Hyperspectral imaging to accurately segment skin erythema and hyperpigmentation in cutaneous chronic graft-versus-host disease.

In 51 lesions from 15 patients with the inflammatory skin condition chronic graft-versus-host-disease, hyperspectral imaging accurately delineated active erythema and post-inflammatory hyperpigmentation. The method was validated by dermatologist-approved confident delineations of only definitely affected and definitely unaffected areas in photographs. A prototype hyperspectral imaging system acquired a 2.5 × 3.5 cm2 area of skin at 120 wavelengths in the 450-850 nm range. Unsupervised extraction of unknown absorbers by endmember analysis achieved a comparable accuracy to that of supervised extraction of known absorbers (melanin, hemoglobin) by chromophore mapping: 0.78 (IQR: 0.39-0.85) vs. 0.83 (0.53-0.91) to delineate erythema and 0.74 (0.57-0.87) vs. 0.73 (0.52-0.84) to delineate hyperpigmentation. Both algorithms achieved higher specificity than sensitivity. Whereas a trained human confidently marked a median of 7% of image pixels, unsupervised and supervised algorithms delineated a median of 14% and 27% pixels. Hyperspectral imaging could overcome a fundamental practice gap of distinguishing active from inactive manifestations of inflammatory skin disease.

Dermoscopy and reflection confocal microscope features of pigmented prurigo.

BACKGROUND: Pigmented prurigo (PP) is a chronic and recurrent inflammatory skin disease. PP is not common clinically, but it is easily misdiagnosed because of its diversified clinical manifestations in different stages. MATERIALS AND METHODS: We retrospectively analyzed the clinical, histopathological, dermoscopy, and reflectance confocal microscopy (RCM) features of 20 patients diagnosed as PP. RESULTS: The female predominance ratio was revealed with male to female of 1:4. Seven female patients were on a diet (without staple food) and one patient had a history of diabetes. Eight cases were suffered in spring, six cases in winter, three cases in summer, and three cases in autumn. Multiple sites were involved in 13 cases. Four patients had urticarial papules and plaques. Nineteen patients had erythematous papules with reticular distribution, of which 14 cases accompanied reticulate hyperpigmentation, four cases with papulovesicle, and two cases accompanied with pustules. One patient only showed reticulate hyperpigmentation. In the early lesions, dermatoscopy showed pink oval lesions, punctate or linear vessels, and pale yellow rings around the skin lesions. RCM is characterized by spongiosis, spongy vesicle, neutrophils scattered in the epidermis, which was consistent with epidermis spongiosis, neutrophils infiltrating into the upper epidermis and necrotic keratinocytes in histopathology. In the fully developed lesions, dermatoscopy showed pink lesions with brown pigment granules in the center and linear vessels in the edge. RCM showed that demarcation of epidermis and dermis is not clear, and inflammatory cells can be seen in the upper dermis and histopathologically lesions assumed a patchy lichenoid pattern, and the inflammatory cells infiltrating the dermis were dominated by lymphocytes. In the late lesions, dermatoscopy showed grainy grayish-brown or yellowish-brown pigmentation surrounding the hair follicle merging with each other. RCM showed that pigment granules were increased on the ring of basal cells, inflammatory cells were sparsely infiltrated in the dermal papilla and superficial layer, and epidermis slightly hyperplastic, with melanophages and a few lymphocytes infiltrating the superficial dermis in histopathology. CONCLUSION: PP is easily misdiagnosed and not always occurs in those on a restrictive diet. A combination of dermatoscopy and RCM is helpful for its diagnosis of PP.

Skin ageing: Clinical aspects and in vivo microscopic patterns observed with reflectance confocal microscopy and optical coherence tomography.

Few studies have combined high-resolution, non-invasive imaging, such as standardized clinical images, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT), for age-related skin change characterization according to age groups. This study aimed to correlate clinical manifestations of ageing with skin cytoarchitectural background observed with high-resolution, non-invasive imaging according to age-related skin pattern distribution. A set of 140 non-pathological facial skin images were retrospectively retrieved from a research database. Subjects, aged between 20 and 89, were divided into 7 age groups. Clinical features were explored with VISIA, including hyperpigmentation, skin texture, wrinkles, pores and red areas, quantified and expressed as automated absolute scores. Previously described RCM and OCT epidermal and dermal features associated with ageing were investigated. All features were assessed for distribution and correlation among age groups. Significant direct correlations between age and clinical features were proven for cutaneous hyperpigmentation, skin texture, wrinkles and red areas. As age advances, RCM epidermal irregular honeycomb and mottled pigmentation are more frequently observed and collagen is more frequently coarse, huddled and curled, while the epidermis in OCT is thickened and the dermal density is decreased with more disrupted collagen fibres. RCM and OCT feature changes correlate directly and indirectly as well as correlating directly and indirectly with standardized clinical images. Clinical manifestations of ageing correlate with skin cytoarchitectural background observed with RCM and OCT. In conclusion, complimentary information between standardized clinical images and high-resolution, non-invasive imaging will assist in the development of future studies dedicated to skin ageing assessment and treatment effectiveness.

Dermoscopy aids in differentiating primary cutaneous amyloidosis and post-inflammatory hyperpigmentation: A clinico-dermoscopic-histopathaological study.

BACKGROUND: Primary cutaneous amyloidosis (PCA) and post-inflammatory hyperpigmentation (PIH) are common causes of cutaneous hyperpigmentation that are usually diagnosed clinically. However, their presentations are sometimes atypical, and their differentiation is difficult. Dermoscopy is a valuable diagnostic tool for pigmented diseases that might aid in their diagnosis. OBJECTIVE: To describe the characteristic dermoscopic features of PCA and PIH together with histopathological correlation, and to differentiate between these conditions in a non-invasive way. METHODS: Fifty-two patients with PCA (n = 26) and PIH (n = 26) were enrolled. A detailed history, skin examination, dermoscopic examination using handheld and video dermoscopy, and histopathological evaluation were performed. RESULTS: A statistically significant difference could be detected between PCA and PIH in terms of the duration of the disease (p = 0.027), symmetry (p = 0.044), rippling (p < 0.001), and back affection (p = 0.048). On dermoscopic examination, central hubs were seen more in the PCA group (p < 0.001) with different patterns of peripheral pigmentation. Histopathologically, the number of melanophages per high-power field was significantly higher in the PCA group (p = 0.013). CONCLUSION: The results of this study shed the light on the potential of dermoscopy as a non-invasive diagnostic tool in differentiating between doubtful cases of PCA and PIH.

Dermoscopy as an efficient aid to diagnose pigmentary and vascular component of periorbital melanosis: A cross-sectional study.

INTRODUCTION: Periorbital melanosis (POM) has a significant impact on quality of life. There is a dearth of literature regarding POM, especially in Asian population. Accurate classification of POM is contributory to the choice of therapy. The aim of this study was to assess the role of dermoscopy in etiologic classification of POM. METHODS: Two hundred and fifty adult patients (age > 18 years) of POM were enrolled over a period of 2 years. POM was classified clinically and re-evaluated based on their dermoscopic findings (pattern of pigmentary and vascular involvement, surface changes). RESULTS: Pigmented, vascular, structural, and mixed types of POM represented 6.4%, 4.8%, 0.4%, and 88.4%, respectively. Dermoscopy was found to be statistically more accurate in classifying pigmentary and vascular types of POM as compared to clinical examination with the naked eyes (p- value <0.05). Patchy or post-inflammatory pigmentation was the most common pigmentary pattern on dermoscopy (53.8%) followed by pseudoreticular (37.1%) and mixed pattern (9.1%). 80.4% patients had vascular involvement of which the most common vascular pattern was telangiectasia (58.8%). Wrinkling or increased skin laxity as a cause of shadow effect was found in 52% patients. Diffuse erythema and scaling suggestive of subtle inflammation was detected in 47.6% patients on dermoscopy. CONCLUSION: Dermoscopy as a diagnostic modality is more accurate in detecting pigmentary and vascular causes of POM and subtle signs of active inflammation in the form of erythema and scaling which is difficult to detect clinically. The major limitations of this study were lack of correlation of dermoscopic findings with the histological findings and the absence of any control group for comparison.

Dynamic evaluation of an in vivo postinflammatory hyperpigmentation model using reflectance confocal microscopy and spectrophotometry.

BACKGROUND: Postinflammatory hyperpigmentation (PIH) reflects a dynamic process from primary injury and cutaneous inflammation to subsequent melanogenesis and hyperpigmentation, of which pathogenesis remains unclear, hindering the development of targeted therapies. AIMS: To observe the dynamic development of PIH; determine the starting point and peak point of the inflammatory phase and pigmentary phase; and clarify the timing of anti-inflammatory and anti-pigmentary treatment. METHODS: Thirty healthy volunteers with Fitzpatrick skin types III-IV were enrolled and underwent suction blisters. The noninvasive evaluation of inflammation and hyperpigmentation on suction blister sites were performed via spectrophotometry (CM2600d and SIAscope) and RCM for the following 24 weeks. RESULTS: We successfully observed suction blister-induced PIH lasting over 24 weeks. The inflammatory phase started soon after the procedure and lasted for 8-12 weeks, manifested by significantly elevated a* values and erythema index detected by spectrophotometry, as well as inflammatory infiltration and angiogenesis shown in RCM images. Meanwhile, melanogenesis was accelerated after week 3 and reached peak on week 8, manifested by significantly accumulated melanin granules and bright pigment rings in different depths under RCM, which was in parallel with elevated melanin index. The darkening skin tone in PIH actually presented a mixture of inflammatory erythema, angiogenesis, and hyperpigmentation. The inflammation and pigmentation phases of PIH were not sequential but partially overlap. CONCLUSION: The duration of suction blister-induced PIH is more than 24 weeks. The inflammatory phase partially overlaps with the pigmentary phase, and those drugs with anti-inflammatory and anti-pigmentary dual effects are potential choices.

Efficacy of topical antioxidants in the skin hyperpigmentation control: A clinical study by reflectance confocal microscopy.

BACKGROUND: Some in vitro studies have reported the potential of antioxidants for the reduction of melanogenesis. However, it is important to assess the clinical efficacy of these substances in reducing skin hyperpigmentation. Thus, the aim of this study was to evaluate the clinical efficacy of dermocosmetic formulations based on antioxidants using Reflectance confocal microscopy (RCM). METHODS: Thirty-two healthy females aged 39-55 years were enrolled and divided into four groups: Vehicle (V), V with ascorbyl tetraisopalmitate (ATIP), V with Spirulina sp., and V with hydroxytyrosol-titrated olive extract. Imaging analyses by high-resolution methods and RCM were performed in the malar region of the face before and after a 42-day period of application of the studied formulations. RESULTS: Reflectance confocal microscopy imaging analyses showed a significant reduction of number of hyperreflective pixels and basal layer brightness after 42 days of application of formulations containing the antioxidants compared to vehicle and baseline values, suggesting an improvement of the skin pigmentation pattern. CONCLUSION: Reflectance confocal microscopy permitted the identification of skin hyperpigmentation and the assessment of the clinical efficacy of dermocosmetic formulations based on antioxidants in a noninvasive way. All formulations containing antioxidants significantly reduced skin hyperpigmentation after the period of application.

Fundus Autofluorescence Lifetimes and Spectral Features of Soft Drusen and Hyperpigmentation in Age-Related Macular Degeneration.

Purpose: To investigate the autofluorescence lifetimes as well as spectral characteristics of soft drusen and retinal hyperpigmentation in age-related macular degeneration (AMD). Methods: Forty-three eyes with nonexudative AMD were included in this study. Fluorescence lifetime imaging ophthalmoscopy (FLIO), which detects autofluorescence decay over time in the short (SSC) and long (LSC) wavelength channel, was performed. The mean autofluorescence lifetime (τm) and the spectral ratio (sr) of autofluorescence emission in the SSC and LSC were recorded and analyzed. In total, 2760 soft drusen and 265 hyperpigmented areas were identified from color fundus photographs and spectral domain optical coherence tomography (SD-OCT) images and superimposed onto their respective AF images. τm and sr of these lesions were compared with fundus areas without drusen. For clearly hyperfluorescent drusen, the local differences compared to fundus areas without drusen were determined for lifetimes and sr. Results: Hyperpigmentation showed significantly longer τm (SSC: 341 ± 81 vs. 289 ± 70 ps, P < 0.001; LSC: 406 ± 42 vs. 343 ± 42 ps, P < 0.001) and higher sr (0.621 ± 0.077 vs. 0.539 ± 0.083, P < 0.001) compared to fundus areas without hyperpigmentation or drusen. No significant difference in τm was found between soft drusen and fundus areas without drusen. However, the sr was significantly higher in soft drusen (0.555 ± 0.077 vs. 0.539 ± 0.081, P < 0.0005). Hyperfluorescent drusen showed longer τm than surrounding fundus areas without drusen (SSC: 18 ± 42 ps, P = 0.074; LSC: 16 ± 29 ps, P = 0.020). Conclusions: FLIO can quantitatively characterize the autofluorescence of the fundus, drusen, and hyperpigmentation in AMD. Translational Relevance: The experimental FLIO technique was applied in a clinical investigation. As FLIO yields information on molecular changes in AMD, it might support future diagnostics.

Múltiples pápulas parduzcas asintomáticas de reciente aparición en el tronco / Recent Onset of Multiple Asymptomatic Brownish Papules

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In vivo reflectance confocal microscopy for evaluating common facial hyperpigmentation.

BACKGROUND: In clinical settings, atypical facial hyperpigmentation such as nevus of Ota, acquired bilateral nevus of Ota-like macules (ABNOM), melasma, and café-au-lait spots are often missed and misdiagnosed. Summarizing in vivo reflectance confocal microscopy (RCM) features of the hyperpigmentation is helpful in the diagnosis of ambiguous lesions. METHODS: We recruited 196 patients referred for unequivocal facial hyperpigmentation, including 55 patients with nevus of Ota, 45 patients with ABNOM, 62 patients with melasma, and 34 patients with café-au-lait spots. The RCM images were evaluated at the epidermis, the dermis-epidermis junction (DEJ), and the upper papillary dermis from both hyperpigmented patches and normal skin. RESULTS: In the superficial and middle dermis, 41 of 55 patients (74.5%) with nevus of Ota were characterized by a cord-like or lumpy structure between the collagen fibers. And there was no melanin deposition detected in the dermis in 14 of 55 (25.5%) patients. In ABNOM, 37 of 45 (82.2%) patients were characterized by a cord-like or lumpy structure in the superficial dermis and 8 of 45 patients (17.8%) was no melanin deposition detected in the dermis. The epidermis was no difference between nevus of Ota, ABNOM, and the normal skin. Melasma was detected increased cobblestone pattern in the epidermis of all patients, branching architecture in 21 of 62 patients (33.9%), and focally aggregated round to triangular cells in the upper dermis of 18 of 62 patients (29.0%). In all patients with afé-au-lait spots, increased cobblestone pattern in the epidermis and regular and increased density of ringed pattern in the DEJ were visualized. CONCLUSIONS: Our findings indicate that RCM may be useful in the auxiliary diagnosis of nevus of Ota, ABNOM, melasma, and café-au-lait spots.

Confocal laser scanning microscopy, a diagnostic alternative for five pigmented lesions on the face: An observational study.

OBJECTIVE: To describe the confocal laser scanning microscopy (CLSM) features of five different facial hyperpigmentation diseases and to highlight the features that can be used to differentiate between the diseases. MATERIALS AND METHODS: Confocal laser scanning microscopy features of skin lesions of 406 patients with different facial hyperpigmentation diseases (chloasma, naevus fusco-caeruleus zygomaticus, naevus of Ota, freckles and Riehl melanosis) were retrospectively analysed. All patients were diagnosed clinically. The features of each layer of the skin in the involved regions and at the junction of the lesion with normal skin were studied, and the characteristic features of each disease were identified. The CLSM probe was applied perpendicular to the skin surface. Scanning was performed with medical ultrasonic coupling agent applied between the adhesive window and skin and between the lens and adhesive window. The skin was scanned layer by layer, and the best cross-sectional images were stored in the computer for analysis. RESULTS: Chloasma lesions showed significantly increased pigment content in the epidermal basal layer and, in some cases, varying degrees of pigment particle deposition in the upper dermis. Naevus fusco-caeruleus zygomaticus and naevus of Ota lesions showed normal epidermal pigment content, with cord-like high-refractive pigment masses scattered in the dermis; cord-like or dendritic melanocytes were seen between collagen fibre bundles in the upper and middle dermis, but no inflammatory cell infiltration was seen. Freckles lesions showed increased numbers of pigment particles in the basal layer, but no abnormal changes in the dermis. Riehl melanosis was characterised by liquefaction degeneration of the basal cells, accompanied by considerable monocyte and melanophage infiltration in the dermal papilla. CONCLUSIONS: Used in combination with clinical manifestations, CLSM can be a useful auxiliary method for diagnosis of naevus fusco-caeruleus zygomaticus, naevus of Ota, chloasma, freckles and Riehl melanosis.

Inter- and intra-observer agreement in dermatologists' diagnoses of hyperpigmented facial lesions and development of an algorithm for automated diagnosis.

BACKGROUND: Hyperpigmentation has varied aetio-pathologies. Hence, accurate and reproducible diagnosis of the type of hyperpigmentation is essential for effective management. It is typically made clinically by dermatologists but the rate of inter- and intra-observer agreement/variability is unknown. Hyperpigmented facial lesions are extremely common but access to dermatological services is difficult or costly in most countries. Thus, it is desired to evaluate dermatologists' inter- and intra-observer agreement in the diagnosis and to develop an algorithm for automated diagnosis. MATERIALS AND METHODS: Hyperpigmented lesions on 392 facial images were diagnosed by three experienced dermatologists either jointly or independently, and this process was subsequently repeated for 52 randomly selected images. When there was non-concordance amongst the dermatologists for the diagnosis, a majority decision was taken as correct diagnosis. Inter-observer and intra-observer agreement were analysed for the diagnosis of the hyperpigmented lesions. Thereafter, a multiclass classification method was developed to perform the task in an automatic manner. The developed algorithm was compared and validated against the ground truth derived from the dermatologists. RESULTS: Both inter- and intra-observer agreements are in the moderate range. The algorithm agreed well with the derived ground truth, with a Kappa value of 0.492, which is similar to the Kappa values of inter- and intra- observer agreements. CONCLUSION: The rates of inter- and intra-observer agreement in the diagnosis of hyperpigmented facial lesions amongst dermatologists were moderate in this study. Compared to visual assessment from the dermatologists, automated diagnosis using the developed algorithm achieved a high rate of concordance.

Q-switched double-frequency Nd:YAG (532 nm) laser is an effective treatment for racial lip pigmentation.

INTRODUCTION: Lip darkening is a relatively common condition, especially in the Middle East and Southeast Asia. It is well documented in the literature and generally considered to be multifactorial. The presentation can be physiologic or pathologic and caused by a variety of local or systemic factors. CASE PRESENTATION: A 32-year-old female with skin type IV presented to the clinic with concerns of darkening lips with no associated symptoms or history of disease. On examination, her lips were homogenously dark brown with the upper lip slightly darker than the lower lip. OBJECTIVE: To report effectivness of Q-switched 532 nm laser for treatment of lip pigmentation. METHOD: Topical 2.5% lidocaine/prilocaine (EMLA) cream was applied 30 minutes prior to laser therapy. The region was treated with Q-switched 532 nm laser (Medlite). RESULT: Two weeks after laser treatment , threre was satisfying subjective and objective improvment in lip pigmnetation. CONCLUSION: Q-Switched 532 nm laser effectively reduces lip pigmentation after one session with minimal adverse effects and lasting results.

Relationship between dermoscopy and pathology in a case of clonal-type pigmented Bowen's disease: Observation with vertical-view dermoscopy.

Pigmented Bowen's disease (pBD) is a subtype of Bowen's disease, which presents clinically as a well-circumscribed, hyperpigmented plaque. Its clinical manifestations are not fully characterized, and differential diagnoses include various pigmented skin lesions. Dermoscopy could be useful for the diagnosis, although nothing has been reported on the dermoscopic features of clonal-type pBD. We herein report a first case of clonal-type pBD on the sole and its dermoscopic features. Dermoscopy showed brown to blue-gray dots/globules and focally anastomosing lines on the non-weight-bearing area, while the weight-bearing area had a brown to blue-gray fibrillar-like pattern. To investigate the relationship between dermoscopy and histopathology, we focused on the melanin distribution in the horny layer of the epidermis, and used vertical dermoscopy observation. We investigated the relationship between dermoscopy and pathology by melanin depth estimation using a color lightness value.