Standardized Clinical Photographs Research Articles

Digital photometric analysis as a non-invasive method to determine gingival phenotype: A comparative study

ObjectiveIdentification of periodontal phenotype is critical in clinical practice. Thick and thin tissues respond differently to inflammation, and trauma. It significantly influences the outcomes of restorative treatment, regenerative therapy, and success of implants and periodontal surgery. Periodontal phenotype can be assessed via invasive or non-invasive methods. This study aimed to establish the reliability of non-invasive methods in determining gingival phenotypes in comparison with validated methods. MethodsThis preapproved cross-sectional observational study was conducted at Batterjee Medical College in Saudi Arabia. The participants were conveniently sampled based on the inclusion criteria. The clinical study utilized Colorvue® biotype probes to evaluate gingival tissue phenotype in the region of interest, intraoral digital scanner (IOS) (iTero® scanner), and digital photography. Densitometric acquisition of photographs and intraoral scans was performed using Adobe Photoshop to quantify three-dimensional color measurements expressed in Delta E values (ΔE). Furthermore, patient-reported experience measures (PREMs) were used to evaluate anxiety and pain perception. Values of p < 0.05 were considered statistically significant. ResultsThe analysis of color difference values (ΔE) revealed significant variations in color perception across methods for the thin, medium and very thick groups, indicating perceptible color differences (p < 0.001). The assessment of anxiety levels indicated a statistically significant decrease in stress levels in favor of the IOS method for the medium phenotype. Furthermore, perceived pain was significantly lower with the IOS method than with the probing method for all phenotypes. ConclusionDensitometric analysis of standardized clinical photographs and intraoral scans of the marginal gingiva offers a promising, non-invasive, less stressful, and virtually non-painful method of periodontal phenotype evaluation with reliable numerical outputs. Furthermore, these data may be used to feed AI systems, where machines can learn to recognize color differences and possibly deduce phenotype assessments.

Mitomycin Intravascular Chemoembolization for Corneal Neovascularization.

The purpose of the study was to evaluate the efficacy of mitomycin C intravascular chemoembolization (MICE) for corneal neovascularization (CNV). This is a prospective, nonrandomized, interventional study. Patients with stable CNV irrespective of the underlying etiology were enrolled in the study. 0.1% mitomycin C was injected intravascularly in CNV at the slit lamp under topical anesthesia. To evaluate the regression of vessels, the ImageJ software was used to trace and quantify vasculature by a pixel count in standardized clinical slit-lamp photographs. Eight eyes from 8 patients with corneal neovascularization and lipid keratopathy were studied. The mean age at treatment was 37 ± 12.75 (range 17-64) years. The median follow-up was 419.5 days (74-1166 days). Herpes simplex keratitis was the main underlying etiology (75%). The visual axis was compromised in 75%, and 100% had stromal scarring. The mean pixel count before MICE was 5983.41 ± 5004.96 pixels. After the treatment, the mean pixel count was 2060.38 ± 3142.96 pixels (delta: 3923.03, P = 0.029). No complications were recorded during the follow-up period. No recurrence of the CNV was observed at the last follow-up. Two eyes (25%) underwent a successful keratoplasty 4 months after MICE. MICE effectively reduced neovascularization with no immediate safety concerns, though its impact on vision and long-term safety requires further investigation with larger, longer term studies.

The Difference in the Morphometric Assessment of Gingival Biotype by Using Periodontal Probe Transparency Method and Photogrammetry

Objective: To evaluate the photogrammetric assessment of gingival biotype against the clinical gold standard method of probe transparency in terms of their consistency in assessment Study Design and Setting: Cross-sectional comparative; Periodontology Department, Institute of Dentistry, CMH Medical and Dental College, Lahore Methodology: The study targeted 149 adult subjects aged 18-30 years reporting to dental out patient department for routine dental treatment. A periodontal probe was inserted into the marginal gingiva of maxillary right central incisor and probe visibility through the gingival soft-tissues was judged. A probe visible through the tissues yielded thin gingiva and vice versa. For morphometric analysis, standardized clinical photographs were captured using digital DSLR camera. A photoshop software was used to measure crown width, crown height and papillary height for maxillary central incisor on all photographs. A crown width-to-height ratio &gt;0.75 and a papillary height &lt;4.5 mm indicated thick gingiva and vice versa. Data was analyzed via Statistical Package for Social Sciences version 24. Descriptive statistics were calculated. An inter-method reliability analysis using Cohen’s Kappa was performed to determine the consistency among the two methods in diagnosing gingival biotype. p=0.05 was taken as significant. Results: About 54.4% subjects were identified having a thin gingival biotype. A significant difference was observed between males and females as well as between age groups for gingival biotypes (p&lt;0.001). Using Cohen’s Kappa, a “perfect agreement” between probe transparency and photogrammetric methods was observed (ê = 1, p&lt;0.001) Conclusion: Photogrammetry offers a reliable and noninvasive method for evaluation of gingival thickness

Sequential Assessment of External Nasal Deviation Angle Changes in Patients With a Deviated Nose Who Underwent Bilateral Osteotomy.

A deviated nose is traditionally classified as bony, cartilaginous, or combined deviation. Osteotomy is commonly used to correct bony deviation, and accurate surgical techniques and postoperative patient management are important for favorable outcomes. The authors investigated the change in the external nasal deviation angle over time using sequential clinical photographs to identify the optimal postoperative follow-up duration. Medical records and sequential standardized clinical photographs of 22 patients who underwent bilateral medial and lateral osteotomies without dorsal augmentation from January 1, 2014 to May 31, 2021, were retrospectively reviewed. Clinical photographs were classified into 4 periods: "a" preoperative, "b" postoperative day (POD) ≤3 weeks, "c" POD ≤9 weeks, and "d" POD >9 weeks. The angle of deviation (AoD) was measured in both frontal and chin-on-chest views for each period. Differences in AoD between temporally adjacent periods were analyzed. Nineteen men and 3 women (mean age: 28.8y) were included. Thirteen patients showed rightward deviation, whereas 9 showed leftward deviation. Eleven patients underwent surgery through an endonasal approach, whereas the other 11 underwent surgery through an external approach. In the frontal view, AoD differences (mean ± SD) between periods "a" and "b," "b" and "c," and "c" and "d" were 5.79 ± 3.36 degrees (P < 0.001), 1.44 ± 1.14 degrees (P < 0.001), and 1.07 ± 1.24 degrees (P < 0.05), respectively. In the chin-on-chest view, the values were 5.17 ± 2.69 degrees (P < 0.001), 2.06 ± 2.63 degrees (P < 0.001), and 1.46 ± 1.31 degrees (P < 0.001), respectively. No statistically significant difference in AoD differences was observed between the two approaches. Angle of deviation can change even 9 weeks after bilateral osteotomy. Thus, long-term follow-up using sequential clinical photographs is mandatory. If needed, close follow-up with early postoperative interventions may be required. The chin-on-chest view showed better sensitivity for assessing AoD than the frontal view.

The Safety and Efficacy of a Dual CO 2 and 1570-nm Hybrid Laser for Periorbital Rejuvenation.

Many modalities are used for periorbital rejuvenation, with a wide range of efficacy and safety. To achieve favorable outcomes with minimal downtime and adverse effects, professionals developed a hybrid laser, which allows simultaneous treatment with 2 wavelengths: fractional ablative and fractional nonablative lasers. To evaluate the safety and efficacy of a new hybrid laser for periorbital rejuvenation. This retrospective single-center study includes 24 patients who underwent a single-pass treatment with a CO 2 and 1570-nm hybrid laser for periorbital rejuvenation between 2020 and 2022. Patients' standardized clinical photographs before and after the treatment were assessed by 4 independent physicians for objective improvement. Treatment data, safety, and patients' satisfaction were also reviewed. Statistically significant objective improvements were found in all investigated scales with an improvement of 1 to 2 points on each scale. Patients' satisfaction was 3.1/4. Average downtime was 5.9 ± 1.7 days. Most adverse effects were mild to moderate in severity (89.7%), including erythema, crusting, pruritis, edema, and hyperpigmentation. After a single-pass treatment, the laser generates 26% to 50% improvement in the periorbital area, with a strong safety profile and a relatively simple recovery. Further research is needed to validate the efficacy of this technology compared with more aggressive modalities.

Objective Outcomes of Trichophytic Brow Lift and Hairline Advancement in Facial Feminization Surgery.

Importance: The upper facial third is an important area to address in facial feminization surgery (FFS). Objective: This study seeks to quantify the changes in eyebrow, hairline, and forehead heights associated with brow lift and hairline advancement surgery in the transgender patient population. Design, Setting, and Participants: A cohort study performed at an academic medical center. Main Outcomes and Measures: Pre- and postoperative frontal view photographs underwent computer-aided photograph analysis. Brow position, hairline position, and forehead height were measured. Patient self-identified race, ethnicity, as well as other demographic factors were also collected. Results: Forty-six patients underwent FFS with brow lift and hairline advancement with photographs permitting measurement. Eyebrow analysis was performed in 33 patients. Hairline and forehead analyses were accomplished in 30 patients. The mean brow elevation was 4.6 mm across all locations. The forehead reduction achieved was 9.8-11.3 mm. Conclusion and Relevance: Trichophytic brow lifting with hairline advancement outcomes was able to be reliably quantified from standardized clinical photographs. On average, 4-5 mm of brow lift, 6-7 mm of hairline lowering, and 10-11 mm of forehead reduction were achieved, contributing to a more feminine appearance of the upper facial third.

Efficacy of a Photograph-Based Triage System Initiated During the COVID-19 Pandemic to Identify and Streamline Pediatric Foot and Ankle Referrals

Background: The COVID-19 pandemic required hospitals to reduce in-person visits. Although most pediatric foot and ankle conditions do not require urgent consultation, clubfoot (CF) relies on early identification and treatment. To avoid unnecessary hospital visits for infants, we developed a triage system using standardized clinical photographs of the child's feet taken by the parents for clinician review. This study assesses the efficacy of this triage system based on accuracy of the triage diagnosis (TDx) and time from referral to initial consultation (IC).Methods: This is a retrospective cohort review of patients referred to a tertiary care pediatric institution for a foot and ankle condition from 03/16/20 to 09/15/20 (onset of COVID-19), and from the same period in 2019 (prior to use of the triage system). Patients were identified by referring diagnosis (RDx). Patients were excluded if they missed their initial visit or the RDx was not clear. Chart review was performed to collect demographic data, clinical photographs, RDx, TDx, IC diagnosis, and time to IC. Diagnosis accuracy (DA) scores were assigned: 0 when RDx or TDx did not match diagnosis at IC, 0.5 if the diagnosis was partly correct, and 1 when diagnoses aligned. Sensitivity and specificity of the photo-based triage system were calculated for patients referred for clubfoot.Results: Of the 118 patients included, 62 were referred for CF and 56 for other foot and ankle conditions (FA). In 2020, 23/27 CF and 11/12 FA patients sent photographs. The average time to IC for FA patients was similar in both years (142 days in 2019 vs. 183 days in 2020, p=0.24), while the average time to IC for CF decreased from 66 days in 2019 to 31 days in 2020 (p=0.08). Accuracy for TDx in 2020 was high for CF (0.98) and FA (0.92) patients (p=0.49). Sensitivity and specificity of TDx for clubfoot patients were 100%.Conclusion: Triage diagnosis was accurate and time from referral to consultation decreased for clubfoot patients from 2019 to 2020, supporting that this novel photo-based triage system for pediatric foot and ankle referrals is effective in identifying urgent consults and ensuring timely assessment.Level of Evidence: III Key Concepts•Diagnosis of pediatric foot and ankle conditions by clinical photographs submitted by parents is accurate.•Triage of pediatric foot and ankle referrals with submitted clinical photographs enables appropriate streamline of urgent consultations and avoids unnecessary visits for self-resolving conditions.•Wait times for urgent consultations decreased with adoption of a photo-based triage system.

502 The genomic and phenotypic landscape of ichthyosis: An analysis of 1000 kindreds

Objective: Clear genotype-phenotype associations in ichthyosis have been difficult to establish. We aimed to expand the genotypic and phenotypic spectra of ichthyosis and delineate genotype-phenotype associations. Design: We recruited an international group of individuals with ichthyosis, including participants of all ages, races, and ethnicities. Genetic analysis of saliva or blood, a phenotyping questionnaire, and standardized clinical photographs were obtained. Results: Among 1000 unrelated individuals, 266 novel variants in 32 genes were identified.

The Use of Validated Visual Scales in Plastic Surgery: Where Are We Now?

The assessment of the human body, whether for aesthetic or reconstructive purposes, is an inherently visual endeavor. Ideally, reproducible, prompt, and cost-effective systems of visual evaluation would exist that can provide validated assessments of the aesthetic endpoints of treatment. One method to accomplish a standardization of the appreciation of visual endpoints is the use of visual scales. The goal of this systematic review is to summarize and evaluate the use of validated visual scales within aesthetic medicine, dermatology, and plastic and reconstructive surgery. A literature search was performed with a defined search strategy and extensive manual screening process. The Medical Outcomes Trust guidelines for visual scales in medicine were used, with special attention paid to each study's validation metrics. The review process identified 44 publications with validation data of sufficient quality from an initial survey of 27,745 articles. All rating scales based on imaging other than standardized clinical photographs were excluded. The review demonstrates that validated visual assessment in plastic surgery is incomplete. Within specific subfields of aesthetic medicine and dermatology, many of the ( n = 20) facial aging scales were well-validated and demonstrated high reliability. Publications ( n = 8) focused on the evaluation of facial clefts demonstrated heterogeneity in the methods of validation and in overall reliability. Within the areas of breast surgery ( n = 9), body contouring ( n = 2), and scarring ( n = 5), the scales were variable in the methods used and the validation procedures were diverse. Scales using a visual guide tended to have better interrater (kappa = 0.75) and intrarater reliability (kappa = 0.78), regardless of the specific area of interest. The fields of aesthetic medicine, and aesthetic and reconstructive plastic surgery require assessment of visual states over time and between many observers. For these reasons, the development of validated and reliable methods of visual assessment are critical. Until recently, the use of these tools has been limited by their time-consuming nature and cost.

The Genomic and Phenotypic Landscape of Ichthyosis

Ichthyoses are clinically and genetically heterogeneous disorders characterized by scaly skin. Despite decades of investigation identifying pathogenic variants in more than 50 genes, clear genotype-phenotype associations have been difficult to establish. To expand the genotypic and phenotypic spectra of ichthyosis and delineate genotype-phenotype associations. This cohort study recruited an international group of individuals with ichthyosis and describes characteristic and distinguishing features of common genotypes, including genotype-phenotype associations, during a 10-year period from June 2011 to July 2021. Participants of all ages, races, and ethnicities were included and were enrolled worldwide from referral centers and patient advocacy groups. A questionnaire to assess clinical manifestations was completed by those with a genetic diagnosis. Genetic analysis of saliva or blood DNA, a phenotyping questionnaire, and standardized clinical photographs. Descriptive statistics, such as frequency counts, were used to describe the cases in the cohort. Fisher exact tests identified significant genotype-phenotype associations. Results were reported for 1000 unrelated individuals enrolled from around the world (mean [SD] age, 50.0 [34.0] years; 524 [52.4%] were female, 427 [42.7%] were male, and 49 [4.9%] were not classified); 75% were from the US, 12% from Latin America, 4% from Canada, 3% from Europe, 3% from Asia, 2% from Africa, 1% from the Middle East, and 1% from Australia and New Zealand. A total of 266 novel disease-associated variants in 32 genes were identified among 869 kindreds. Of these, 241 (91%) pathogenic variants were found through multiplex amplicon sequencing and 25 (9%) through exome sequencing. Among the 869 participants with a genetic diagnosis, 304 participants (35%) completed the phenotyping questionnaire. Analysis of clinical manifestations in these 304 individuals revealed that pruritus, hypohydrosis, skin pain, eye problems, skin odor, and skin infections were the most prevalent self-reported features. Genotype-phenotype association analysis revealed that the presence of a collodion membrane at birth (odds ratio [OR], 6.7; 95% CI, 3.0-16.7; P < .001), skin odor (OR, 2.8; 95% CI, 1.1-6.8; P = .02), hearing problems (OR, 2.9; 95% CI, 1.6-5.5; P < .001), eye problems (OR, 3.0; 95% CI, 1.5-6.0; P < .001), and alopecia (OR, 4.6; 95% CI, 2.4-9.0; P < .001) were significantly associated with TGM1 variants compared with other ichthyosis genotypes studied. Skin pain (OR, 6.8; 95% CI, 1.6-61.2; P = .002), odor (OR, 5.7; 95% CI, 2.0-19.7; P < .001), and infections (OR, 3.1; 95% CI, 1.4-7.7; P = .03) were significantly associated with KRT10 pathogenic variants compared with disease-associated variants in other genes that cause ichthyosis. Pathogenic variants were identified in 869 (86.9%) participants. Most of the remaining individuals had unique phenotypes, enabling further genetic discovery. This cohort study expands the genotypic and phenotypic spectrum of ichthyosis, establishing associations between clinical manifestations and genotypes. Collectively, the findings may help improve clinical assessment, assist with developing customized management plans, and improve clinical course prognostication.

Thermo-Mechanical Fractional Injury Therapy for Facial Skin Rejuvenation in Skin Types II to V: A Retrospective Double-Center Chart Review.

Thermo-mechanical fractional injury (TMFI) therapy (Tixel®; Novoxel®, Netanya, Israel) is an innovative technology. Along with its drug delivery enhancement features, it is widely used for facial skin rejuvenation. Our study explores the beneficial effect of the Tixel® on the different features of facial skin rejuvenation along with patients' satisfaction rate, aiming to suggest practical recommendations for an optimal aesthetic result. A retrospective chart review of 24 patients (20 women, 4 men, average age 56 years old) with skin types II-V who received 2 or 3 Tixel® treatments, 3-5 weeks apart in two medical centers (12 from Israel, 12 from the United Kingdom). Four experienced dermatologists compared standardized clinical photographs taken before each treatment and 3 months after the final treatment based on seven parameters that were set by 10 physicians and rated the difference on a scale of -1 to 4. Furthermore, epidemiology, treatment data, satisfaction, and safety were reviewed. Out of the seven parameters that were compared (blood vessels and erythema, skin complexion, periorbital wrinkles, pigmentation and toning, pore size, vitality, wrinkles, and laxity), all features demonstrated an overall improvement, with the greatest improvement demonstrated in skin complexion (2.1 ± 0.49) and periorbital wrinkling (2.09 ± 0.65) followed by vitality (1.7 ± 0.49). Side effects were transient, including erythema and hyperpigmentation, and the average downtime was 1.7 days. TMFI is a safe and effective method forimproving facial skin quality. Addressing patient's expectations while maximizing the benefits of this novel technology will provide superior aesthetical results.

Preliminary study on factors associated with the gingival papillae deficiency between maxillary anterior teeth in periodontitis patients with alveolar ridge resorption

Objective: To evaluate the factors associated with the gingival papilla deficiencies of different degrees between maxillary anterior teeth showing alveolar ridge absorption. Methods: A total of 64 gingival papillae between maxillary anterior teeth of 14 patients with periodontitis, who received periodontal treatment and regular review in the Department of Periodontology, Peking University School and Hospital of Stomatology from June 2019 to December 2019, were observed in the present study. Indices were measured by using standardized clinical photographs and cone-beam CT images. The correlations between the gingival papilla deficiencies of different degrees and the distance from contact point to bone crest (CP-BC), the distance from proximal cemento-enamel junction to bone crest (pCEJ-BC), interproximal distance between roots (RD), the width of bone crest (BCW) and the height of gingival papilla (PH) were evaluated. Statistical analyses such as t-test, ANOVA, Pearson correlation coefficient and so on were conducted. Results: The rate of maxillary anterior gingival papilla completely filled the adjacent spaces between anterior teeth was 28% (18/64) and the rate of gingival papilla with deficiencies was 72% (46/64). The mild, moderate and severe deficiencies were 36% (23/64), 27% (17/64) and 9% (6/64) respectively. When CP-BC≥7.0 mm or pCEJ-BC≥4.5 mm, only moderate or severe deficiencies appeared. However, when CP-BC<5.0 mm or pCEJ-BC<1.5 mm, only completely filled adjacent tooth space or mild deficiency appeared. There was a strong positive correlation between CP-BC and pCEJ-BC. The Pearson correlation coefficient was 0.812 (P<0.01), and the linear fitting coefficient was 0.93 (R2=0.659) (64 gingival papillae). There was no significant difference of RD for gingival papilla deficiencies of different degrees between maxillary anterior teeth (P>0.05). BCW at the crest level increased slightly with the increase of the degree of gingival papilla deficiency, and the difference was statistically significant between completely filled adjacent tooth space and moderate or severe deficiency (P<0.05). However, PH at the crest level decreased slightly with the increase of the degree of gingival papilla deficiency, and the difference was statistically significant between completely filled adjacent tooth space and moderate or severe deficiency (P<0.05). Conclusions: When the alveolar ridge is absorbed, the rate of deficiency is significantly higher than the completely filled adjacent tooth space. The gingival papilla deficiencies of different degrees between maxillary anterior teeth are mainly associated with the absorption of bone crest.

The Effects of Nasoalveolar Molding on Nasal Proportions at the Time of Nasal Maturity.

The aim of this study is to assess the effect of nasoalveolar molding (NAM) versus no-NAM on nasal morphology in patients with unilateral cleft lip and palate (UCLP) at the time of nasal maturity. A retrospective, single-institution review was conducted on all non-syndromic patients with UCLP. Inclusion criteria included age 14 years or above, unilateral cleft repair at the time of infancy, and adequate photography taken at nasal maturity and prior to rhinoplasty. Exclusion criteria included age less than 14 years, syndromic diagnosis, and rhinoplasty prior to nasal maturity. Ten parameters were measured twice from standardized clinical photographs using the Dolphin Imaging Software for establishment of intrarater reliability. Subjective analysis was achieved through completion of the Asher McDade grading scale by 3 expert cleft practitioners. Nostril height, columellar angle, alar cant, vertical alar height, alar height angle, nasofacial angle, and nasolabial angle were found to be significantly less severe in patients who had undergone NAM in conjunction with surgical repair when compared with those who had undergone surgical repair alone. Asher McDade grading revealed significant improvement in nasal form, nasal symmetry/deviation, nasal profile, vermillion border, and overall score in patients who underwent NAM compared to no-NAM. The use of presurgical NAM during infancy can improve nasal symmetry and nasal proportions at the time of nasal maturity.

Assessment and Treatment Outcomes of Persistent Radiation-Induced Alopecia in Patients With Cancer

Persistent radiation-induced alopecia (pRIA) and its management have not been systematically described. To characterize pRIA in patients with primary central nervous system (CNS) tumors or head and neck sarcoma. A retrospective cohort study of patients from January 1, 2011, to January 30, 2019, was conducted at 2 large tertiary care hospitals and comprehensive cancer centers. Seventy-one children and adults diagnosed with primary CNS tumors or head and neck sarcomas were evaluated for pRIA. The clinical and trichoscopic features, scalp radiation dose-response relationship, and response to topical minoxidil were assessed using standardized clinical photographs of the scalp, trichoscopic images, and radiotherapy treatment plans. Of the 71 patients included (median [range] age, 27 [4-75] years; 51 female [72%]), 64 (90%) had a CNS tumor and 7 (10%) had head and neck sarcoma. Alopecia severity was grade 1 in 40 of 70 patients (56%), with localized (29 of 54 [54%]), diffuse (13 of 54 [24%]), or mixed (12 of 54 [22%]) patterns. The median (range) estimated scalp radiation dose was 39.6 (15.1-50.0) Gy; higher dose (odds ratio [OR], 1.15; 95% CI, 1.04-1.28) and proton irradiation (OR, 5.7; 95% CI, 1.05-30.8) were associated with greater alopecia severity (P < .001), and the dose at which 50% of patients were estimated to have severe (grade 2) alopecia was 36.1 Gy (95% CI, 33.7-39.6 Gy). Predominant trichoscopic features included white patches (16 of 28 [57%]); in 15 patients, hair-shaft caliber negatively correlated with scalp dose (correlation coefficient, -0.624; P = .01). The association between hair density and scalp radiation dose was not statistically significant (-0.381; P = .16). Twenty-eight of 34 patients (82%) responded to topical minoxidil, 5% (median follow-up, 61 [interquartile range, 21-105] weeks); 4 of 25 (16%) topical minoxidil recipients with clinical images improved in severity grade. Two patients responded to hair transplantation and 1 patient responded to plastic surgical reconstruction. Persistent radiation-induced alopecia among patients with primary CNS tumors or head and neck sarcomas represents a dose-dependent phenomenon that has distinctive clinical and trichoscopic features. The findings of this study suggest that topical minoxidil and procedural interventions may have benefit in the treatment of pRIA.

Persistent radiation-induced alopecia in patients with central nervous system tumors and head and neck sarcomas.

e23072 Background: Persistent radiation-induced alopecia (pRIA), or incomplete hair regrowth 6 months following radiotherapy (RT) completion, poses a significant quality of life burden, but its clinical characteristics and management outcomes are not well understood. Methods: Retrospective database query of patients with primary central nervous system tumors or head and neck sarcomas evaluated at an oncodermatology clinic and diagnosed with pRIA between 1/1/11 and 9/19/18. Clinical data and standardized clinical photographs were analyzed. Alopecia was graded according to the CTCAE v5. Results: Sixty-two patients with pRIA were identified (mean [SD] age, 33 [19]; 75% female; 18 &lt; 21 years at pRIA diagnosis). The most common diagnoses were medulloblastoma (20, 32%) and glioblastoma multiforme (17, 27%). Mean duration between RT and pRIA diagnosis was 3.1 years (95% CI, 2.3-4.2). Additional cancer therapies included surgery (57, 92%), cytotoxic chemotherapy (35, 57%), and combination cytotoxic + targeted therapy (24, 39%). Cancer type, age, number of chemotherapy agents, and duration between RT and pRIA diagnosis were significantly associated with alopecia type: mixed pattern (localized and diffuse) alopecia was predominant in younger patients with medulloblastoma exposed to greater number of agents (p &lt; .005). Alopecia grade 2 ( &gt; 50% hair loss) was predominant in patients that received concurrent chemotherapy and RT (p = .046). Among 22 patients treated with 5% minoxidil topical solution, a response was noted in 16 (73%) (Table). One patient receiving hair transplantation and one receiving scalp reconstruction had complete resolution of pRIA. Conclusions: Concurrent chemotherapy with RT may be a risk factor for grade 2 pRIA. Topical minoxidil may provide some benefit in pRIA; however, prospective trials are needed to assess efficacy. Procedural interventions should be considered as a viable therapeutic option in a subset of patients. [Table: see text]

Esthetic improvements of postorthodontic white-spot lesions treated with resin infiltration and microabrasion: A split-mouth, randomized clinical trial.

To compare the esthetic improvement between postorthodontic white-spot lesions (WSLs) treated by resin infiltration and microabrasion for 12 months. A total of 20 patients with 128 teeth with postorthodontic WSLs were recruited. A simple randomized, split-mouth, positive controlled design was used to allocate patients to resin infiltration or microabrasion groups. The lesion area ratio (R value) was calculated between the area of a WSL and the labial surface of the corresponding tooth based on standardized clinical photographs. The color change (ΔE) of each tooth was measured with a Crystaleye spectrophotometer (Olympus, Tokyo, Japan). Every measurement was taken before treatment (T0) and at different time points after treatment: 1 week (T1), 6 months (T6), and 12 months (T12). A total of 16 patients with 108 trial teeth were available at T12. Each group had 54 trial teeth. In both groups, there was a significant decrease in R value and ΔE between T1 and T0 (P < .0001). In the infiltration group, the R value and ΔE had no significant changes over time from T1 to T12. In the microabrasion group, the R value and ΔE decreased significantly from T1 to T6. The R value of resin infiltration was lower when compared with microabrasion at every recall point (P < .001). The ΔE had no significant differences between the two groups at any timepoint. Resin infiltration and microabrasion improved the esthetic appearance of WSLs and showed sufficient durability for 12 months. Resin infiltration showed a better esthetic improvement effect when compared with microabrasion at 12 months.

Endocrine Therapy–Induced Alopecia in Patients With Breast Cancer

Endocrine therapy-induced alopecia (EIA) has been anecdotally reported but not systematically described. To characterize EIA in patients with breast cancer. Retrospective cohort study of 112 patients with breast cancer, diagnosed with EIA from January 1, 2009, to December 31, 2016, the patients were examined at the dermatology service in a large tertiary care hospital and comprehensive cancer center. The clinical features, alopecia-related quality of life (QoL), and response to minoxidil of EIA in patients with breast cancer were assessed. Data from the Hairdex Questionnaire was used to assess the impact of the alopecia on patients QoL. Higher score indicates lower QoL (0-100 score). Efficacy of minoxidil was measured at 3 or 6 months by a single-blinded investigator through standardized clinical photographs of the scalp. A total of 112 female patients with breast cancer were included (median [range] age, 60 [34-90] years). A total of 104 patients (93%) had standardized clinical photographs; of these, 59 patients (53%) had trichoscopy images available at baseline, and 46 patients (41%) were assessed for response to minoxidil. Alopecia was attributed to aromatase inhibitors in 75 patients (67%) and tamoxifen in 37 (33%). Severity was grade 1 in 96 of 104 patients (92%), and the pattern was similar to androgenetic alopecia. The predominant trichoscopic feature at baseline was the presence of vellus hairs and intermediate- and thick-diameter terminal hair shafts. A negative impact on QoL was reported, with a higher effect in the emotion domain according to the Hairdex score (mean [SD], 41.8 [21.3]; P < .001). After treatment with topical minoxidil, moderate or significant improvement in alopecia was observed in 37 of 46 patients (80%). Endocrine therapies are associated with a pattern alopecia similar to androgenetic-type, consistent with the mechanism of action of causal agents. A significant negative impact on QoL was reported by patients, despite mostly mild alopecia severity.

Automatic discrimination of actinic keratoses from clinical photographs

Background and ObjectiveActinic keratoses (AK) are common premalignant skin lesions that can progress to invasive skin squamous cell carcinoma (sSCC). The subtle accumulation of multiple AK in aging individuals increases the risk of sSCC development, and this underscores the need for efficient treatment and patient follow-up. Our objectives were to develop a method based on color texture analysis of standard clinical photographs for the discrimination of AK from healthy skin and subsequently to test the developed approach in the quantification of field-directed treatment interventions. MethodsAK and healthy skin in clinical photographs of 22 patients were demarcated by experts and regions of interest (ROIs) of 50 × 50 pixels were cropped. The data set comprised 6010 and 13915 ROIs from AK and healthy skin, respectively. Color texture features were extracted using local binary patterns (LBP) or texton frequency histograms and evaluated employing a support vector machine (SVM) classifier. Classifier evaluation was performed using a leave-one-patient-out scheme in RGB, YIQ and CIE-Lab color spaces. The best configuration of the SVM model was tested using 157 AK and 216 healthy skin rectangular regions of arbitrary size. AK treatment outcome was evaluated in an additional group of eight patients with 32 skin lesions. ResultsThe best configuration of the discrimination model was achieved by employing LBP color texture descriptors estimated from the Y and I components of the YIQ color space. The sensitivity and specificity of the SVM model were 80.1% and 81.1% at ROI level and 89.8% and 91.7% at region level, respectively. Based on the classifier results the quantitative AK reduction was 83.6%. ConclusionsIt is important that patients with AK seek evaluation for treatment to reduce the risk of disease progression. Efficient patient follow-up and treatment evaluation require cost-effective and easy to use approaches. The proposed SVM discrimination model based on LBP color texture analysis renders clinical photography a practical, widely available and cost-effective tool for the evaluation of AK burden and treatment efficacy.

Long-term Stability of Soft Tissue Esthetic Outcomes Following Conventional Single Implant Treatment in the Anterior Maxilla: 10-12 Year Results.

Purpose:The present study aimed to evaluate the long-term stability of esthetic outcomes of soft tissue around maxillary anterior single-tooth implants after 10-to-12 years of loading.Methods:Patients who had been treated for single-tooth implants in the anterior maxilla between February 2000 and July 2002 were invited to participate in the study. All implants had been placed according to delayed implant placement and conventional loading protocols without any connective tissue graft or papilla preservation flaps. Pink Esthetic Score (PES) was rated using standardized clinical photographs to assess the esthetic outcomes of the implant treatment at the time of crown placement and at time of follow-up examination which was at least 10 years after the crown placement.Results:A total of 19 patients were included. The mean score of PES was 11.63 (SD 1.61; range 7-14) at baseline. After 10-to-12 years of function, a mean PES score of 11.05 (SD 2.09; range 6–14) was recorded. No significant differences were found in the esthetic outcomes, categorized based on clinically relevant levels, between the baseline and follow-up session (p>0.05).Conclusion:Within limitation of the present study, it can be concluded that the esthetic outcomes of soft tissue around the maxillary anterior single-tooth implants placed using conventional implant placement technique remained stable in the long-term.

Trunk appearance perception scale for physicians (TAPS-Phy) - a valid and reliable tool to rate trunk deformity in idiopathic scoliosis.

BackgroundEvaluation of trunk deformity by physicians in patients with idiopathic scoliosis (IS) has been considered an important part of clinical practice. Different methods to quantify the severity of trunk deformity by external observation have been reported. A valid tool to evaluate patients’ perception of trunk deformity, the Trunk Appearance Perception Scale (TAPS), is hereby validated for use by physicians (TAPS-Phy).MethodsCross-sectional study of patients with non-surgically treated IS. Patients were prospectively recruited. On the day of the visit, a posterior-anterior radiograph in standard position and clinical photographs in three different views (anterior, posterior and forward bending position) were obtained. Patients also completed a TAPS questionnaire (TAPS-Pat). Three different observers scored the TAPS questionnaire (TAPS-Phy), based on the digital photographs previously obtained, twice a week. The angle of trunk inclination (ATRI) was also measured on digital photographs. Inter and intra-rater reliability was calculated through weighted kappa coefficient. External validity was tested by the Spearman correlation coefficient between the TAPS-Phy score and the scoliosis magnitude determined using the magnitude of the largest curve (MLC), ATRI, and TAPS-Pat.ResultsFifty two patients (46 women; mean age 16.6 years) were included. The average curve magnitude of the major curve was 44°. Mean scores of TAPS-Phy for the three evaluators ranged from 3.4 to 3.5. No differences between the three means were found. TAPS-Phy showed good internal consistency (Cronbach’s alpha coefficient 0.84). Inter-observer reliability ranged from slight to substantial (0.14 to 0.63); intra-observer reliability ranged from 0.35 to 0.99. Correlation between TAPS-Phy and ATRI (r = −0.54 to −0.75), MLC (r = −0.47 to −0.6) and TAPS-Pat (r = 0.29 to 0.34) were statistically significant (p < 0.01).ConclusionsTAPS-Phy is a valid and reliable scale to rate a physician’s impression of the severity of the deformity in patients with idiopathic scoliosis and can be useful in routine clinical records.Electronic supplementary materialThe online version of this article (doi:10.1186/s13013-016-0085-8) contains supplementary material, which is available to authorized users.