Artificial intelligence in cosmetic dermatology: An update on current trends.

The use of artificial intelligence (AI) will soon be commonplace within the field of cosmetic dermatology. Current uses for AI in the discipline have focused on empowering patients to be more involved in treatment decisions with customizable skin care, augmented-reality applications, and at-home skin analysis tools. AI-driven skin analysis tools are also included in many dermatology practices with the development of three-dimensional facial reconstruction, including models for predicting clinical outcomes. We highlight current and developing applications of AI in cosmetic dermatology and provide insight into future modalities in this field. Dermatologists need to be well-informed about emerging technologies to better educate patients and enhance their clinical practices.

Nutraceuticals for Androgenetic Alopecia.

Background: Several oral nutraceuticals have recently emerged as products marketed to increase hair growth and thickness. However, these supplements typically lack the rigorous testing and statistically significant data that apply to pharmaceuticals. Therefore, the potential benefits of oral nutraceuticals for conditions of hair loss, such as androgenetic alopecia, have yet to be fully understood by dermatologists. Objective: The purpose of this article is to evaluate current studies in the literature to assess the efficacy of popular oral nutraceuticals marketed for hair growth in subjects with androgenetic alopecia. Methods: This article reviews the currently available literature on the nutraceuticals Nutrafol® and Viviscal® for hair growth and describes and evaluates the results observed. Results: Oral nutraceuticals are effective to a modest degree in promoting hair growth in men and women with androgenetic alopecia. Conclusion: Oral nutraceuticals have demonstrated efficacy in promoting modest hair growth in men and women with androgenetic alopecia and may serve as useful adjuncts to current treatments. As the popularity of nutraceuticals grows, it is important for dermatologists to be knowledgeable of the potential benefits and pitfalls of these supplements to appropriately counsel patients seeking treatment for hair loss.

Lasers, lights, and compounds for hair loss in aesthetics.

Hair loss is a common complaint that is often stressful for patients and a challenge for practitioners to treat. Fortunately, innovations in the field have contributed to growing evidence for several promising topical, oral, and light and energy-based therapies. We have reviewed the current literature about the efficacy of these treatments, including topical agents (finasteride, latanoprost, spironolactone, caffeine, and metformin), oral minoxidil, nutraceuticals, platelet-rich plasma, low-level laser therapy, fractional lasers, and laser-assisted drug delivery. In addition, several debates related to these treatments have been discussed, including post-finasteride syndrome, effects of biotin supplementation on laboratory testing, standardization of platelet-rich plasma and low-level laser therapy, and combination treatment to enhance hair transplantation.

Dermatoscopy.

The dermatoscope has gained tremendous popularity among dermatologists as an adjunctive tool to better visualize subsurface structures and identify patterns that may improve the diagnosis of a wide range of skin diseases. Initially, the pigmented lesion experts who were the early adopters promoted the use of the dermatoscope to increase diagnostic accuracy of early melanomas and decrease the harvesting of benign lesions. With current near universal adoption of the diagnostic technique by dermatologists, the dermatoscope is now employed to help identify a wide variety of inflammatory, infectious, and vascular conditions of the skin, hair, and nails, resulting in the emergence of several branches of dermatoscopy-inflammoscopy, trichoscopy, onychoscopy, and entodermoscopy. The future of dermatoscopy will involve incorporation of artificial intelligence that will make the assessment process increasingly objective, more accurate, and universally available. Despite the wide acceptance and adoption of dermatoscopy, the overall impact of its widespread use still remains unclear, whether it has decreased biopsy rates of benign lesions, reduced health care costs, or improved patient outcomes.

Nonsurgical Light and Energy-Based Devices: Utility in Eyelid and Periorbital Surgery.

Periorbital rejuvenation is a common reason for patients to seek cosmetic treatment. There are several nonsurgical light and energy-based devices available to treat various aspects of periorbital rejuvenation without risks of an invasive, surgical procedure. Although ablative laser resurfacing appears to offer the most impressive clinical improvements, nonablative devices result in noticeable cosmetic improvement with more favorable side-effect profiles and shorter recovery times. The specific modality selected for periorbital rejuvenation should be tailored to patients' individual characteristics, preferences, and aesthetic goals. With continued advancements, additional nonsurgical light and energy-based devices will become available in the future for periorbital rejuvenation.

Rheologic properties of soft tissue fillers and implications for clinical use.

BACKGROUND: The use of injectable soft-tissue fillers has become an essential tool in esthetic rejuvenation. Rheology, the study of flow of matter, helps to understand the function of these products. AIMS: The purpose of this article is to review the rheologic properties of soft-tissue fillers currently available in the United States and to evaluate how these properties relate to clinical performance. METHODS: This article explains basic rheologic terms and describes how rheologic properties of specific soft-tissue fillers affect filler performance. RESULTS: The currently available soft-tissue fillers have unique rheologic and physicochemical properties that influence performance and cosmetic outcome. These properties determine that filler product is most appropriate based on degree of soft-tissue defect and anatomic location. CONCLUSION: It is imperative for physicians to have an in-depth understanding of the rheologic properties of soft-tissue fillers in order to appropriately select and utilize these products for the desired cosmetic outcome.

The role of artificial intelligence in cosmetic dermatology-Current, upcoming, and future trends.

Within the field of cosmetic dermatology, several promising developments utilize artificial intelligence to better patient care. While many new treatments in cosmetic dermatology feature components of artificial intelligence, there is a knowledge gap within the field regarding the current and developing products featuring AI. We aim to highlight current and developing applications of artificial intelligence in cosmetic dermatology and provide insight into future modalities in this field. Methods include literature review, including peer-reviewed journal articles as well as product websites. In an age of medical and technological advancement, the utility of artificial intelligence models continues to grow.There are many new facets of artificial intelligence in cosmetic dermatology, marketed to both the consumer and the physician. With the development of customizable skin care, augmented reality applications, and at-home skin analysis tools, patients are empowered to be the masters of their cosmetic care. Artificial intelligence is utilized by physicians in new ways in their practices, with the advent of models for prediction of clinical outcome to treatments and tools for in-depth analysis of the patient's skin. Further research is required in the development of automated energy-based treatment devices and robotic-assisted treatments. Models for AI in cosmetic dermatology serve to increase patient involvement in their skin care decisions and have the ability to enhance the patient-physician experience. Dermatologists should be well-informed of the emerging technologies to better educate patients and enhance their clinical practice.

Cancer-testis antigens as biomarkers for Merkel cell carcinoma: Pitfalls and opportunities.

BACKGROUND: The prognosis and treatment options for metastatic Merkel cell carcinoma (MCC) are poor. The immune-privileged status of cancer-testis (CT) antigens imparts tumor specificity, making them ideal candidates for targeted immunotherapy. We investigate the usefulness of the CT antigens SPA17 (sperm protein-17 [SP-17]), IGF2BP3 (insulin-like growth factor-II mRNA-binding protein 3 [IMP-3]), and transmembrane protein with epidermal growth factor (EGF)-like and two follistatin-like domains 1 (TMEFF1) as potential MCC biomarkers and evaluate their possible utility in immunotherapy and molecularly targeted image-guided treatment. METHODS: The CT antigens SP-17, IMP-3, and TMEFF1 were selected using transcriptome profiling to identify CT antigens expressed in MCC tumors. Antibodies directed against these CT antigens were stained. Twelve normal skin tissue samples were used as a control. The average percentage of positive cells in each tumor was computed. RESULTS: Twelve of 14 (86%) MCC cases showed crisp nuclear staining for SP-17, with 2.06% of cells staining positive. IMP-3 showed crisp, perinuclear staining in all 14 MCC cases, with 52.93% MCC cells staining positive. TMEFF1 showed perinuclear staining in all 14 MCC cases, with 96.51% of tumor cells staining positive. CONCLUSIONS: CT antigens were found to be expressed in both MCC and some control tissues. SP-17 was the most specific yet the least sensitive. IMP-3 and TMEFF1 were both sensitive but not specific. CT antigens may represent valuable treatment targets in MCC.

Musculoskeletal and overgrowth syndromes associated with cutaneous abnormalities.

There are cutaneous abnormalities that are characteristic to certain peculiar musculoskeletal conditions. The understanding of associated imaging and clinical skin findings together in this context can play an important role for the dermatologist and radiologist in establishing the correct diagnoses. The scope of dermatological manifestations of many acquired diseases of the soft tissues, muscles or bone is broad. Therefore, the intent of this article is to review those entities that are genetic and/or inherited. The goal of this review is to develop a better understanding of the cases presented. In these cases, collaboration between dermatologists and radiologists may be paramount to generating a diagnosis and monitoring at-risk patients.

Creating a blended learning module in an online master study programme in oncology.

BACKGROUND: The medical faculty of Ulm University has launched the postgraduate master online study programme Advanced Oncology (AO) in 2010. We describe the challenges in developing an e-learning module using the example of a medical biometry course, focusing the implementation of the course material and our single-loop learning experience after the first students have finished and evaluated the lecture. METHODS: Programme participants are qualified medical doctors and researchers in biomedical areas related to the field of oncology. The study programme provides the majority of lectures online via didactic videos accompanied by one-week attendance seminars. Supplementary learning materials include review articles, supportive reading material, multiple choice questions, and exercises for each unit. Lecture evaluations based on specific questions concerning learning environment and information learned, each measured on a five-point Likert scale. RESULTS: Lecture videos were implemented following the classical triad of the didactic process, using oncological examples from practice to teach. The online tutorial support offered to students was hardly used, thus we enhanced faculty presence during the face-to-face seminars. Lecture evaluations improved after revising the learning material on the basis of the first AO student cohort's comments. DISCUSSION: Developing and implementing an online study programme is challenging with respect of maximizing the information students learn due to limited opportunities for personal contact between lecturers and students. A more direct interaction of lecturers and students in a blended learning setting outperforms a mere web-based contact in terms of learning advantage and students' satisfaction, especially for complex methodological content.

Observer agreement on the Dejour trochlear dysplasia classification: a comparison of true lateral radiographs and axial magnetic resonance images.

BACKGROUND: Trochlear dysplasia is known to be an important cause of patellofemoral instability. D. Dejour's radiographic and magnetic resonance imaging (MRI) classifications are widely used in clinical practice and in the orthopaedic literature to assess the severity of trochlear dysplasia. The indication for deepening trochleoplasty to treat trochlear dysplasia is also mainly based on the severity of trochlear dysplasia according to Dejour's criteria. PURPOSE: To our knowledge, there is no study evaluating the efficacy of the Dejour classification. The aim of this study was to assess the intraobserver and interobserver agreements of the radiographic and MRI-based classification as described by Dejour. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: From 50 patients, 50 lateral radiographs as well as 50 MRI scans were read twice independently within 4 weeks by 4 surgeons (2 senior and 2 junior examiners). Analysis was made according to Dejour's 4 grades of radiological criteria of trochlear dysplasia as well as differentiating between 2 grades: low-grade (type A) and high-grade trochlear dysplasia (types B-D). RESULTS: The 4-grade analysis showed fair intraobserver and interobserver agreements (24%-78%), while the 2-grade analysis showed good to excellent agreement (56%-96%). The best overall agreement was found for the 2-grade analysis on MRI scans (62%-96%). The lateral radiographs tended to underestimate the severity of trochlear dysplasia compared with axial MRI. CONCLUSION: D. Dejour's classification is valid for typing trochlear dysplasia and is particularly useful in separating low-grade from high-grade dysplasia.

Choosing the optimal fit function: comparison of the Akaike information criterion and the F-test.

In many circumstances of data fitting one has to choose the optimal fitting function or model among several alternatives. Criteria or tests on which this decision is based are necessary and have to be well selected. In this preliminary analysis the application of the corrected Akaike information criterion is demonstrated considering the example of determining pharmacokinetic parameters for the blood serum time activity curves of 111In-labeled anti-CD66 antibody. Another model selection criterion, the F-test, is used for comparison. For the investigated data the corrected Akaike information criterion has proved to be an effective and efficient approach, applicable to nested and non-nested models.

Absent endocervical cells on Pap smears after loop electrosurgical excision procedure.

OBJECTIVE: To evaluate the absence of endocervical cells on Pap smear after loop electrosurgical excision procedure (LEEP) as a possible marker for cervical stenosis. MATERIALS AND METHODS: All LEEPs performed at a public health teaching hospital caring for the indigent between July 1, 1999, and September 30, 2002, were reviewed; 1,190 eligible charts of patients were reviewed, and extracted data included the following: age, parity, ethnicity, histology obtained during colposcopy, volume of loop specimen taken, and follow-up Pap smear results. RESULTS: One thousand four hundred twenty-one patients had LEEPs during this period. One thousand one hundred ninety first follow-up Pap smears were evaluated; 200 patients had no follow-up Pap smears. The baseline background rate for absent endocervical cells was 7% for the general population. The study showed that the rate of absent endocervical cells on first follow-up Pap smears was 13.64% (173/1,193) (p = .03). The mean age of patients was 33.6 years; 11% (20/1,193) were aged older than 50 years. There was no significant difference with age and parity in the stenosis versus nonstenosis group. CONCLUSION: The LEEP was significantly associated with absent endocervical cells on follow-up Pap smears, which may be indicative of cervical stenosis.

Coverage of Miller class I and II recession defects using enamel matrix proteins versus coronally advanced flap technique: a 2-year report.

BACKGROUND: The aim of this study was to evaluate a comparison of the coronally advanced flap procedure with or without the use of enamel matrix proteins in the treatment of recession defects. METHODS: This 2-year study was conducted as a blinded, split-mouth, placebo-controlled, and randomized design. Thirty patients from two dental schools with two paired buccal recession defects were chosen. Surgical recession coverage was performed as the coronally advanced flap technique. One site was additionally treated with derivative (EMD) and the other site with a placebo (propylene glycol alginate [PGA]). A blinded examiner assessed pre- and post-surgical measurements. Measurements comprised the height and width of the gingival recession, height of keratinized tissue, probing attachment level, probing depth, and alveolar bone level. RESULTS: Twenty-four months after therapy, both treatment modalities showed significant root coverage and probing attachment gain. The mean gingival recession decreased from 3.6 to 0.8 mm for the EMD-treated sites and from 3.8 to 1.4 mm for the control sites. However, this difference was not statistically significant (P = 0.122). Similarly, all other clinical parameters did not differ significantly in the between-group comparison except for the recession width (P = 0.027) and probing depth (P = 0.046) exhibiting higher reductions in the EMD group. Complete root coverage could be maintained over 2 years in 53% of the EMD versus merely 23% in the control group. A total of 47% of the treated recessions in the control group deteriorated again in the second year after therapy compared to 22% in the EMD group. CONCLUSION: Enamel matrix derivative seems to provide better long-term results.