Subepidermal Low Echogenic Band Thickness Research Articles

A Preliminary Study Using High‐Frequency Ultrasound to Evaluate Vulvar Skin With Lichenoid Vulvar Dermatoses

ABSTRACTBackgroundLichenoid vulvar dermatoses (LVD) are inflammatory diseases primarily affecting the vulva and anus. This study aims to evaluate the skin changes in patients with LVD using high‐frequency ultrasound.MethodsForty‐five patients with LVD, who attended Henan Provincial People's Hospital from November 2021 to March 2024, were selected. According to the pathological conclusions, patients were divided into two groups: the vulvar lichen sclerosus (VLS) group (n = 24) and the vulvar lichen simplex chronicus (VLSC) group (n = 21). Thirty age‐ and BMI‐matched healthy women were selected as the control group. We assessed the epidermal thickness, subepidermal low echogenic band (SLEB) thickness, dermal thickness, and vascular index (VI) among the three groups. Receiver operating characteristic curve (ROC) analysis was performed to determine the diagnostic efficacy of these ultrasound parameters for LVD. Binary logistic regression was used to investigate risk factors influencing LVD pathology in VLS patients.ResultsEpidermal thickness, SLEB thickness, dermal thickness, and VI were increased in the VLS and VLSC groups compared to the control group (p < 0.05). There were no statistically significant differences in ultrasound parameters between the VLS and VLSC groups (p > 0.05). The ROC curves showed that the area under the curve (AUC) value for the dermis (AUC = 0.882) was the largest for VLS, and VI (AUC = 0.917), it was the largest for VLSC. Binary logistic regression indicated that having an allergic disease was a risk factor for VLS between VLS and VLSC groups (OR = 6.797, p = 0.028).ConclusionHigh‐frequency ultrasound can detect thickening of the skin and increasing VI in patients with LVD, which can be helpful in the evaluation and management of LVD.

Topical Lactiplantibacillus plantarum LB244R® ointment alleviates skin aging: An exploratory trial.

The skin is of vital importance for health and well-being. As people age, the skin undergoes visual and morphological changes such as wrinkling, loss of elasticity, increased pigmentation, and decreased cell turnover. This is not only visually unappealing to many but can also pose health issues. In this study, a probiotic ointment (PO) containing live lactic acid bacteria (LAB) (Lactiplantibacillus plantarum LB244R®) was investigated for its ability to alleviate symptoms of skin aging in an exploratory clinical trial. The PO was applied twice daily for 56 days by 21 subjects. Anti-aging efficacy was evaluated by skin ultrasonography, skin biomechanical properties, skin hydration, and clinical evaluations at day 0, 28, and 56. Sub-epidermal low echogenic band thickness decreased (0.261 ± 0.069 mm to 0.247 ± 0.055 mm) after 56 days. Dermal density increased (324.689 ± 57.506 pixel/mm2 to 367.831 ± 75.790 pixel/mm2 ). Skin hydration increased (34.1 ± 6.9 to 51.3 ± 10.0AU). Additionally, skin firmness increased, as shown by decreasing values (0.264 ± 0.038 to 0.228 ± 0.037 mm). Skin elasticity increased (0.578 ± 0.045 to 0.618 ± 0.044). Trans-epidermal water loss decreased (9.1 ± 2.0g/h/m2 to 8.5 ± 1.3). All clinical evaluations, Crow's feet, spot score, smoothness score, and complexion radiance, were improved. The PO improved all measured parameters with statistical significance after 56 days of application, clearly demonstrating the potential of the PO as an anti-aging agent and reaffirming the potential of topical probiotic LAB. Future studies need to elucidate the mode of action of anti-aging effects by probiotics, but at present time, this study paves the way for the use of probiotic LAB topically to alleviate aging of the skin.

226 Non-invasive skin-surface biomarkers for psoriasis monitoring

In clinical dermatology there is a need for non-invasive efficient and accurate diagnostic tools that can objectively measure psoriasis (PS) activity and can be used to monitor therapeutic effects of PS treatment. This exploratory study aimed to determine whether non-invasive measurements of proteins from PS lesional skin can be used to assess disease severity and measure treatment efficacy. BM measurements from skin were performed using non-invasive Transdermal Analysis Patch (TAP) capture antibody microarrays detecting IL-1α, IL-1RA, CXCL-1/2, hBD-1 (ng/ml). Captured BM were visualised using spot-ELISA.TAPs were applied to non-lesional (NL) and lesional (L) skin of PS patients (N=30). PASI and local inflammation scores of lesions were documented; thickness of epidermis, dermis, subepidermal lowechogenic band (SLEB) was analysed using ultrasound (US) at the same skin site as TAP measurements and clinical scores. Potential of these skin-surface BM was further studied by monitoring skin lesions of PS patients (N=14) undergoing UVB (311nm) therapy using TAP together with clinical scores for PS severity. Skin surface measurements of PS patients revealed clear differences of IL-1a, IL-1RA, CXCL-1/2 on L skin when compared to NL. Comparing BM expression patterns with clinical scores of PS skin following correlations were observed: between CXCL-1/2 and lesion thickness (p<0.05), between CXCL-1/2 and SLEB thickness (p<0.001) on L; IL-1RA and SLEB thickness (p<0.05) of analysed NL skin. During UVB treatment, clear patterns towards normalisation of IL-1RA and CXCL-1/2 levels were noted on L which was in accordance with clinical parameters. Skin surface analysis of IL-1RA and CXCL-1/2 displayed a different profile than achieved by visual scoring of local inflammation or US - confirming that measuring the ‘molecular root’ of inflammation appears to have value as an objective, non-invasive BM measurement for scoring disease severity in its own right.

Usefulness of high-frequency ultrasound to assess the healing progress of shin ulcers.

IntroductionAs the average lifespan becomes longer, the number of cases of chronic shin ulcers is rising, which is slowly becoming a societal problem. Currently, there no methods for objective evaluation of ulcer healing process.Aim of the studyThe aim of the study was to assess the use of high-frequency ultrasound to monitor the healing of shin ulcers subjected to laser biostimulation.Material and methodsThe study included 8 patients (4 men and 4 women) aged from 46 to 81 years with 9 shin ulcers in whom the healing process did not progress within 8 weeks despite effective causal treatment. The ulcers were subjected to laser biostimulation. The induced changes were monitored using high-frequency ultrasound and photographic records. Ultrasound examination was used to assess the depth of ulceration and the thickness of granulation tissue, migrating epidermis, subepidermal low-echogenic band (SLEB) and epidermis in the immediate vicinity. The wound severity index and ulcer vascularity were also assessed.ResultsAs a result of laser therapy, in 7 out of 9 cases the ulcers healed completely and in the remaining 2 cases ulcer size was reduced. During the ulcer healing process induced by laser therapy, ultrasound examination revealed decreasing ulcer depth, wound severity index and SLEB thickness. Granulation tissue increased in thickness and there was an epidermal formation effect (newly formed epidermis was much thicker than the one surrounding the wound and became thicker as a result of laser therapy sessions). During the healing of ulcers induced by laser therapy no significant changes were observed in ulcer vascularity and thickness of the surrounding epidermis.ConclusionsHigh-frequency ultrasound is a useful technique for the imaging of leg ulcers. It allows one to monitor their healing process induced by laser biostimulation. Further research on the subject needs to be pursued.

The value of high-frequency ultrasonography in the differential diagnosis of early mycosis fungoides and inflammatory skin diseases: A case-control study.

The clinical manifestations of early mycosis fungoides (eMF) are non-specific and similar to inflammatory skin diseases. High-frequency ultrasonography (HF-US) can show small structure of skin lesions and is helpful to provide information objectively. A case-control study was designed in 62 patients with multiple erythemas and scales, including 18 eMF and 44 age-matched patients with eczema (EC) or psoriasis vulgaris (PsV). The most significant lesions were collected by 50MHz HF-US. The assessment of ultrasound included epidermal morphology and thickness, infiltration depth, subepidermal low echogenic band (SLEB) boundary and thickness, internal echo, and number of linear acoustic shadows (LAS) behind the epidermis. The ultrasonic characteristics of eMF, EC, and PsV lesions were analyzed. Epidermal thickness (P<.001, sensitivity 88.9%, specificity 75.0%) and SLEB thickness (P= 0.006, sensitivity 55.6%, specificity 90.9%) were useful for differential diagnosis of eMF and PsV/EC. When eMF was diagnosed by epidermal thickness<0.2375mm, the AUC was 0.845, which had the highest diagnostic efficacy among all ultrasound signs. In addition, compared with eMF and EC, the LAS number of PsV lesions was the highest and statistically significant. The results showed that HF-US could provide some extra information in identification of eMF, EC, and PsV and has potential clinical value.

High-frequency ultrasonography in objective evaluation of the efficacy of PUVA and UVA 1 phototherapy in mycosis fungoides.

The aim of the present study was to assess the effectiveness of UVA1 and PUVA therapy in treating patients with mycosis fungoides (MF) and to evaluate high-frequency ultrasonography (HF-USG) to monitor the clinical response of these patients. A total of 18 patients diagnosed with MF (stages I-IIA) underwent phototherapy, either UVA1 (6 cases) or PUVA (12 cases). Clinical response was evaluated according to modified Severity Weighted Assessment Tool (mSWAT) criteria and HF-USG (20MHz). In the PUVA group, 50% of patients (6/12) achieved complete remission (CR) versus 33% (2/6) of patients in the UVA1 group. Before treatment, all subjects (100%) presented a subepidermal low echogenic band (SLEB) on HF-USG in the lesional skin. After phototherapy, the SLEB decreased significantly in all cases, with complete disappearance in 66% of cases. SLEB thickness was associated with disease severity and was wider in stage IIA patients than in stage IA and IB. These findings demonstrate that skin ultrasonography can be used to monitor treatment response in these patients. Moreover, HF-USG can quantify response, thus providing an objective measure of response that closely corresponds to scoring systems such as mSWAT used in routine clinical practice.

The Association Between Skin Blood Flow and Edema on Epidermal Thickness in the Diabetic Foot

Skin blood flow plays an important role in maintaining the health of the skin. The development of interstitial edema may impede oxygen diffusion to the skin. The aim of this study was to evaluate the association of skin blood flow and edema and epidermal thickness in the feet of people with and without diabetic neuropathy compared with a healthy control group. Eighty-seven subjects (19 people with diabetic neuropathy and foot ulceration, 35 people with diabetes but without neuropathy, and 33 healthy controls without diabetes) participated in the study. High-frequency ultrasonography was used to measure the epidermal thickness and edema in papillary skin at the big toe as reflected by the thickness of the subepidermal low echogenic band (SLEB). The capillary nutritive blood flow was measured by the use of video capillaroscopy, and skin blood flux was monitored by laser Doppler flowmetry. There was a 7.2% increase in epidermal thickness in those with diabetes but without neuropathy and a 16.5% decrease in people with diabetic neuropathy and foot ulceration compared with the healthy controls (all P<0.05). The SLEB thickness increased in all subjects with diabetes to a greater degree in those with neuropathy and ulceration than in those without (64.7% vs. 11.8%, P<0.001). Skin blood flux was shown to be higher in the diabetes groups than in the controls (all P<0.05), but no significant differences were found in the resting nutritive capillary blood flow (P>0.05). A significant negative correlation (P=0.002, r=-0.366) was demonstrated between the SLEB and epidermal thickness at the pulp of the big toe, whereas no significant correlation was demonstrated between skin blood flow and epidermal thickness (all P>0.05). An increase in subepidermal edema was demonstrated in people with diabetic neuropathy and ulceration, which may partly contribute to reduced epidermal thickness at the pulp of the big toe. This may subsequently lead to the breaking down of skin in the diabetic foot.

Clinical and Echographic Analysis of Ablative Fractionated Carbon Dioxide Laser in the Treatment of Photodamaged Facial Skin

Ablative fractional photothermolysis (AFP) has been reported to be effective in the treatment of photoaging. Treatment was administered using an AFP device and assessed photographically 3 months after treatment by a blinded physician. Ultrasound measurements evaluated skin thickness and subepidermal low echogenic band thickness (SLEB), the portion of the papillary dermis filled with solar elastosis. Three months after treatment, the mean score improved 61.0% (95% confidence interval (CI)=56.8-65.2%) for dyschromia, 54.3% (95% CI=51.6-57.0%) for skin laxity, 51.5% (95% CI=49.6-53.4%) for rhytides, and 60.2%9 (95% CI=56.8-63.6%) for overall cosmetic outcome. Patients had a significant decrease in SLEB in all anatomic sites treated (0.078 cm at baseline, 0.038 cm at 3 months, 40.0% decrease) (p<.001). Total skin thickness increased with AFP (0.163 cm at baseline, 0.188 cm at 3 months, 10.3% increase) (p<.05). In this pilot study, AFP improved pigmentary and textural components of photoaged skin. Future investigation is warranted to validate the results demonstrating that high resolution ultrasound can be used as a quantitative tool to assess skin changes after AFP.

Ultrasound Structure and Digital Image Analysis of the Subepidermal Low Echogenic Band in Aged Human Skin: Diurnal Changes and Interindividual Variability

Subepidermal low-echogenic band is a consistent echostructural finding in aged and photodamaged skin. The thickness of subepidermal low-echogenic band is considered to closely reflect the degree of cutaneous aging and its use for the monitoring of the severity of photoaging and the efficacy of drugs is rapidly expanding. We investigated subepidermal low-echogenic band structure in 23 old healthy volunteers (ages 75-100) with a high-frequency ultrasound scanner (B-mode, 20 MHz). Images were collected from the volar fore-arm twice daily: in the morning before getting up and 12 h later. To assess the severity of subepidermal low-echogenic band, echogenicity of the subepidermal region was determined by the image analysis and compared with visual scoring and subepidermal low-echogenic band thickness. All three methods gave consistent results, image analysis being the most sensitive, reliable, and bias-free. Significant interindividual variability of subepidermal low-echogenic band echostructure was revealed. Moreover, circadian variability of subepidermal low-echogenic band echogenicity was observed. These major interindividual and diurnal variations of subepidermal low-echogenic band suggest that this band does not only represent an irreversible structural change but also a redistribution of fluid in the aged dermis. Diurnal variations in the subepidermal low-echogenic band would limit the use of this parameter in studies of skin aging, photoaging, and efficiency of medication.