Clinical Skin Research Articles

Improved microvascular imaging with optical coherence tomography using 3D neural networks and a channel attention mechanism

Skin microvasculature is vital for human cardiovascular health and thermoregulation, but its imaging and analysis presents significant challenges. Statistical methods such as speckle decorrelation in optical coherence tomography angiography (OCTA) often require multiple co-located B-scans, leading to lengthy acquisitions prone to motion artefacts. Deep learning has shown promise in enhancing accuracy and reducing measurement time by leveraging local information. However, both statistical and deep learning methods typically focus solely on processing individual 2D B-scans, neglecting contextual information from neighbouring B-scans. This limitation compromises spatial context and disregards the 3D features within tissue, potentially affecting OCTA image accuracy. In this study, we propose a novel approach utilising 3D convolutional neural networks (CNNs) to address this limitation. By considering the 3D spatial context, these 3D CNNs mitigate information loss, preserving fine details and boundaries in OCTA images. Our method reduces the required number of B-scans while enhancing accuracy, thereby increasing clinical applicability. This advancement holds promise for improving clinical practices and understanding skin microvascular dynamics crucial for cardiovascular health and thermoregulation.

In vivo confocal Raman spectroscopy: The window into the skin.

Development of invivo confocal Raman spectroscopy (ICRS) methodology over the last 20 years has enabled previously unavailable capability to acquire molecular concentration gradients across the stratum corneum (SC), at the micron level and in a clinical setting. Professor Tony Rawlings has been a driving force in SC research for over 30 years, working with a wide range of teams across the world. Because a detailed knowledge of skin biochemistry was key to interpreting ICRS-acquired molecular concentration gradients, the authors formed a close working relationship with Professor Rawlings during the development of ICRS. This article, therefore, presents a summary of this process and how challenges raised by application of ICRS were tackled, towards the goal of validating the technique for clinical skin measurement.

Understanding the causes of skincare product pilling.

Skincare and makeup "pilling" is an unsightly and undesirable phenomenon whereby skincare such as moisturizers or foundation ball up to form flakes on the skin. To date, the causes of skincare product pilling have not been studied. This study aimed to examine the relationship between skin physiology and pilling potential of sunscreen and foundation (the two products most reported by consumers to cause pilling). This study also examined the effects of product application methods on pilling. 528 female volunteers from Guangzhou, China, aged between 20 and 49 years, underwent various clinical skin assessments, followed by three steps of product layering. Pilling was assessed after each product application step. 217 volunteers (41%) experienced pilling. The majority of pilling (n=655 events) occurred following sunscreen application, while only a few pilling events (n=35) occurred with foundation. Foundation improved pilling caused by sunscreen in 98.9% of cases. Volunteers experiencing pilling with both sunscreen and foundation had significantly lower facial skin hydration and oiliness, higher pH, and smoother skin texture (P<0.05). Two application methods, rubbing of products in circular and linear motions, yielded the highest numbers of pilling events. This study has provided the first insights into the causes of pilling. Sunscreen is a promoter of pilling, while foundation may resolve sunscreen-induced pilling in many cases. Skin physiology, particularly drier, smoother skin with higher pH, and product application methods are likely contributing factors to this undesirable phenomenon.

Ibuprofen as an adjuvant to conventional antimicrobials and essential oil compounds against skin pathogens.

Antimicrobial resistance continues to be a growing concern, resulting in increased use of drug combinations. Antibiotic adjuvants are an emerging strategy that may potentiate an antibiotics efficacy. Ibuprofen's polypharmacological properties have been investigated for their antimicrobial and host-modulating potential. This study aimed to investigate the potential of a novel multidrug combination involving ibuprofen, essential oil compounds (EOCs), and conventional antimicrobials against skin pathogens. The minimum inhibitory concentrations of ibuprofen, conventional antimicrobials, and EOCs were determined and then combined and tested against 14 (reference and clinical) skin pathogens. The cytotoxicity was analysed using the MTT assay, whilst the anti-inflammatory effects were evaluated using lipopolysaccharide activated RAW264.7 murine macrophages. Four pairwise (Ibuprofen and antibiotic) (ΣFIC 0.33-0.50) and three triple (Ibuprofen and antibiotic with EOC) (ΣFIC 0.44-0.47) synergistic antimicrobial interactions were identified. These combinations demonstrated cell viability of 77.59%-100%. No combination significantly reduced nitric oxide production. The results from this study provide insight into the potential of a multidrug combination involving ibuprofen with conventional antimicrobials and EOCs against common skin pathogens.

Perimarginal quadrangle dissection: Pushing the boundaries of neck dissection in gingivo-buccal complex cancer

ObjectivesPerimarginal nodes (PMN) lie in close relationship with marginal mandibular nerve (MMN), in the lymphatic drainage pathway of gingivo-buccal cancers (GBC), above the lower border of mandible and remain unaddressed in conventional neck dissection. We have aimed to define the boundaries of perimarginal node dissection, explore incidence of PMN metastasis and its correlation with histopathological characteristics. Materials and methodsA prospective study was conducted on 112 consecutive patients of GB carcinoma. PMN dissection was performed in an anatomically defined quadrangle. Prospective clinical characteristics included subsite, tumor and nodal stage, location of primary and clinical skin involvement. Histopathological characteristics analyzed included grade, size, pathological tumor, nodal stage, skin and/or bone involvement, depth of invasion, Brandwein Gensler histological risk score and lympho-vascular emboli. MMN function was graded at 3 and 6 months post-operatively. ResultsThe PMN were identified histologically in 75.89 % patients. 15.2 % patients harboured metastasis in PMN. 16.7 % patients had clinically occult metastasis with 11.7 % having isolated PMN metastasis. None of the pre-operative clinical factors was found to be significant in predicting incidence of metastasis. Higher nodal burden (p = 0.01) and pathological skin involvement (p = 0.03) were found statistically significant on multivariable analysis. At 6 months follow-up, none of the patients had any MMN functional deformity at rest. ConclusionThere is a high incidence of occult PMN metastasis from gingivo-buccal complex cancer. High nodal stage and pathological skin involvement are independent predictors for PMN metastasis. PMN dissection must be performed in all cases of GB cancer.

Helicobacter Pylori: Beyond The Gut - Insights Into Its Association With Dermatological Conditions

Introduction: Helicobacter pylori (H. pylori) is a Gram-negative bacterium associated with gastrointestinal diseases and extra-gastrointestinal manifestations, including dermatological conditions. Understanding the precise mechanisms and clinical implications of the H. pylori skin disorder association is essential. Materials and methods: A cross-sectional observational study was conducted at a private dermatology center in Ahmedabad, Gujarat, from January 2021 to August 2023. Patients coming with various dermatological conditions and with suspected H. pylori infection underwent clinical examination, laboratory tests, and skin biopsy to confirm the diagnosis of disease. The statistical analysis assessed associations between demographics, dermatological conditions, and H. pylori antibody test results. Laboratory Investigation: H. pylori antibody levels were measured using serology by doing H.pylori IgG antibody level testing and cut-off values of &gt;0.90 were considered positive. Statistical Analysis: Data entry and analysis involved Microsoft Excel 360, calculating proportions, and percentages, and drawing appropriate inferences. Results: Of 1131 enrolled patients (male-female ratio 1:1.43), 22% tested positive for H. pylori, with higher positivity rates in patients aged &gt;60 years and 40-60 years. Analysis revealed varying proportions of H. pylori positivity across dermatological conditions, with alopecia areata and chronic urticaria showing the highest rates. Conclusions: While studies suggest H. pylori’s involvement in dermatological diseases, further research is needed to understand this relationship fully. Systematic investigations into the impact of eradication therapy are essential to inform clinical management strategies and guide future research directions.

To assess the diagnostic accuracy of LRINEC Score for prediction of necrotizing fasciitis in patients presenting with clinical skin and subcutaneous tissue infections

To assess the diagnostic accuracy of LRINEC Score for prediction of necrotizing fasciitis in patients presenting with clinical skin and subcutaneous tissue infections

No difference in clinical parameters and drug retention in PsA patients receiving b/tsDMARD monotherapy versus combination with methotrexate: data from the RABBIT-SpA registry

BackgroundThe potential benefit of methotrexate (MTX) in combination with biologic (b) and targeted synthetic (ts) disease modifying anti-rheumatic drugs (DMARDs) in psoriatic arthritis (PsA) is still a matter of debate.ObjectivesTo...

Metagenomics reveals unique gut mycobiome biomarkers in psoriasis.

In present, the diagnosis of psoriasis is mainly based on the patient's typical clinical manifestations, dermoscopy and skin biopsy, and unlike other immune diseases, psoriasis lacks specific indicators in the blood. Therefore, we are required to search novel biomarkers for the diagnosis of psoriasis. In this study, we analyzed the composition and the differences of intestinal fungal communities composition between psoriasis patients and healthy individuals in order to find the intestinal fungal communities associated with the diagnosis of psoriasis. We built a machine learning model and identified potential microbial markers for the diagnosis of psoriasis. The results of AUROC (area under ROC) showed that Aspergillus puulaauensis (AUROC=0.779), Kazachstania africana (AUROC=0.750) and Torulaspora delbrueckii (AUROC=0.745) had high predictive ability (AUROC>0.7) for predicting psoriasis, While Fusarium keratoplasticum (AUROC=0.670) was relatively lower (AUROC<0.7). The strategy based on the prediction of intestinal fungal communities provides a new idea for the diagnosis of psoriasis and is expected to become an auxiliary diagnostic method for psoriasis.

Comprehensive evaluation of the efficacy and safety of a new multi-component anti-aging topical eye cream.

The delicate periorbital region is susceptible to skin dehydration, wrinkles, and loss of elasticity. Thus, targeted and effective anti-aging interventions are necessary for the periorbital area. To evaluate the efficacy and safety of a new anti-aging eye cream formulated with the active complex (Yeast/rice fermentation filtrate, N-acetylneuraminic acid, palmityl tripeptide-1, and palmitoyl tetrapeptide-7). The cell viability and expressions of key extracellular matrix (ECM) components of the active complex were evaluated using a human skin fibroblast model. In the 12-week clinical trial, skin hydration, elasticity, facial photographs, and collagen density following eye cream application were assessed using Corneometer, Cutometer, VISIA, and ultrasound device, respectively. Dermatologists and participants evaluated clinical efficacy and safety at baseline, and after 4, 8, and 12weeks. PCR and immunofluorescent analyses revealed that the active complex significantly stimulated fibroblast proliferation (p<0.05) and markedly promote the synthesis of collagen and elastin. Clinical findings exhibited a substantial enhancement in skin hydration (28.12%), elasticity (18.81%), and collagen production (54.99%) following 12weeks of eye cream application. Dermatological evaluations and participants' assessments reported a significant improvement in skin moisture, roughness, elasticity, as well as fine lines and wrinkles by week 8. The new anti-aging eye cream, enriched with the active complex, demonstrates comprehensive rejuvenating effects, effectively addressing aging concerns in the periorbital area, coupled with a high safety profile.

儿童面部获得性色素沉着斑131例临床及影像学特征回顾分析

儿童面部获得性色素沉着斑131例临床及影像学特征回顾分析

Perimarginal lymph node metastasis in gingivo-buccal complex carcinoma: Is it time to push the limits of neck dissection?.

6069 Background: Perimarginal nodes (PMN) are a group of perifacial lymph nodes that lie in close relationship with marginal mandibular nerve (MMN). They lie in the lymphatic drainage pathway of gingivo-buccal cancers (GBC), above the lower border of mandible which forms the superior limit of conventional neck dissection and thus remain unaddressed. With reported incidence of metastasis as high as 20.5%, we aimed to explore incidence of PMN metastasis in GBC, its correlation with histopathological tumor and nodal characteristics. Methods: A prospective study was conducted on 112 consecutive treatment naïve patients of GB squamous cell carcinoma. Patients with unresectable nodal disease, distant metastasis and prior radiotherapy or surgery to neck were excluded. PMN dissection was performed in the quadrangle bounded superiorly by the mandibular alveolar ridge, inferiorly by lower border of mandible, anteriorly by mental foramen and posteriorly by anterior border of masseter. On histopathological analysis, serial step sectioning and cytokeratin immunohistochemistry were performed. Prospective clinical characteristics analyzed were subsite, clinical tumor, nodal stage, location of primary and clinical skin involvement. PMN positivity was correlated with demographic, clinical, nodal status. Histopathological characteristics analyzed included tumor grade, pathological tumor, nodal stage, tumor size, skin and/or bone involvement, depth of invasion, Brandwein Gensler histological risk score and lympho-vascular emboli. MMN functional outcome was graded according to House-Brackman (HB) grading recorded at 3 and 6 months post-operatively. Results: Baseline characteristics are summarized in the table. The PMN were identified histologically in 75.89% (85/112) patients. Metastasis in these nodes were identified in 15.2% (17/112) patients. Our study revealed an occult PMN metastasis of 16.67% (13/78). None of the pre-operative clinical factors was found to be significant in predicting incidence of metastasis. Higher nodal burden (p=0.01) and pathological skin involvement (p=0.03) had statistically significant odds of having PMN metastasis on multivariable analysis. At 6 months follow-up, none of the patients had any MMN functional deformity at rest. Conclusions: There is a high incidence of occult PMN metastasis from gingivo-buccal complex cancer. High nodal stage and pathological skin involvement are independent adverse prognostic factors for PMN metastasis. The limits of conventional neck dissection should be expanded to include clearance of PMN in all cases of gingivo-buccal cancers. [Table: see text]

ORAL RETINOID TREATMENT IN A NEWBORN WITH LAMELLAR ICHTHYOSIS

Ichthyosis is a heterogeneous group of conification disorders characterized by hyperkeratosis involving the skin. One form of ichthyosis, lamellar ichthyosis (LI), is autosomal recessively inherited with an incidence of 1/300,000. The diagnosis is based on clinical findings, skin biopsy and genetic analysis. Treatment includes moisturizing the skin, reducing fluid loss and keratolytics. Oral retinoids have been found to be very successful in the treatment of LI(1). In this case, a premature newborn diagnosed with LI is presented because of its rarity and good response to oral retinoid treatment.

Resveratrol-coated chitosan mats promote angiogenesis for enhanced wound healing in animal model.

Growing incidences of chronic wounds recommend the development of optimal therapeutic wound dressings. Electrospun nanofibers have been considered to show potential wound healing properties when accompanied by other wound dressing materials. This study aimed to explore the potential role of Chitosan (CS) nanofibrous mats coated with resveratrol (RS) as an antioxidant and pro-angiogenic agent in rat models of skin wound healing. Electrospun chitosan/polyethylene oxide (PEO) nanofibers were prepared using electrospinning technology and coated by 0.05 and 0.1 mg.ml resveratrol named as (CS/RS 0.05) and (CS/RS 0.1), respectively. The scaffolds were characterized physiochemically such as invitro release study, TGA, FTIR spectroscopy analysis, biodegradability, and human dermal fibroblast seeding assay. The scaffold was subsequently used invivo as a skin substitute on a rat skin wound model. In vitro tests revealed that all scaffolds promoted cell adhesion and proliferation. However, more cell viability was observed in CS/RS 0.1 scaffold. The biocompatibility of the scaffolds was validated by MTT assay, and the results did not show any toxic effects on human dermal fibroblasts. It was observed that RS-coated scaffolds had the ability to release RS in a controlled manner. In invivo tests CS/RS 0.1 scaffold had the greatest impact on the healing process by improving the neodermis formation and modulated inflammation in wound granulation tissue. Histological analysis revealed enhanced vascular endothelial growth factor expression, epithelialization and increased depth of wound granulation tissue. The RS-coated CS/PEO nanofibrous scaffold accelerates wound healing and may be useful as a dressing for cell transfer and clinical skin regeneration.

Polysensitisation is associated with more severe symptoms: The reality of patients with allergy.

Studying the sensitisation profiles of patients with allergies allows for a deeper understanding of the disease which may facilitate the selection of the best-personalised allergen immunotherapy. This observational, cross-sectional, multicentre study aimed to demonstrate the heterogeneity of the German population with allergies by analysing specific immunoglobulin E (sIgE) patterns towards aeroallergens and exploring the relationship between sensitisation and clinical symptoms. In total, 500 patients with allergies from different regions of Germany were recruited based on their case histories, clinical allergic symptoms and skin prick test data for aeroallergens. Serum samples were analysed using ImmunoCAP assays to determine sIgE levels for 33 allergenic sources and 43 molecular allergens. Most patients (81%) were polysensitised. Betula verrucosa pollen was the most common cause of sensitisation (59%), followed by Phleum pratense (58%) and Dermatophagoides pteronyssinus (44%). The highest prevalence rates of molecular allergens were observed for Bet v 1 (84%) from birch pollen, Phl p 1 from grass pollen (82%), Der p 2 (69%) from mites and Fel d 1 (69%) from cat. Polysensitisation was significantly associated with the presence of asthma and the severity of rhinitis symptoms. Our findings show a high rate of polysensitisation and emphasise the importance of molecular diagnosis for more precise and comprehensive insights into sensitisation patterns and their association with clinical symptoms. These data may help improve personalised diagnosis and immunotherapy adapted to the needs of individual patients in the region.

Image Quality Assessment Using Convolutional Neural Network in Clinical Skin Images

The image quality received for clinical evaluation is often suboptimal. The goal is to develop an image quality analysis (IQA) tool to assess patient and primary care physicians (PCP) derived images using deep learning model. Dataset included patient and PCP derived images from August 21, 2018 - June 30, 2022 with 4 unique quality labels. VGG16 model was fine-tuned with input data and optimal threshold was determined by Youden’s index. Ordinal labels were transformed to binary labels by using a majority vote as model distinguishes between 2 categories (good vs. bad). At a threshold of 0.587, AUC for the test set was 0.885 (95%CI 0.838 - 0.933); sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 0.829, 0.784, 0.906 and 0.645 respectively. Independent validation of 300 additional images (from patients and PCPs) demonstrated AUC 0.864 (95%CI: 0.818 - 0.909) and AUC 0.902 (95%CI: 0.85 - 0.95) respectively. The sensitivity, specificity, PPV and NPV for the 300 images were 0.827, 0.800, 0.959 and 0.450 respectively. We demonstrate a practical approach improving the image quality for clinical workflow. While users may have to capture additional images, this is offset by the improved workload and efficiency for clinical teams.

Human-multimodal deep learning collaboration in 'precise' diagnosis of lupus erythematosus subtypes and similar skin diseases.

Lupus erythematosus (LE) is a spectrum of autoimmune diseases. Due to the complexity of cutaneous LE (CLE), clinical skin image-based artificial intelligence is still experiencing difficulties in distinguishing subtypes of LE. We aim to develop a multimodal deep learning system (MMDLS) for human-AI collaboration in diagnosis of LE subtypes. This is a multi-centre study based on 25 institutions across China to assist in diagnosis of LE subtypes, other eight similar skin diseases and healthy subjects. In total, 446 cases with 800 clinical skin images, 3786 multicolor-immunohistochemistry (multi-IHC) images and clinical data were collected, and EfficientNet-B3 and ResNet-18 were utilized in this study. In the multi-classification task, the overall performance of MMDLS on 13 skin conditions is much higher than single or dual modals (Sen = 0.8288, Spe = 0.9852, Pre = 0.8518, AUC = 0.9844). Further, the MMDLS-based diagnostic-support help improves the accuracy of dermatologists from 66.88% ± 6.94% to 81.25% ± 4.23% (p = 0.0004). These results highlight the benefit of human-MMDLS collaborated framework in telemedicine by assisting dermatologists and rheumatologists in the differential diagnosis of LE subtypes and similar skin diseases.

Residual cosine similar attention and bidirectional convolution in dual-branch network for skin lesion image classification

Skin cancer is one of the most serious threats to human health among skin lesions. Computer-aided diagnosis methods can assist patients in identifying and detecting skin lesion types early, thereby enabling corresponding treatments. In this paper, we propose a dual-branch neural network model Conformer with Residual Cosine Similarity Attention and Bidirectional Convolutional fusion strategy, named RCSABC-Conformer. The core of this network structure comprises three parts: a Convolutional Neural Network (CNN) branch with Residual Cosine Similarity Attention (RCSA), a Transformer branch, and a Feature Couple Unit with Bidirectional Convolutional strategy (BC-FCU). The RCSA module calculates the cosine similarity value between the feature map generated by the convolutional operation and the feature map of the residual edge to assess whether their semantic information is similar. The semantic information of similar parts is weighted by exponential normalization to enhance the network's memory of similar features of the same type of skin lesion. The BC-FCU module interactively fuses local features and global representations of skin lesion images with different resolutions in the two branches. Specifically, when the global representations is integrated into local features, we introduce a new bidirectional convolution strategy to extract the feature map from both forward and backward directions, and then select the element with the smaller feature value from the two directions to fuse into local features. In this way, we can minimize the interference of the artifact features extracted by the Transformer branch on the CNN branch. In addition, taking advantage of the Transformer branch's capacity to construct global representations, our model can learn contextual semantic information of normal skin and lesion areas to enhance model robustness. We conducted experiments on three datasets, consisting of clinical and dermoscopic skin lesion images, as well as a hybrid of both. The experimental results show that RCSABC-Conformer outperforms both advanced and classical classification methods in terms of classification accuracy across all three datasets, without requiring an increase in the number of parameters and computational complexity. Compared with the baseline model, the classification accuracy of our proposed method improves by 2.40%, 5.39%, and 4.44% on the three datasets, respectively. To the best of our knowledge, this is the first study to apply an interactive fusion dual-branch network for multi-disease classification on different modalities of skin lesion databases. Code will be available at https://github.com/AlenLi817/RCSABC-Conformer.

Reactive Microneedle Patches with Antibacterial and Dead Bacteria-Trapping Abilities for Skin Infection Treatment.

Bacterial skin infections are highly prevalent and pose a significant public health threat. Current strategies are primarily focused on the inhibition of bacterial activation while disregarding the excessive inflammation induced by dead bacteria remaining in the body and the effect of the acidic microenvironment during therapy. In this study, a novel dual-functional MgB2 microparticles integrated microneedle (MgB2 MN) patch is presented to kill bacteria and eliminate dead bacteria for skin infection management. The MgB2 microparticles not only can produce a local alkaline microenvironment to promote the proliferation and migration of fibroblasts and keratinocytes, but also achieve >5 log bacterial inactivation. Besides, the MgB2 microparticles effectively mitigate dead bacteria-induced inflammation through interaction with lipopolysaccharide (LPS). With the incorporation of these MgB2 microparticles, the resultant MgB2 MN patches effectively kill bacteria and capture dead bacteria, thereby mitigating these bacteria-induced inflammation. Therefore, the MgB2 MN patches show good therapeutic efficacy in managing animal bacterial skin infections, including abscesses and wounds. These results indicate that reactive metal borides-integrated microneedle patches hold great promise for the treatment of clinical skin infections.

Weeping blisters – Clinical presentation in an uncommon site

Lymphangioma Circumscriptum (LC), a microcystic hamartomatous lymphatic malformation is a rare benign condition characterized by the proliferation of dilated lymphatic vessels in the skin. Usually, it is congenital, but some may become clinically apparent later in life. They account for 4% of all vascular malformations. Usually seen in and around the shoulder and pelvic girdle. This case report discusses LC in a teenage girl with a 13-year-old history of painless, grouped fluid filled blisters on the right side of her chest, an uncommon site presenting after several years seeking intervention. The diagnosis was established through clinical examination and skin biopsy. With normal basic laboratory investigations, we initiated her with lesional cryotherapy as the primary efficacious intervention before planning for surgical excision. Cryotherapy is cheap, safe and easily available option.