. CONCLUSION: Such methodological approach paves the road in fulfilling the need of consumers of a better transparency in the claims of an anti-aging product.

Developing an Artificial Intelligence (A.I)-based descriptor of facial appearance that fits with the assessments of makeup experts.

OBJECTIVE: To develop an A.I-based automatic descriptor that detects and grades, from selfie pictures, 23 facial signs, hairs included, as a help to making-up procedures. MATERIAL AND METHODS: The selfie images taken in very different conditions by 3326 women and men were used to create (90% of dataset) and validate (10% of dataset) a new algorithm architecture to appraise and grade 23 different facial signs such as lips, nose, eye color, eyebrows, eyelashes, and hair color as defined by makeup artists. Each selfie image was annotated by 12 experts and defined references to train Artificial Intelligence (A.I)-based algorithm. RESULTS: As some the 23 signs present a continuous or discontinuous feature, these were analyzed by two different statistical approaches. The results provided by the automatic descriptor system were not only in good agreement with the expert's assessments but were even found of a better precision and reproducibility. This automatic descriptor system has proven a good and robust accuracy despite the very variable conditions in the acquisition of selfie pictures. CONCLUSION: Such automatic descriptor system seems providing a valuable help in making-up procedures and may extend to other activities such as Skincare or Haircare. As such it should allow large investigations to better evaluate the consumers' needs of esthetical improvements.

Analysis of images supplied by Skincam® can record the changes of some scar features that occur over time. Comparisons with the assessments of dermatologist and patients' perception.

OBJECTIVE: The objective of the study was to assess in vivo the validity of a new imaging device in quantifying the scarring process over time and to compare its data with the expertise of dermatologist and patients' self-appraisals. MATERIALS AND METHODS: A total of 37 Korean women, aged 20-50 year, with closed scars of different types, were enrolled after a dermatological evaluation. All subjects applied daily a hydrating cream on their scars for 2 months. Images of scars at different times (Day 0, Day 28, and Day 56) were taken and further analyzed, yielding various parameters such as color, luminance, size, volume, and depth of each scar. A dermatologist visually graded, at each time point, the clinical aspect of the scar, and patients were asked to answer to some questions dealing with their self-examination of their scar. RESULTS: The changes in some scar features that occurred during the application period were quantified and statistically differed from the D0 baseline value. Scars became of reduced size, lighter (Increased luminance), less red, less deep, and less voluminous. Some of these parameters (volume, lightness, smoothness, texture regularity) were statistically different at D28 whereas some others (area, depth, redness) showed significant changes at D56 . Dermatologist expertise and patients' assessments were in high agreement. CONCLUSION: This methodological approach that uses a dedicated camera associated with image analysis, despite some inherent limits (size of the scar), appears as a valuable aid to surgeons in the management of scars, in the follow-up of a given procedure or treatment. Beyond scar management, this approach may be extended to other skin disorders such as acne.

Infliximab to etanercept switch in patients with spondyloarthropathies and psoriatic arthritis: preliminary data.

OBJECTIVE: To report early experience of switching anti-tumor necrosis factor-a (TNF-alpha) therapy from infliximab to etanercept in patients with spondyloarthropathy (SpA) and psoriatic arthritis (PsA). METHODS: Thirteen patients with various SpA (7 with ankylosing spondylitis and 6 with undifferentiated SpA) and 2 patients with PsA were receiving infliximab. Because they were experiencing inadequate response or adverse events, therapy was changed to etanercept. Patients were evaluated for response to the change in anti-TNF-alpha therapy at baseline, after 3 months, and then every 6 months. RESULTS: During the mean 10-month followup after the change in therapy, 9 of 13 patients with SpA and both patients with PsA responded to etanercept and none experienced intolerance to this agent. CONCLUSION: These data suggest that switching between anti-TNF-alpha drugs may be useful for patients with SpA who are unresponsive or intolerant to a first anti-TNF-alpha agent.