Ultrasound Skin Research Articles

Enhancing skin aging parameter assessment in clinical trials: AI-Driven analysis of ultrasound images

BackgroundHigh-frequency ultrasound (HFUS) imaging offers valuable insights into skin aging parameters in clinical trials. However, manual measurements are time-consuming and operator-dependent, necessitating the exploration of automated approaches. ObjectiveThis study aimed to develop, train, and validate an artificial intelligence model for automated HFUS image parameter acquisition in dermatological assessments. A secondary goal was its application in evaluating data from an anti-aging skin therapy clinical trial. MethodsSupervised machine learning algorithms were used to predict target variables from ultrasound images. The best models were selected through independent validation. A training dataset of 144 ultrasound skin images and a validation set of 40 images were employed. A clinical trial involved 34 female subjects with aging skin signs, randomized into two groups: (1) cosmetic formulation plus therapeutic unfocused ultrasound (TUS) and (2) placebo formulation plus TUS. HFUS imaging was conducted before and after a 4-week and 8-week study period. ResultsOur algorithms successfully predicted echogenicity and thickness variables, showing competitive performance. In the clinical trial, the treatment group exhibited a significant improvement in skin echogenicity, while no significant changes were observed in the placebo group. ConclusionThis study demonstrates the feasibility of automating the prediction of bioimage variables for anti-aging strategy development. Mathematical algorithms reduced HFUS image evaluations to minutes, expediting clinical trial progress.

Investigating the efficacy of Endolift laser and Nanofat as a combination therapy for horizontal neck lines compared to Nanofat autologous alone.

The emergence of horizontal neck wrinkles is increasingly becoming a focal point for both cosmetic professionals and clients. Various treatment approaches must be considered to address this issue effectively, owing to its diverse underlying causes. The study explores the potential of utilizing the Endolift laser in conjunction with nanofat injection as a viable treatment option. Twenty patients with horizontal neck wrinkles involved in the study. Ten patients underwent treatment with a combination of Endolift laser and nanofat injection and 10 patients treated with nanofat injection alone. The participants were monitored for 6 months post-treatment. Biometric measurements were utilized to assess outcomes, including changes in volume, depth, and area of the wrinkles, skin elasticity, as well as the diameter and density of the epidermis and dermis in the treated area. Skin improvement was evaluated by two independent dermatologists, who compared before and after photos in a blinded manner. Patient satisfaction levels were also documented. The Visioface analysis showed a notable decrease in neck wrinkle depth and area in both groups. However, the group receiving the combination treatment of Endolift laser and nanofat exhibited a significantly greater improvement compared to the group treated with nanofat alone. Skin ultrasonography results demonstrated an increase in thickness and density of the dermis and epidermis in both groups. Particularly, the group treated with Endolift laser-nanofat displayed significant enhancements in dermis and epidermis density and thickness when contrasted with the nanofat-only group. Analysis with Cutometer revealed a marked enhancement in skin elasticity in the Endolift-nanofat treated group in comparison to the nanofat-only treated group. Furthermore, in the Endolift-nanofat treated group, a substantial majority (90%) of patients exhibited improvement. Patient evaluations highlighted significant distinctions between the two groups, with 95% of patients in the Endolift-nanofat treated group demonstrating enhancement. Both methods notably enhance horizontal neck wrinkles; nevertheless, the combination of endolift laser and nanofat seems to be more efficient for treating horizontal neck wrinkles.

Ultrasound rejuvenation for upper facial skin: A randomized blinded prospective study.

Growing demand for facial rejuvenation drives advancements in these therapies, including laser, radiofrequency, and focused ultrasound, alongside thermal stimulation adjuncts. These methods, known for stimulating collagen regeneration, skin tightening, and lifting, have gained popularity due to their minimal side effects, low trauma, and high safety, demonstrating favorable outcomes in clinical practice. We sought to assess the efficacy of ultrasound skin tightening for brow lift within the scope of a procedure addressing facial sagging across the entire face. Our aim was to explore a noninvasive method capable of effectively enhancing mild to moderate brow ptosis by tightening and lifting the skin in the upper facial region. This was a rater-blinded, prospective cohort study. The upper facial region of the participants was treated with the new device, micro-focused ultrasound (MFU), in model D3.0/D2.0/M3.0. Outcomes of brow lift were measured in comparison of pretreatment and posttreatment photographs and three-dimensional (3D) vector analysis. A total of 42 participants (37 females) were enrolled, with 2 participants withdrawing from the trial, resulting in 40 subjects who completed 180-day-follow-up and evaluation. 35 (87.5%) were deemed to have clinically significant brow elevation by two blinded assessors (experienced clinicians) at 180-day posttreatment (p < 0.01). The mean change in brow height after 90-day was 2.16 ± 0.63 mm at the frontal position (straight-ahead gaze) (p < 0.01). The 3D vector analysis reveals varying magnitudes of vector displacement in the upward and outward directions of the skin on the frontal region above the eyebrows. Focused ultrasound appears to be a safe and effective method for upper facial skin rejuvenation. A single focused ultrasound treatment on the forehead and temple areas resulted in an average brow elevation of 2.1 mm.

Anti-aging trends in Australia.

Anti-aging trends in Australia have changed considerably since the country emerged from the lockdowns associated with the SARS-Cov2 pandemic. People now rely on social media influencers for skin care advice and skin care products, including professional skin care treatments that can be purchased on Internet platforms. The quest for the perfect 'zoom face' led to a 300% rise in cosmetic procedures across Australia in the year to April 2021. People now want to use less products on their skin, while looking healthy and natural (termed 'skin minimalism'). The popularity of retinoid derivatives for preventing wrinkles has been superseded by non-irritating actives like hyaluronic acid (HA) and niacinamide that provide skin barrier protection, skin hydration, plumping and anti-inflammatory effects. Botulinum toxin injections remain the most popular non-surgical cosmetic procedure, followed by HA fillers, and biostimulators that promote the synthesis of collagen and give longer lasting but more gradual results than HA fillers. Laser resurfacing is widely used for epidermal resurfacing and skin tightening, as well as non-ablative lasers, intense pulsed light and radiofrequency or ultrasound skin tightening devices. Superficial chemical peels are still popular because they are relatively gentle, inexpensive, and require no downtime, whereas medium-to-deep chemical peels have largely been superseded by laser technology. However, the most efficient approach to prevent skin aging is adopting a healthy lifestyle and taking action against all factors of the skin aging exposome.

Treatment of horizontal neck wrinkles by Endolift laser: Biometric measurement.

One of the common esthetic complaints of patients is horizontal neck wrinkles that have limited treatment modality. In the present study, we evaluated the efficacy of the Endolift laser on the horizontal neck wrinkles. Totally, 10 healthy female and male patients suffering horizontal neck wrinkles were joined in this study. All patients are treated with Endolift laser. The effect of the Endolift methods on the horizontal neck wrinkles was evaluated by biometric parameter changed results with Cutometer, Visioface, and the Skin Ultrasound Imaging system. Also, three blinded dermatologists and patients' satisfaction were evaluated. The Visoface results showed that the Endolift laser treatment significantly decline the depth and area of horizontal neck wrinkle. The skin ultrasonography results reported the epidermis and dermis density and thickness were significantly increased. Also, the cutometer outcomes displayed that the Endolift laser treatment can increase skin elasticity. Also, significantly a greater number of patients were well satisfied with the technique. In conclusion, Endolift laser is a safe and effective method for decreasing the horizontal neck wrinkles and improving the appearance of the neck. This procedure does not require general anesthesia and recovery time.

Skin ultrasonography and magnetic resonance; new clinical applications and instrumentation.

Technological advances in skin ultrasonography and magnetic resonance are discussed. Literature review. 40 publications cited. This article illustrates crucial contributions made by the Editors, the Editorial Board and this Journal to these fields.

Dynamics of the ultrasonographic picture of the skin and subcutaneous tissue in the physiotherapy treatment of cellulite by compression microvibration: а non-randomized prospective study

BACKGROUND: Various methods are offered to effectively eliminate cellulite and improve skin appearance; however, its treatment remains one of the most difficult tasks in aesthetic medicine. The arsenal of tools that allow an objective assessment of cosmetic and esthetic therapeutic measures is very limited.&#x0D; AIM: To evaluate the effectiveness of the compression microvibration method to treat structural and functional skin changes in women with gynoid lipodystrophy of different age groups.&#x0D; MATERIALS AND METHODS: A single-center, nonrandomized, prospective study of the effectiveness of the compression microvibration method (Endospheres Therapy) was carried out in 27 women (4069 years old) with mild-to-moderate gynoid lipodystrophy under the control of ultrasonographic skin examination before treatment, after 12 procedures, and after 2 months. After a course of therapy, skin ultrasonography was performed using a specialized high-resolution digital ultrasound system DUB SkinScanner (tpm GmbH, Germany) equipped with a 75 MHz transducer with a resolution of 21 m and a scanning depth of 46 mm. Additionally, anthropometric parameters were measured, and the body mass index was calculated.&#x0D; RESULTS: Changes in body mass index (BMI) revealed a trend toward weight loss in most of the participants. The circumference of the hips and waist in participants aged 4049, 5059 and 6069 years decreased by 3.01.1 and 5.31.1, 2.20.9 and 4.11.3 and 2.50.9 and 6.31.5 cm, respectively. It was found that after the course of Endospheres Therapy in patients of the 1st, 2nd and 3rd age groups in the areas of the anterior, inner, posterior surface of the thigh and the anterior surface of the abdomen, the thickness of the dermis decreased by 15.6, 9.5 and 18.1%; 10.9, 10.5 and 19.3%; 6.1, 15.7 and 13.8%, 23.4, 14.7 and 14.5% (p 0.05), respectively; increased echogenicity of the dermis in the areas of the anterior, inner, posterior thigh and anterior abdominal surface by 2, 1.4 and 1.3; 1.2, 1.4 and 1.2; 1.4, 1.4 and 1.5; 1.3, 1.5 and 1.7 times (p 0.05), respectively. The echogenicity of the hypodermis decreased in the studied areas by 30.8, 27.6 and 31.2% (p 0.05); 20.1, 37.3 and 40.4% (p 0.05); 43.2, 57.8 (p 0.05) and 9.3%; 23.6, 15.2 (p 0.05) and 9.3%, respectively. The effect persisted 60 days after the course of therapy.&#x0D; CONCLUSION: These results have convincingly demonstrated the effectiveness of Endospheres Therapy in women with mild-to-moderate gynoid lipodystrophy for body shaping and skin improvement in the long term without revealing any side effects.

Efficacy evaluation of endolift laser for treatment of nasolabial folds and marionette lines.

The nasolabial folds are the most marked sign of aging. Endolift laser was used for the treatment of nasolabial folds and marionette lines (one of the facial danger zones). Ten female subjects were engaged in this study. Patients underwent Endolift laser for nasolabial folds and marionette lines treatment. The efficacy of the Endolift technique on the nasolabial folds and marionette lines was evaluated by biometric assessment with Cutometer, Visioface, and the Skin Ultrasound Imaging system. Also, patient's satisfaction and blinded dermatologists' assessment were assessed. The Visoface results displayed that the Endolift laser treatment significantly declined the depth and area of the nasolabial wrinkles. The skin ultrasonography results reported that the epidermis and dermis density and thickness were significantly increased. Also, the cutometer outcomes showed that the Endolift laser treatment can increase skin elasticity. The results showed that a large number of patients were very satisfied with the technique. In conclusion, Endolift laser has an effective technique for decreasing the nasolabial folds, marionette lines, and improve the appearance of the face without any sever side effect. This technique does not need general anesthesia and recovery time.

Correlation of ultrasound features with Bcl-2 protein expression in basal cell carcinomas (BCCs).

The expression of the Bcl-2 protein is frequently observed in basal cell carcinomas (BCCs), making it a significant biological marker and potential therapeutic target. Skin ultrasonography offers a noninvasive means of obtaining anatomical information about cutaneous tumors. The purpose of this study was to investigate the correlation between ultrasound features and Bcl-2 expression in BCCs, to provide a reference for developing pharmacological treatment plans. According to the Bcl-2 protein expression, 74 BCCs confirmed by surgical pathology were divided into high Bcl-2 expression BCCs (HB-BCCs) and low Bcl-2 expression BCCs (LB-BCCs). Preoperative lesion ultrasound features were analyzed retrospectively based on Liang's criteria, which included the following features: shape, surface, keratinization, base, infiltration level, internal echogenicity, distribution of hyperechoic spots, posterior echogenic changes, internal Doppler signal, and lesion size (maximum diameter and infiltration depth). The differences of two groups were compared using a chi-square test or a paired t-test. Based on ultrasound features, cystic areas were more frequent in LB-BCCs (χ2 = 7.015, P = .008). Furthermore, LB-BCCs exhibited greater infiltration depth than HB-BCCs (4.86 ± 2.12 mm vs. 2.72 ± 1.40 mm, P = .000), had a higher propensity to infiltrate the subcutaneous tissue (χ2 = 12.422, P = .002), and displayed a more abundant internal Doppler signal within the lesions (χ2 = 24.696, P = .000). Conversely, maximum diameter of the lesions, shape, surface, keratinization, base, hyperechoic spots distribution, and posterior echogenic changes of the lesions did not differ significantly between the two groups. Ultrasound features are correlated with Bcl-2 protein expression level in BCCs. LB-BCCs show greater infiltration depth, subcutaneous infiltration, more cystic changes and more abundant internal Doppler signal than HB-BCCs, which may suggest a potential basis for drug selection in BCC chemotherapy.

Efficacy of autologous adipose-derived stem cells and fractional carbon dioxide laser in the treatment of atrophic linear scars

Background Atrophic linear scars are scars that exhibit indentation or depression in the skin below the level of the surrounding tissues. Hyperpigmentation or hypopigmentation may be present. They are often caused by surgery, burns, and trauma. Objective To evaluate the efficacy of autologous adipose-derived stem cells (ADSCs) combined with fractional carbon dioxide (CO2) laser in the treatment of atrophic linear scars. Patients and methods This randomized, controlled preliminary study included 20 patients aged 20–45 years of both sexes with facial atrophic linear scars. The patients were randomized systematically into two groups: group A (combined ADSCs and fractional CO2 laser procedure) and group B (fractional CO2 laser only) of 10 patients each. The scar was evaluated using the Vancouver scar scale, along with a subjective satisfaction questionnaire, and ultrasound skin analysis at baseline and 1 month after the third treatment session. Results All participants completed the study. The mean Vancouver scar scale score improved significantly from 3.60±0.69 to 1.20±0.79 and from 2.20±1.03 to 1.60±0.52 with fractional CO2 laser plus ADSCs and CO2 laser procedure, respectively (P&lt;0.001). However, CO2 laser plus ADSCs was significantly superior. Ultrasound skin examination showed a statistically significant increase in dermal collagen density (thickness) in both groups. Conclusion Our study shows that treatment with CO2 laser exposure plus ADSCs is safe and more effective for atrophic linear scar management than CO2 laser exposure alone.

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.

Influence of contextual factors and reliability of ultrasound skin measures in persons with systemic sclerosis and healthy controls.

To examine the influence of contextual factors upon the evaluation of skin thickness and stiffness by ultrasound and to assess the reliability of these parameters. Ultrasound dermal thickness (by B-mode, 18MHz) and skin stiffness (by shear-wave elastography, 9MHz) were assessed in persons with systemic sclerosis (SSc) and in healthy controls. The influence of contextual factors upon repeated measures was evaluated: (i) room temperature (16-17ºC vs. 22-24ºC); (ii) time of day (morning vs. afternoon), and (iii) menstrual cycle phase (menstrual vs. ovulatory). Differences were analysed using the related-samples Wilcoxon signed-rank test. Inter- and intra-rater reliability of ultrasound skin thickness and stiffness were evaluated in the 17 skin Rodnan sites of 20 persons with SSc and 20 healthy controls, under stable contextual conditions. A significant increase in ultrasound dermal thickness was observed at the leg in the afternoon vs morning, in both patients and controls. Similar observations were made for skin stiffness at the leg (in SSc) and at the foot (in SSc and controls) in the afternoon. No significant changes were observed in association with room temperature and menstrual cycle. Intra- and inter-rater-reliability was good to excellent for ultrasound dermal thickness and stiffness, both in SSc and healthy controls. The timing of the ultrasound procedure within each day seems to influence the ultrasound measures at the legs and feet. Our study corroborates that ultrasound dermal thickness and skin stiffness are reliable domains to quantify skin involvement in SSc.

Acne scar treatment using combination therapy: Subcision and human autologous fibroblast injection

Acne scar treatment is a problem for both the dermatologist and the dermatologic surgeon. Many therapies have been advanced to improve acne scars over the past years. Nevertheless, they were often related to adverse side effects like hyperpigmentation. These combination therapy using subcision and autologous fibroblast injection can provide a better technique for the acne scar treatment. In this study, we describe nine patients with the age of 25 to 48 and rolling acne scars (moderate to severe) that were treated with combination therapy using subcision (cannula, 18gauge) and autologous fibroblast injection. Finally, before and 6months after the final injection, the patients' biometric characteristics were evaluated by Visioface 1000D and Mexameter and a skin ultrasound imaging system. The results show a significant improvement in the acne scars in the patients. The Visioface results showed that the size and number of skin pores and spots were reduced after combination therapy. Also, the results of skin ultrasonography exhibited denser skin layers both in the epidermis and dermis. In summary, the combination therapy of autologous fibroblast injection and subcision can be considered as a new alternative, safe, and useful method for acne scar treatment.

In vivo evaluation of topical ascorbic acid application on skin aging by 50MHz ultrasound.

Ascorbic acid (AA) is a powerful antioxidant capable of acting significantly both in the prevention and treatment of the skin aging process. One way to assess the in vivo efficacy of anti-aging treatments is by using the high-frequency ultrasound (HFUS) skin image analysis technique, a non-invasive approach that allows for a new level of evaluating the effectiveness of dermatological and cosmetic products. The aim of the present study was to assess the performance of a topical emulsion of liquid crystalline structures containing AA using the 50MHz HFUS skin image analysis method. Twenty-five healthy female participants between 35 and 60years were included, all of whom randomly applied a placebo formulation and an AA-containing formulation to each forearm, once a day, for 30days. HFUS measurements were performed before using the products (T0), 2h later (T2h), and after 30days of use (T30d). The analyzed parameters included total skin, dermal, and epidermal echogenicity; variation and mean thickness of total skin, the epidermis and dermis; and surface roughness. Statistical analyses were performed using the Friedman test, followed by Dunn's test for comparisons of multiple means (α=0.05). A significant increase in total skin and dermal echogenicity was observed after topical AA application. Our findings suggest that collagen synthesis significantly increased after topical therapy with AA, which was responsible for the increment in dermal echogenicity. This study showed, through the HFUS technique, that the topical use of AA promoted dermal redensification after 30days of application.

Ultrasound measurements of pathological and physiological skin thickness: a scoping review protocol

IntroductionUltrasound is a quick, safe, and non-invasive imaging method that can be used to measure skin thickness in pathological cutaneous conditions in clinical and research settings. Despite widespread use, there...

Еfficiency of Basal Cell Diagnosis Skin Carcinomas Using Dermatoscopy in Combination with Ultrasound (Literature Review; Description of Clinical Cases)

Introduction. Basal cell carcinoma of the skin is the most common skin cancer in people with fair skin color. Early detection of basal cell carcinoma and proper surgical approach are crucial to reduce the incidence of this tumor. Visual examination is the first screening tool used by clinicians, but sometimes it is not enough to differentiate and determine treatment tactics. Therefore, non-invasive methods such as dermatoscopy and ultrasonography of the skin have recently become widely used, which provide a clear diagnosis, fully correlate with the pathomorphological diagnosis and allow determining the invasiveness of the process and the scope of surgery. The aim of the study. To establish the effectiveness of the diagnosis of basal cell carcinoma of the skin using dermatoscopy in combination with ultrasound, to clarify and justify the feasibility of using a double diagnostic test "Dermatoscopy + Ultrasound" in the diagnosis of skin tumors for future surgery. Materials and methods. Two cases of basal cell basal cell carcinoma in young patients with atypical localization, dermatoscopic and ultrasonographic parameters, correlation with pathomorphological diagnosis are described. Dermatoscopic parameters were evaluated according to G. Kittler's algorithm, skin ultrasound was performed on an expert class device "ACUSON Juniper Ultrasound System" with color and energy Doppler modes by a linear multifrequency transducer (5-17MHz) according to the original protocol developed by G.Alakhverdian. Results. A feature of the described clinical cases is the young age of patients (21 and 29 years), which is an atypical phenomenon in relation to the manifestations of BCC and indicates that recently basal cell carcinoma begins to occur at a young age and its typical location changes. The obtained data of dermatoscopic and ultrasonographic examination confirm specific clinical symptoms and are completely correlated with pathomorphological diagnosis. Conclusions. Dermatoscopy in combination with skin ultrasonography are reliable non-invasive techniques that allow real-time detection of clinical and subclinical lesions and should be used to diagnose and monitor for all skin cancers. Keywords: basal cell carcinoma of the skin, dermatoscopy, ultrasonography of the skin.

A randomized, double-blind, comparative study for efficacy assessment of two hyaluronic acid nasolabial fillers

&lt;p class="Default"&gt;Hyaluronic acid fillers are considered safe for use in cosmetics as described in the safety assessment. This study was aimed to assess and compare the efficacy and safety of two hyaluronic acid (HA) fillers on mild nasolabial folds. Ten women aged 30-50 years with mild nasolabial folds participated for injection of A and B gels into right or left nasolabial folds. The volume and surface of nasolabial folds were measured by CSI software and the density and thickness of dermis assessed by skin ultrasonography before and 2, 12, and 24 weeks after injection. The data were analyzed using SPSS software version 20, and p-value &amp;lt;0.05 were considered as significant. Global assessment showed over 50% improvement in patients injected with both gel A and B. At 2 weeks after injecting gel A the volume and surface of wrinkles decreased significantly. In the side injected with gel B, this reduction was significant at 2 and 12 weeks after injection. In addition, 24 weeks after injection of both gels the dermis echo-density increased and the dermis thickness decreased. This study indicated the significant positive filling effect of both HA fillers in decreasing the clinical signs of wrinkles at nasolabial folds. Comparing both fillers, there were not any statistically significant differences in any of measurements, but the persistence of gel B to improve the wrinkle appearance was slightly better than gel A. &lt;/p&gt;

Deep Learning-Based High-Frequency Ultrasound Skin Image Classification with Multicriteria Model Evaluation

This study presents the first application of convolutional neural networks to high-frequency ultrasound skin image classification. This type of imaging opens up new opportunities in dermatology, showing inflammatory diseases such as atopic dermatitis, psoriasis, or skin lesions. We collected a database of 631 images with healthy skin and different skin pathologies to train and assess all stages of the methodology. The proposed framework starts with the segmentation of the epidermal layer using a DeepLab v3+ model with a pre-trained Xception backbone. We employ transfer learning to train the segmentation model for two purposes: to extract the region of interest for classification and to prepare the skin layer map for classification confidence estimation. For classification, we train five models in different input data modes and data augmentation setups. We also introduce a classification confidence level to evaluate the deep model’s reliability. The measure combines our skin layer map with the heatmap produced by the Grad-CAM technique designed to indicate image regions used by the deep model to make a classification decision. Moreover, we propose a multicriteria model evaluation measure to select the optimal model in terms of classification accuracy, confidence, and test dataset size. The experiments described in the paper show that the DenseNet-201 model fed with the extracted region of interest produces the most reliable and accurate results.

Discriminative deep learning based benignity/malignancy diagnosis of dermatologic ultrasound skin lesions with pretrained artificial intelligence architecture.

Deep-learning algorithms (DLAs) have been used in artificial intelligence aided ultrasonography diagnosis of thyroid and breast lesions. However, its use has not been described in the case of dermatologic ultrasound lesions. Our purpose was to train a DLA to discriminate benign form malignant lesions in dermatologic ultrasound images. We trained a prebuilt neural network architecture (EfficientNet B4) in a commercial artificial intelligence platform (Peltarion, Stockholm, Sweden) with 235 color Doppler images of both benign and malignant ultrasound images of 235 excised and histologically confirmed skin lesions (84.3% training, 15.7% validation). An additional 35 test images were used for testing the algorithm discrimination for correct benign/malignant diagnosis. One dermatologist with more than 5 years of experience in dermatologic ultrasound blindly evaluated the same 35 test images for malignancy or benignity. EfficientNet B4 trained dermatologic ultrasound algorithm sensitivity; specificity; predictive positive values, and predicted negative values for validation algorithm were 0.8, 0.86, 0.86, and 0.8, respectively for malignancy diagnosis. When tested with 35 previously unevaluated images sets, the algorithm´s accuracy for correct benign/malignant diagnosis was 77.1%, not statistically significantly different from the dermatologist's evaluation (74.1%). An adequately trained algorithm, even with a limited number of images, is at least as accurate as a dermatologic-ultrasound experienced dermatologist in the evaluation of benignity/malignancy of ultrasound skin tumor images devoid of clinical data.

Tofacitinib in the treatment of skin and musculoskeletal involvement in patients with systemic sclerosis, evaluated by ultrasound

Systemic sclerosis (SSc) is a rare autoimmune connective tissue disease characterized by fibrosis of the skin and internal organs, autoimmunity-driven damage and vasculopathy. The current approved disease-modifying treatments have limited efficacy, and treatment is guided toward alleviating organ complications. Thus, there is an unmet need for discovering new effective treatment options. There is recent evidence that the JAK/STAT signaling pathway is markedly activated in SSc patients. To assess the efficacy and safety of tofacitinib (TOF) on skin and musculoskeletal involvement as compared to methotrexate (MTX) in systemic sclerosis (SSc). In this 52-week pilot study, 66 patients with SSc were enrolled: 33 patients received 5 mg of oral TOF twice a day; 33 received 10 mg of MTX weekly. The proportion of dcSSc and lcSSc patients was similar (dcSSc: 42% TOF group and 36% MTX group; lcSSc: 58% TOF group and 64% MTX group). The primary outcome was the change in the modified Rodnan skin score (mRSS). Secondary outcomes included ultrasound (US) skin thickness and musculoskeletal involvement (US10SSc score). Digital ulcers (DUs) and adverse events (AEs) were documented through the treatment. Both groups had similar characteristics and medians on the outcome measures at baseline. At week 52, the TOF median mRSS was significantly lower than the MTX (p < 0.001) with a mean reduction of 13 points versus MTX 2.57. The mean percent improvement in the TOF group was 44% higher than in the MTX group. TOF median US skin thickness was significantly lower than MTX (p < 0.001), with a mean reduction of 0.31 mm versus 0.075 mm in the MTX group. The US10SSc median score was significantly lower in the TOF group (p = 0.002); mean reduction of 10.21 versus 5.27 in the MTX group. Healing of DUs with no new occurrences was observed in the TOF group. There was no significant difference between the groups in the number of AEs from baseline to week 52. TOF showed greater efficacy than MTX in reducing mRSS, skin thickness and musculoskeletal involvement in SSc and a satisfactory safety profile.