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The coronavirus disease 2019 (COVID-19) pandemic and subsequent physical distancing recommendations created major gaps in traditional dermatologic undergraduate and postgraduate medical education delivery. Nevertheless, the educational consequences of various public health restrictions have indirectly set aside the inertia, resistance, and risk averse approach to pedagogical change in medicine. In Canada, rapid collaboration and innovation in dermatologic education has led to novel programs including the implementation of a range of internet-facilitated group learning activities and a dramatic expansion of digital telehealth and virtual care. Going forward, three key issues arising from these developments will need to be addressed: the ongoing assessment of these innovations for efficacy; sustaining the momentum and creativity that has been achieved; and, determining which of these activities are worth maintaining when traditional "tried and true" learning activities can be resumed. [ABSTRACT FROM AUTHOR]

In a recent study, we have demonstrated that real-time Raman spectroscopy could be used for skin cancer diagnosis. As a translational study, the objective of this study is to validate previous findings through a completely independent clinical test. In total, 645 confirmed cases were included in the analysis, including a cohort of 518 cases from a previous study, and an independent cohort of 127 new cases. Multi-variant statistical data analyses including principal component with general discriminant analysis (PC-GDA) and partial least squares (PLS) were used separately for lesion classification, which generated similar results. When the previous cohort ( n = 518) was used as training and the new cohort ( n = 127) was used as testing, the area under the receiver operating characteristic curve (ROC AUC) was found to be 0.889 (95 % CI 0.834-0.944; PLS); when the two cohorts were combined, the ROC AUC was 0.894 (95 % CI 0.870-0.918; PLS) with the narrowest confidence intervals. Both analyses were comparable to the previous findings, where the ROC AUC was 0.896 (95 % CI 0.846-0.946; PLS). The independent study validates that real-time Raman spectroscopy could be used for automatic in vivo skin cancer diagnosis with good accuracy. [ABSTRACT FROM AUTHOR]

The article presents a case study of 65-year-old woman with unwanted pigmented lesions on the face for 10 years, with a history of kidney transplantation 15 years before for treatment of idiopathic renal failure and was on low-dose prednisone, mycophenolate mofetil, cyclosporine and diltiazem. The patient undergone laser surgery using Q-switched alexandrite laser resulting to the darkening of skin colored camouflage tattoo, which was corrected using carbon dioxide laser surgery.

Background: Raman spectroscopy is a non-invasive optical technique that can probe the molecular structure and conformation of biochemical constituents. The probability of Raman scattering is exceedingly low (∼10−10), and consequently up to now the practical application of Raman spectroscopy to clinical medicine has been limited by either the weak spectral signal or by the long data acquisition times. Recent advances in Raman hardware and probe design have reduced spectral acquisition times, paving the way for clinical applications. Methods: We present an integrated real-time Raman spectroscopy system for skin evaluation and characterization, which combines customized hardware features and software implementation. Real-time data acquisition and processing includes CCD dark-noise subtraction, wavelength calibration, spectral response calibration, intensity calibration, signal saturation detection, cosmic ray rejection, fluorescence background removal, and composition modeling. Real-time in vivo Raman measurement of volar forearm skin is presented to illustrate the methods and modeling. Results: The system design implemented full-chip vertical hardware binning to improve the signal-to-noise ratio by 16-fold. The total time for a single in vivo measurement with analysis can be reduced to 100 ms with this implementation. Human skin was well modeled using the base Raman spectra. Conclusion: In vivo real-time Raman can be a very promising research and practical technique for skin evaluation. [ABSTRACT FROM AUTHOR]

This issue of Photodermatology, Photoimmunology, and Photomedicine commemorates the contributions and legacy of Dr Nikiforos Kollias, an outstanding skin biophysicist affectionately known as "Nik" to those who worked and trained with and under him. Nik championed the use of noninvasive optical techniques such as spectroscopy of the skin to probe basic physiologic processes such as pigmentation and inflammation. More than just trying to understand how and why the skin could change its appearance and behavior following exposure to light, Nik actively sought to improve and advance practical biophotonic medical applications including sunscreens, photodynamic therapy, and optical imaging. [Extracted from the article]

Determines the role of biologics in the treatment of psoriasis. Necessity of understanding the modes of action and potential advantages of biologics relative to systemic therapies; Profile of patients who would benefit from biologic therapy; Role of T-cells in psoriasis; Basic strategies for targeted biologic therapies; Helpfulness of combination therapy for achieving interim disease control due to the potential of delayed onset of action of some biologic agents.

The article offers information on the 2015 World Congress of Dermatology (WCD) to be held in Vancouver, British Columbia in June 2015 on topics including new treatments techniques for skin diseases, clinical practice guidelines to dermatologists and patient care.

Eighteen patients with symmetric plaque-type psoriasis were recruited for an open, controlled, bilateral half-body comparison study to evaluate the efficacy of calcipotriol/tar/UVB vs. anthralin/tar/UVB in a day care treatment setting. No patient had been on systemic antipsoriatic agents for at least 3 months prior to enrolment. One half-body was arbitrarily assigned to treatment with gradually increasing concentrations of anthralin as tolerated. The other half-body received calcipotriol ointment twice daily. Both sides received UVB and additional coal tar distillate in accordance with our standard day care regimen. Patients who were admitted to the day care program attended the clinic for UVB, anthralin, and calcipotriol on weekdays for two consecutive weeks. Anthralin was applied to psoriatic plaques on one side in the following fashion: anthralin 0.1% with salicylic acid 3% in zinc oxide paste on days 1 and 2; anthralin 0.2% with salicylic acid 3% in zinc oxide paste on days 3–5; anthralin 1% with salicylic acid 3% in hydrophilic petrolatum for 60 min on days 8–10 to thicker lesions; and anthralin 2% with salicylic acid 3% in hydrophilic petrolatum for 60 min on day 11 to thicker lesions. On the contralateral side, calcipotriol ointment 0.05 μg/mL (Leo Pharmaceuticals, Ajax, Ontario) was applied to lesions twice daily. No anthralin or calcipotriol was applied on weekends. All patients applied coal tar oil 50% (Doak Oil Forte, Trans CanaDerm, St-Laurent, Québec, equivalent to 5% coal tar distillate) with salicylic acid 5% in hydrophilic petrolatum to their lesions at home in the evenings and on weekends. UVB (FSX72T12 lamps, National Biologic Corporation, Twinsburg, Ohio) was administered twice daily on weekdays in increasing doses as tolerated (to erythema) prior to the application of the topical medications. No trial medications were applied to the face, scalp, or genital regions. For clinical evaluation, the standard Psoriasis... [ABSTRACT FROM AUTHOR]

Polymorphous light eruption ( PMLE) is the most common photodermatosis and is characterized by the development of a pruritic skin eruption within a few hours to days after sun or artificial light exposure. The eruption usually takes up to two weeks to resolve in the absence of further ultraviolet radiation. PMLE has been reported as a side effect of ultraviolet A1 ( UVA1) therapy but characteristics of the eruption, especially the duration until resolution after treatment, has not been described. A 37-year-old female developed an unusually persistent PMLE that lasted for 5 weeks after completion of UVA1 phototherapy. [ABSTRACT FROM AUTHOR]

Background. Nodular amyloidosis is a rare cutaneous disorder for which many treatments have been described, including carbon dioxide (CO2) laser vaporization. Objective. We describe the intraoperative tissue effects encountered during successful treatment of nodular amyloidosis with CO2 laser surgery. Methods. Two nodules of cutaneous amyloid on the nose of a patient were vaporized with a defocused, continuous-wave CO2 laser. Results. The tissue was found to be highly friable and hemostasis was difficult to achieve during the surgery. These clinical observations were correlated with amyloid infiltration of the dermis and blood vessels on preoperative histologic examination. Conclusion. CO2 laser vaporization of nodular amyloidosis may be associated with prominent tissue friability and poor hemostasis. [ABSTRACT FROM AUTHOR]

Background: Studies have shown disparities in the perception of skin disease burden between patients and physicians, with patients often feeling that the severity, emotional impact, and social repercussions of their skin condition are underestimated. Although physician's professional behavior is guided by documents such as the Hippocratic Oath, there are no patient-driven principles to guide healthcare interactions involving skin concerns. Objective: To develop a concise and practical charter for patients based on their perceptions of unmet needs with the goals of helping patients express their needs and exercise their rights to accessing and utilizing the healthcare system for conditions, diseases, or traumas involving the skin. Methods: An initial literature review examined healthcare delivery concerns of patients with skin conditions. Results were used to draft a charter that was reviewed by a Canadian patient focus group representing various skin condition advocacy groups. A revised charter was reviewed by Canadian dermatologists before being formally approved by the Canadian Skin Patient Alliance Board and endorsed by the Canadian Dermatology Association. Results: The Patient Charter comprises 8 principles for providing and receiving professional services for the skin in the healthcare setting. Conclusions: This Patient Charter provides direct insights into patient priorities and will be used as an educational and advocacy tool in healthcare, occupational, and social settings. The intended goal is for the Patient Charter to empower patients and to educate health professions, government, industry, and society at large. Accordingly, the charter will be disseminated through print materials, informational videos, and social media campaigns. [ABSTRACT FROM AUTHOR]

Background/Purpose: A recent direction in skin disease classification is to develop quantitative diagnostic techniques. Skin relief, colloquially known as roughness, is an important clinical feature. The aim of this study is to demonstrate a novel polarization speckle technique to quantitatively measure roughness on skin lesions in vivo. We then calculate the average roughness of different types of skin lesions to determine the extent to which polarization speckle roughness measurements can be used to identify skin cancer. Methods: The experimental conditions were set to target the fine relief structure on the order of ten microns within a small field of view of 3 mm. The device was tested in a clinical study on patients with malignant and benign skin lesions that resemble cancer. The cancer group includes 37 malignant melanomas (MM), 43 basal cell carcinomas (BCC), and 26 squamous cell carcinomas (SCC), all categories confirmed by gold standard biopsy. The benign group includes 109 seborrheic keratoses (SK), 79 nevi, and 11 actinic keratoses (AK). Normal skin roughness was obtained for the same patients (301 different body sites proximal to the lesion). Results: The average root mean squared (rms) roughness ± standard error of the mean for MM and nevus was equal to 19 ± 5 μm and 21 ± 3 μm, respectively. Normal skin has rms roughness of 31 ± 3 μm, other lesions have roughness of 35 ± 10 μm (AK), 35 ± 7 μm (SCC), 31 ± 4 μm (SK), and 30 ± 5 μm (BCC). Conclusion: An independent‐samples Kruskal–Wallis test indicates that MM and nevus can be separated from each of the tested types of lesions, except each other. These results quantify clinical knowledge of lesion roughness and could be useful for optical cancer detection. [ABSTRACT FROM AUTHOR]

The article focuses on the study which aims to evaluate the advantages of dermoscopy-assisted sclerotherapy in spider leg veins treatment. Topics discussed include the use of 3-mL syringe wherein the needle point is positioned on the skin surface, the complications of sclerotherapy, and contribution of the technique to enhance the familiarity of residents and other inexperienced physicians about the procedure.

The article describes the case of a 32-year-old Caucasian male with cutaneous larva migrans(CLM). The man had a three-week history of a pruritic eruption on the left foot. Result of the polarized dermoscopy of the serpiginous tract revealed two oval structures, with yellow peripheries and brown centers. It presents an overview on CLM, which is commonly found in tropical and subtropical geographic areas caused by animal hookworm larvae.

A letter to the editor is presented related to a patient suffering from segmental confetti dyschromatosis.

Background: Biases inherent in self‐assessment of sun exposure and sun‐safe behavior may lead to inaccurate conclusions about the effectiveness of sun‐safety educational programs. Objectives: We aimed to compare self‐reports to objective measures of sun exposure, when examining the effectiveness of passive versus active educational interventions. Methods: From May to June 2018, 73 participants recruited at a dermatology clinic were sequentially assigned to receive sun‐safety education through one of 3 modes: interactive online module, video, or no education. A baseline Sun Exposure and Behavior Inventory (SEBI) questionnaire was administered, and spectrophotometric measurements of sun‐exposed and sun‐protected areas were taken and reported in the CIE L*a*b* color space. Participants were followed 4–8 and 16 weeks after the initial visit where the SEBI was re‐administered, and serial measurements of skin color were taken. The change in SEBI scores and L*a*b values, as calculated by the individual typology angle (ITA°), was analyzed. Results: There was a significant increase in skin darkening in all the groups at 4–8 and 16 weeks follow‐up. There was no statistically significant difference between the groups in the magnitude of color change. However, subjectively at 4‐8 weeks post‐intervention, participants in the interactive module and video groups had significantly improved self‐reported SEBI scores compared to control (p <.05, Kruskal‐Wallis). By 16 weeks, only the interactive module group showed significant improvement in SEBI scores compared to control (p <.05, ANOVA). Conclusion: In determining the effectiveness of sun‐safety programs, spectrophotometric evaluation of sun‐induced skin pigmentation can allow for a more complete evaluation of self‐reported sun exposure and sun‐protective behavior. [ABSTRACT FROM AUTHOR]

Background: Although many hair disorders can be readily diagnosed based on their clinical appearance, their progression and response to treatment are often difficult to monitor, particularly in quantitative terms. We introduce an innovative technique utilizing a smartphone and computerized image analysis to expeditiously and automatically measure and compute hair density and diameter in patients in real time. Methods: A smartphone equipped with a dermatoscope lens wirelessly transmits trichoscopy images to a computer for image processing. A black‐and‐white binary mask image representing hair and skin is produced, and the hairs are thinned into single‐pixel‐thick fiber skeletons. Further analysis based on these fibers allows morphometric characteristics such as hair shaft number and diameters to be computed rapidly. The hair‐bearing scalps of fifty participants were imaged to assess the precision of our automated smartphone‐based device in comparison with a specialized trichometry device for hair shaft density and diameter measurement. The precision and operation time of our technique relative to manual trichometry, which is commonly used by hair disorder specialists, is determined. Results: An equivalence test, based on two 1‐sided t tests, demonstrates statistical equivalence in hair density and diameter values between this automated technique and manual trichometry within a 20% margin. On average, this technique actively required 24 seconds of the clinician's time whereas manual trichometry necessitated 9.2 minutes. Conclusion: Automated smartphone‐based trichometry is a rapid, precise, and clinically feasible technique which can significantly facilitate the assessment and monitoring of hair loss. Its use could be easily integrated into clinical practice to improve standard trichoscopy. [ABSTRACT FROM AUTHOR]

Background/purposes Fluorescence emission from in vivo cutaneous melanin was recently detected under near-infrared ( NIR) excitation by our group. We then built a prototype NIR autofluorescence imaging system to observe and characterize the melanin distribution in human skin. In this article, we reported a new setup of NIR fluorescence imaging system and calibration methods to optimize the system for better clinical feasibility and clearer image. Methods The imaging system was designed to perform both fluorescence and reflectance imaging with a 785-nm fiber-coupled laser source. The illumination light was purified by a 785-nm bandpass filter for fluorescence excitation; while the spontaneous components were selected by a longpass filter for NIR reflectance imaging. A hand-controlled filter wheel was used to switch these two filters for different imaging modes. A dichroic filter was used to guide the illuminating light onto the skin surface for excitation. Reflectance and fluorescence signals were collected sequentially by a NIR optimized CCD camera. The captured images were calibrated by the reflectance images of a standard reflectance disk for non-uniform illuminations and light collection efficiencies. Results The clinical results demonstrated that NIR fluorescence intensities and distribution patterns vary among lesion types. It was also confirmed that pigmented skin lesions emitted higher NIR fluorescence than the surrounding normal skin due to the presentation of higher concentrations of cutaneous melanin within the lesions. Conclusion NIR autofluorescence imaging system could be utilized as a powerful tool for visualizing melanin distribution in pigmented skin lesions and as a potential method for aiding melanoma detection. [ABSTRACT FROM AUTHOR]

Abstract: The autofluorescence properties of normal human skin in the near-infrared (NIR) spectral range were studied using Monte Carlo simulation. The light-tissue interactions including scattering, absorption and anisotropy propagation of the regenerated autofluorescence photons in the skin tissue were taken into account in the theoretical modeling. Skin was represented as a turbid seven-layered medium. To facilitate the simulation, ex vivo NIR autofluorescence spectra and images from different skin layers were measured from frozen skin vertical sections to define the intrinsic fluorescence properties. Monte Carlo simulation was then used to study how the intrinsic fluorescence spectra were distorted by the tissue reabsorption and scattering during in vivo measurements. We found that the reconstructed model skin spectra were in good agreement with the measured in vivo skin spectra from the same anatomical site as the ex vivo tissue sections, demonstrating the usefulness of this modeling. We also found that difference exists over the melanin fluorescent wavelength range (880–910nm) between the simulated spectrum and the measured in vivo skin spectrum from a different anatomical site. This difference suggests that melanin contents may affect in vivo skin autofluorescence properties, which deserves further investigation. [Copyright &y& Elsevier]

Raman spectroscopy has been used as a sensitive tool for studying biological tissue and evaluating disease. In many applications, microscopic level resolution spectral analysis is desirable. And this has been performed mostly by expensive commercial confocal micro-Raman systems. In this research, we present a simple method for building an economical and modular Raman microspectroscopy system that combines a microscope with a Raman spectrometer using an optical fiber bundle. The bundle with a circular collection end is positioned at an image plane of the microscope to collect Raman signals from the interested micro-location on the sample. The light delivery end is specially configured so that its 37 fibers are arranged along a straight line to fit into the spectrometer entrance slit. This configuration improves light collection efficiency and maintains high spectral resolution. To battle the great background autofluorescence and Raman signals that could originate from the microscope slides and optics due to the non-confocal set-up of our simplified system, conventional normal-incident illumination is replaced by oblique illumination at 45° degrees and the microscope slides are coated with gold. We demonstrated the usefulness of the system by measuring micro-Raman spectra from different skin layers on vertical sections of normal skin tissue samples. [ABSTRACT FROM AUTHOR]

Abstract: Melanin content and distribution in skin were studied by examining a patient with white, brown and blue skin tones expressed on skin affected by vitiligo. Both diffuse reflectance and autofluorescence spectra of the three distinction skin sites were measured and compared. Monte Carlo simulations were then performed to help explain the measured spectral differences. The modeling is based on a six-layer skin optical model established from published skin optical parameters and by adding melanin content into different locations in the model skin. Both the reflectance and fluorescence spectra calculated by Monte Carlo (MC) simulation were approximately in agreement with experimental results. The study suggests that: (1) trichrome vitiligo skin may be an ideal in vivo model for studying the effect of skin melanin content and distribution on skin spectroscopy properties. (2) Based on the skin optical model and MC simulation, the content and distribution of melanin in skin, or other component of skin could be simulated and predicted. (3) Both reflectance and fluorescence spectra provided information about superficial skin structures but fluorescence spectra are capable of providing information from deeper cutaneous structures. (4) The research method, including the spectral ratio method, the method of adding and modifying the melanin content in skin optical models, and MC simulation could be applied in other non-invasive optical studies of the skin. [Copyright &y& Elsevier]

Alopecia areata is regarded as a tissue-restricted autoimmune disease of hair follicles in which follicular activity is arrested because of the continued activity of lymphocytic infiltrates. Actual loss of hair follicles does not occur, even in hairless lesions. A variety of immunomodulating therapies, including contact sensitizers and immunomodulators, are part of the usual armamentarium for this disorder. None of these treatments have been consistent in their efficacy, and many have untoward side effects. Nevertheless, their uses in valid animal models provide a tool to dissect out molecular mechanisms of therapeutic effects. For several decades, both mechlorethamine (for the treatment of cutaneous T cell lymphoma) and anthralin (for the treatment of psoriasis) have been used successfully. When these therapies were tested in rat and mouse alopecia areata models, we found anthralin and mechlorethamine to be the most effective topical modalities, respectively. The underlying cellular mechanisms may act through targeting infiltrative lymphocytes, and the molecular mechanisms may involve specific cytokine expression changes. These visible, accessible, and unilaterally treated animal model systems are ideal for studying novel alopecia areata therapies, particularly in terms of their in vivo molecular mechanisms of action. [ABSTRACT FROM AUTHOR]

Boniface (Bordeaux, France) found that perilesional skin in progressive vitiligo patients reveals upregulation of NKG2D when compared to stable vitiligo and control patients. Patients with active vitiligo had significantly higher serum IL-23 levels than controls, whereas stable vitiligo patients did not have a significant difference in IL-23 levels when compared to controls. Vitiligo treatments Results of clinical trials and studies on vitiligo treatments were presented. Lectures were given by vitiligo experts from different countries regarding tissue and cell transfer surgical approaches to vitiligo treatment. [Extracted from the article]

Summary: Background and Purpose: Although cutaneous autofluorescence has been utilized for evaluation of skin conditions, there is a paucity of data on normal human skin autofluorescence and its dependence on anatomical site. The objective of this study is to use excitation‐emission matrix spectroscopy to quantify and characterize skin autofluorescence at different body sites. Methods: Ten anatomical sites from 30 healthy volunteers were measured with a double‐grating excitation‐emission matrix spectrofluorometer. Results: For the 10 body sites evaluated, there were four overall patterns of autofluorescence: skin from the head and neck exhibits high superficial and low bilayer fluorescence; the dorsal forearm and dorsal hand have both low superficial and bilayer fluorescence; the upper inner arm and back have high superficial and intermediate bilayer fluorescence; while the palm and thumbnail have both high superficial and bilayer fluorescence. The corresponding fluorescence excitation‐emission peaks for these patterns were as follows: head and neck, 3 peaks at 290‐300/330‐350, 360‐380/460‐485, and 380‐420/610‐630 nm; dorsal forearm and dorsal hand, 2 peaks around 295‐300/345‐360 and 385‐395/460‐485 nm; upper inner arm and back, 3 peaks around 295‐300/335‐355, 335‐340/390‐410, and 375‐390/455‐480 nm; palm and thumbnail, 3 peaks around 285‐300/345‐355, 335‐345/390‐410, and 365‐390/450‐480 nm. Conclusion: Cutaneous fluorescence varies in distinct patterns according to anatomical site, due to the component fluorophores present, skin thickness, and the degree of melanization and long term sun exposure. These EEM patterns for normal skin should be accounted for when interpreting fluorescence signals from disease states and can also be used to guide the selection of optimal wavebands when applying this optical modality. [ABSTRACT FROM AUTHOR]

Summary: Background: There is no accepted method to objectively assess the visual appearance of sunscreens on the skin. Methods: We present a method for sunscreen application, digital photography, and computer analysis to quantify the appearance of the skin after sunscreen application. Four sunscreen lotions were applied randomly at densities of 0.5, 1.0, 1.5, and 2.0 mg/cm2 to areas of the back of 29 subjects. Each application site had a matched contralateral control area. High‐resolution standardized photographs including a color card were taken after sunscreen application. After color balance correction, CIE L*a*b* color values were extracted from paired sites. Differences in skin appearance attributed to sunscreen were represented by ΔE, which in turn was calculated from the linear Euclidean distance within the L*a*b* color space between the paired sites. Results: Sunscreen visibility as measured by median ΔE varied across different products and application densities and ranged between 1.2 and 12.1. The visibility of sunscreens varied according to product SPF, composition (organic vs inorganic), presence of tint, and baseline b* of skin (P < .05 for all). Conclusion: Standardized sunscreen application followed by digital photography and indirect computer‐based colorimetry represents a potential method to objectively quantify visibility of sunscreen on the skin. [ABSTRACT FROM AUTHOR]

Objective measurements of melanin can provide important information for differentiating melanoma from benign pigmented lesions and in assessing pigmentary diseases. Herein, we evaluate near-infrared (NIR) fluorescence as a possible tool to quantify melanin. Various concentrations of in vitro Sepia melanin in tissue phantoms were measured with NIR fluorescence and diffuse reflectance spectroscopy. Similar optic measurements were conducted in vivo on 161 normal human skin sites. Diffuse reflectance spectroscopy was used to quantify the melanin content via Stamatas-Kollias algorithm. At physiologic concentrations, increasing in vitro melanin concentrations demonstrated higher fluorescence that was linearly correlated (R² = 0.99, p < .001). At higher concentrations, the fluorescence signal plateaued. A linear relationship was also observed with melanin content in human skin (R² = 0.59, p < .001). Comparing the fluorescence and reflectance signals with in vitro and in vivo samples, the estimated melanin concentration in human skin ranged between 0 and 1.25 mg/ml, consistent with previous quantitative studies involving invasive methods. [ABSTRACT FROM AUTHOR]

The Vitiligo Global Issues Consensus Conference ( VGICC), through an international e-Delphi consensus, concluded that 'repigmentation' and 'maintenance of gained repigmentation' are essential core outcome measures in future vitiligo trials. This VGICC position paper addresses these core topics in two sections and includes an atlas depicting vitiligo repigmentation patterns and color match. The first section delineates mechanisms and characteristics of vitiligo repigmentation, and the second section summarizes the outcomes of international meeting discussions and two e-surveys on vitiligo repigmentation, which had been carried out over 3 yr. Treatment is defined as successful if repigmentation exceeds 80% and at least 80% of the gained repigmentation is maintained for over 6 months. No agreement was found on the best outcome measure for assessing target or global repigmentation, therefore highlighting the limitations of e-surveys in addressing clinical measurements. Until there is a clear consensus, existing tools should be selected according to the specific needs of each study. A workshop will be conducted to address the remaining issues so as to achieve a consensus. [ABSTRACT FROM AUTHOR]

Real-time Raman spectroscopy can be used to assist in assessing skin lesions suspicious for cancer. Most of the diagnostic algorithms are based on full band of the Raman spectra, either in the fingerprint region or the high wavenumber region. In this paper we explored wavenumber selection based analysis in Raman spectroscopy for skin cancer diagnosis. Wavenumber selection was implemented using windows of wavenumber and leave-one-out cross-validated stepwise regression or least and shrinkage selection operator (LASSO). The diagnostic algorithms were then generated from the selected windows of wavenumber using multivariate statistical analyses, including principal component and general discriminate analysis (PC-GDA) and partial least squares (PLS). In total a combined cohort of 645 confirmed lesions from 573 patients encompassing skin cancers, precancers and benign skin lesions were included, which were divided into training cohort (n = 518) and testing cohort (n = 127) according to the measurement time. It was found that the area under the receiver operating characteristic curve (ROC) was improved from 0.861–0.891 to 0.891–0.911 and the diagnostic specificity for fixed sensitivity 0.99–0.90 was improved from 0.17–0.65 to 0.20–0.75 with wavenumber selection based analysis. [ABSTRACT FROM AUTHOR]

Real-time Raman spectroscopy can be used to assist in assessing skin lesions suspicious for cancer. Most of the diagnostic algorithms are based on full band of the Raman spectra, either in the fingerprint region or the high wavenumber region. In this paper we explored wavenumber selection based analysis in Raman spectroscopy for skin cancer diagnosis. Wavenumber selection was implemented using windows of wavenumber and leave-one-out cross-validated stepwise regression or least and shrinkage selection operator (LASSO). The diagnostic algorithms were then generated from the selected windows of wavenumber using multivariate statistical analyses, including principal component and general discriminate analysis (PC-GDA) and partial least squares (PLS). In total a combined cohort of 645 confirmed lesions from 573 patients encompassing skin cancers, precancers and benign skin lesions were included, which were divided into training cohort (n = 518) and testing cohort (n = 127) according to the measurement time. It was found that the area under the receiver operating characteristic curve (ROC) was improved from 0.861–0.891 to 0.891–0.911 and the diagnostic specificity for fixed sensitivity 0.99–0.90 was improved from 0.17–0.65 to 0.20–0.75 with wavenumber selection based analysis. [ABSTRACT FROM AUTHOR]

Evaluates the regenerative capacity of transversely sectioned hair follicle in athymic nude mice. Occipital areas of patients undergoing hair transplantation; Histologic features of hair follicle; Causes of low successful regeneration rate.

Background Recent advances in biomedical optics have enabled dermal and epidermal components to be visualized at subcellular resolution and assessed noninvasively. Multiphoton microscopy ( MPM) and reflectance confocal microscopy ( RCM) are noninvasive imaging modalities that have demonstrated promising results in imaging skin micromorphology, and which provide complementary information regarding skin components. This study assesses whether combined MPM/ RCM can visualize intracellular and extracellular melanin granules in the epidermis and dermis of normal human skin. Methods We perform MPM and RCM imaging of in vivo and ex vivo skin in the infrared domain. The inherent three-dimensional optical sectioning capability of MPM/ RCM is used to image high-contrast granular features across skin depths ranging from 50 to 90 μm. The optical images thus obtained were correlated with conventional histologic examination including melanin-specific staining of ex vivo specimens. Results MPM revealed highly fluorescent granular structures below the dermal-epidermal junction ( DEJ) region. Histochemical staining also demonstrated melanin-containing granules that correlate well in size and location with the granular fluorescent structures observed in MPM. Furthermore, the MPM fluorescence excitation wavelength and RCM reflectance of cell culture-derived melanin were equivalent to those of the granules. Conclusion This study suggests that MPM can noninvasively visualize and quantify subepidermal melanin in situ. [ABSTRACT FROM AUTHOR]

One challenge in facing the application of biomedical Raman spectroscopy is that the Raman signal is acquired in a dark operation room. It is inconvenient for both the operator and the patient because it is difficult for the operator to accurately and precisely locate the target in the dark environment, and the patient feels uncomfortable in such a setting. In this note, we propose a method to implement biomedical Raman measurement with an illumination source, by multiple filtering of the illumination and the collection optics. Experimental results are demonstrated on skin Raman measurement under 785-nm excitation. [ABSTRACT FROM AUTHOR]

Stem cells offer tremendous opportunities for regenerative medicine. Over the past decade considerable research has taken place to identify and characterize the differentiation states of stem cells in culture. Raman micro-spectroscopy has emerged as an ideal technology since it is fast, nondestructive, and does not require potentially toxic dyes. Raman spectroscopy systems can also be incorporated into confocal microscope imaging systems allowing spectra to be obtained from below the tissue surface. Thus there is significant potential for monitoring stem cells in living tissue. Stem cells that reside in hair follicles are suitable for testing this possibility since they are close to the skin surface, and typically clustered around the bulge area. One of the first steps needed would be to obtain Raman micro-spectra from stem cells located in thin sections of tissue, and then see whether these spectra are clearly different from those of the surrounding differentiated cells. To facilitate this test, standard 5 μm thick sections of murine skin tissue were stained to identify the location of hair follicle stem cells and their progeny. Raman spectra were then obtained from adjacent cells in a subsequent unstained 10 μm thick section. The spectra revealed significant differences in peak intensities associated with nucleic acids, proteins, lipids and amino acids. Statistical analyses of the Raman micro-spectra identified stem cells with 98% sensitivity and 94% specificity, as compared with a CD34 immunostaining gold standard. Furthermore analyses of the spectral variance indicated differences in cellular dynamics between the two cell groups. This study shows that Raman micro-spectroscopy has a potential role in identifying adult follicle stem cells, laying the groundwork for future applications of hair follicle stem cells and other somatic stem cells in situ. [ABSTRACT FROM AUTHOR]

Skin phantoms are often used to study and model light propagation. However, existing skin phantoms overlook the important effect of surface roughness on light propagation patterns. This paper reports the construction of durable phantoms with controllable surface roughness and bulk optical properties. With silica microspheres as the scattering particles, we theoretically model the scatterer density required to achieve the desired phantom optical properties before fabrication. The surface roughness and the attenuation coefficients of the constructed phantoms were validated using optical profilometry and ballistic spatial filter photometry. These rough skin phantoms were originally developed for laser speckle studies, but could also be used for studying optical phenomena where light experiences surface and bulk scattering at the same time. [ABSTRACT FROM AUTHOR]

Irregular streaks are important clues for Melanoma (a potentially fatal form of skin cancer) diagnosis using dermoscopy images. This paper extends our previous algorithm to identify the absence or presence of streaks in a skin lesions, by further analyzing the appearance of detected streak lines, and performing a three-way classification for streaks, Absent, Regular, and Irregular, in a pigmented skin lesion. In addition, the directional pattern of detected lines is analyzed to extract their orientation features in order to detect the underlying pattern. The method uses a graphical representation to model the geometric pattern of valid streaks and the distribution and coverage of the structure. Using these proposed features of the valid streaks along with the color and texture features of the entire lesion, an accuracy of 76.1% and weighted average area under ROC curve (AUC) of 85% is achieved for classifying dermoscopy images into streaks Absent, Regular, or Irregular on 945 images compiled from atlases and the internet without any exclusion criteria. This challenging dataset is the largest validation dataset for streaks detection and classification published to date. The data set has also been applied to the two-class sub-problems of Absent/Present classification (accuracy of 78.3% with AUC of 83.2%) and to Regular/Irregular classification (accuracy 83.6% with AUC of 88.9%). When the method was tested on a cleaned subset of 300 images randomly selected from the 945 images, the AUC increased to 91.8%, 93.2% and 90.9% for the Absent/Regular/Irregular, Absent/Present, and Regular/Irregular problems, respectively. [ABSTRACT FROM AUTHOR]

Background Skin cancer is the most common type of cancer in humans. Current techniques for identifying normal and neoplastic tissues are either destructive or not sensitive and specific enough. Raman spectroscopy and confocal imaging may obviate many limitations of existing methods by providing noninvasive, high-resolution, and real-time morphological and biochemical analysis of living tissues and cells. Methods We conducted micro- Raman spectroscopy studies on HaCaT cells, melanocytes ( MC) and their malignant counterparts squamous cell carcinoma ( SCC) and melanoma ( MM) cells, respectively. Reflectance confocal imaging is used as guidance for the spectral measurements. Results Significant differences were found between the spectra of HaCaT cells and SCC cells, MC cells and MM cells, as well as all normal cells ( HaCaT and MC) and all tumor cells ( SCC and MM). Approximately 90% sensitivity and specificity was achieved for all the separations that we performed. Conclusion Our results demonstrated the robust capability of confocal Raman spectroscopy in separating different cell lines. The acquired Raman spectra of major types of skin cells and their malignant counterparts will be useful for the interpretation of Raman spectra from in vivo skin. We believe it will eventually help diagnosis of skin cancer and other skin disease in clinical dermatology. [ABSTRACT FROM AUTHOR]

Background: Informed shared decision making is a mutual process engaging both doctor and patient and informed by best medical evidence and patient values and preferences. Objective: Our aim was to identify the needs of psoriasis patients in decisions on selecting treatment. Methods: Psoriasis subjects participated in an online survey on decisional role, postdecisional conflict, and treatment awareness. Results: Of 2,622 people invited to participate, 248 completed surveys. Their most recent treatment decision was either made by subjects alone (42%) or physicians alone (28%) or was shared (29%). Subjects perceived that their doctors lacked time to stay abreast of treatments, to provide counseling, and to access appropriate treatments. Deficiencies most frequently identified were information on options, clarification of values, access to physicians, and decision-making skills. Those with a body surface area (BSA) ≥ 3% more frequently indicated that having the skill or ability to make treatment decisions was important. Limitations: The limitations of this study include sampling, recall, and reporting bias. Percent BSA was not verified. Conclusions: The multiple deficiencies in support of psoriasis patients in treatment decisions may preclude informed shared decision making. [ABSTRACT FROM AUTHOR]

Abstract: Quantification of surface roughness greater than a micron is desirable for many industrial and biomedical applications. Polychromatic speckle contrast has been shown theoretically to be able to detect such roughness range using an appropriate light source with a Gaussian spectral shape. In this paper, we extend the theory to arbitrary spectral profile by formulating speckle contrast as a function of spectral profile, surface roughness, and the geometry of speckle formation. Under a far-field set-up, the formulation can be simplified and a calibration curve for contrast and roughness can be calculated. We demonstrated the technique using a blue diode laser with a set of 20 metal surface roughness standards in the range 1–73μm, and found that the method worked well with both Gaussian and non-Gaussian surfaces. [Copyright &y& Elsevier]

Background: Evidence from clinical trials supports the use of alefacept for the treatment of patients with chronic plaque psoriasis, either as monotherapy or combined with other treatment modalities. Objective: AWARE (Amevive Wisdom Acquired from Real-World Evidence) is a multicenter, observational, phase IV Canadian registry of psoriasis patients treated with alefacept. Methods: Patients with chronic plaque psoriasis were treated with at least one course of alefacept treatment followed by a period of at least 12 weeks off-treatment. The use of combination therapy with alefacept in a real-world population of psoriasis patients is presented here, including the types of psoriasis therapies received by patients at the time of enrolment, reasons for initiating alefacept, and discontinuation or dosage reduction of concomitant therapy. Results: The majority of patients were receiving other antipsoriatic therapies at the time of enrolment into the AWARE study, most commonly topical therapy, systemic agents, or phototherapy. Most patients were receiving monotherapy prior to the initiation of alefacept. There was little change in the use of topical therapies with alefacept at 24 weeks, whereas a substantial proportion of patients were able to reduce or discontinue concomitant systemic therapies and/or phototherapy. The use of combination therapy regimens was relatively consistent across the country and by age groups, although younger patients were prescribed systemic agents more often.than older patients. Conclusion: Alefacept is commonly added to other antipsoriatic therapies in a broad population of real-world chronic plaque psoriasis patients in Canada and may allow for dosage reduction or discontinuation of concomitant systemic agents or phototherapy [ABSTRACT FROM AUTHOR]

Background: Alefacept has demonstrated efficacy in clinical trials of patients with chronic plaque psoriasis, either as monotherapy or combined with other treatment modalities such as phototherapy. Objective: AWARE (Amevive Wisdom Acquired from Real-World Evidence) is a multicenter, observational, phase IV Canadian registry of psoriasis patients treated with alefacept. Methods: Patients with chronic plaque psoriasis were treated with at least one course of alefacept, either alone or added on to their existing antipsoriatic treatment regimen. Each course of alefacept was followed by a period of at least 12 weeks off treatment. Efficacy outcomes included physicians' and patients' assessments of response at week 18, as well as change in percent body surface area (BSA) involvement with psoriasis. The time to retreatment was assessed in patients receiving a second course of alefacept during at least 60 weeks of prospective follow-up. Results: The majority of patients received alefacept in combination with other antipsoriatic therapies. Physicians' and patients' assessments of response at 18 weeks showed that 42% and 41% of patients, respectively, had a "cleared to marked response" and a further 42% had a "moderate to some response." Among those patients whose psoriasis was moderately controlled or not controlled at baseline, 49 to 51% and 33 to 36%, respectively, improved to "cleared to marked response" at 18 weeks. A substantial shift in percent BSA involvement with psoriasis was observed at 18 weeks, with 55% of patients having a BSA involvement of < 10% at week 18 compared to only 20% having this level of BSA involvement at baseline. The meantime to retreatment among the 60% of patients who received a second course of alefacept was 19.3 weeks (range 2-47 weeks). Conclusion: A single course of alefacept therapy improved outcomes in this broad population of real-world chronic plaque psoriasis patients [ABSTRACT FROM AUTHOR]

Background: Alefacept was the first biologic therapy approved by Health Canada for the treatment of moderate to severe chronic plaque psoriasis and is used either alone or as part of combination therapy. Objective: AWARE (Amevive Wisdom Acquired from Real-World Evidence) is a multicenter, observational phase IV Canadian study of psoriasis patients treated with alefacept. This study's main goals were to. develop a shared, real-time, national clinical database to support best practice and optimize the care of patients receiving alefacept and to gain an understanding of how alefacept is used in Canadian clinical practice. Baseline patient demographic data are described herein. Methods: Patients with chronic plaque psoriasis were enrolled from 37 clinics across Canada. Subjects received at least one course of alefacept treatment followed by a period of at least 12 weeks off treatment and were prospectively followed for at least 60 weeks. Baseline assessments included patient demographics, relevant medical history, psoriasis and treatment history, reasons for initiating alefacept, enrolling physician's initial alefacept treatment plan and strategy, percent body surface area (BSA) involvement with psoriasis, and physician's baseline assessment of disease control. Subsequent assessments at each follow-up visit included the patient's response and the physician's assessment. Results: A total of 426 adult patients with predominantly chronic plaque psoriasis, with or without other types of psoriasis, were enrolled into the AWARE registry. Patients generally had moderate to severe psoriasis, with more than half (55.8%) having little or no disease control at baseline as assessed by their clinician, and 77% had > 10% BSA involvement with psoriasis. All patients in the AWARE patient population were receiving one or more treatments for psoriasis prior to or at the time of enrolment, and the majority continued to receive concomitant treatments at the time of study enrolment. Conclusion: The AWARE registry enrolled a broad group of real-world patients with chronic plaque psoriasis treated with alefacept in clinical practices across Canada [ABSTRACT FROM AUTHOR]

Background: Few data exist documenting the effectiveness of psoriasis day-care treatment programs (PDTPs) using standardized efficacy measurements. Objectives: We sought to analyze the efficacy of a PDTP using the Psoriasis Area and Severity Index (PASI). Methods: A retrospective review was performed on 132 patients treated at our PDTP. Sufficient data existed to permit PASI analysis using a simplified method for a representative subgroup of 64 patients, who formed the study population. Patients received phototherapy and topical treatments over 2 weeks. The outcome measures included a baseline and day 11 PASI, a physician global assessment (PGA), and adverse events reported by the patients. Results: Mean baseline PASI was 13.6 (N = 64), with a 59.6% reduction by day 11. A PASI reduction of ⩾ 50% was seen in 75% of patients, with 30% of patients achieving ⩾ 75% reduction of PASI. Day 11 PGA demonstrated a 69.9% improvement. Conclusion: With a reduction in PASI of 59.6% at 11 days, our PDTP, with phototherapy and topical agents, seems to be a rapid and effective therapy for psoriasis. [ABSTRACT FROM AUTHOR]

• Developed a novel polarization speckle system that incorporates deep learning. • Polarization speckle data lends itself to augmentation for machine learning and deep learning. • In a clinical validation study, multiple types of skin cancers are separated from benign skin lesions. • Deep learning enables improved detection performance over machine learning and previous speckle analysis methods. Polarization speckle is a growing research field, especially for the purposes of biomedical imaging and diagnostics. The statistical uniformity of speckle creates novel opportunities for AI methods to analyze speckle patterns, as they are difficult for a human to interpret. We employed deep learning and traditional machine learning methods (Support Vector Machine, K Nearest Neighbor, and Random Forests) to analyze polarization speckle images generated from the general categories of malignant and benign lesions, a classification task previously found to be very difficult. Their performance in classifying the patterns were compared both to each other and to the previous statistical methods of speckle analysis. A collection of 122 malignant and 196 benign skin lesion speckle images were augmented for deep learning using patch cropping, an advantageous method given the patterns' statistical homogeneity. The machine learning technique performed with a diagnostic accuracy of less than 65%, a result comparable to those of previous statistical methods, despite the fact that the same machine learning technique could achieve a high 90% accuracy in the simpler classification task of differentiating malignant melanoma and the benign lookalike seborrheic keratosis. However, ResNet, our chosen deep learning architecture, achieved the best performance of 82% diagnostic accuracy in the general classification task of malignant and benign. These results show that deep learning extracts previously hidden information from polarization speckle, which further develops towards a rapid, real-time, analysis technique for an automatic skin cancer detection system. [ABSTRACT FROM AUTHOR]

Background: Spectroscopic methods have been used to analyze in vivo melanin in the past but the specific effect of melanin depth on autofluorescence and reflectance spectroscopy has not been determined. In patients with blue vitiligo, three distinctive clinicopathologic patterns are present: (1) normal skin with normal epidermal melanin pigmentation (2), skin of blue vitiligo with dermal melanin pigmentation, and (3) tissue of regular vitiligo with no melanin pigmentation. Blue vitiligo may thus serve as an in vivo model to assess dermal pigment using spectroscopic techniques. Objectives: To evaluate the reflectance and autofluorescence spectra of a patient with blue vitiligo in order to assess the effect of melanin pigmentation and its localization on the optical properties of the skin. Methods: The blue-gray, normal and depigmented lesions of a patient with blue vitiligo were analyzed using reflectance and fluorescent spectroscopy. The condition was likely induced by a phototoxic reaction in a patient with pre-existing vitiligo. These data were then correlated to the histologic and electron microscopic findings present in the various types of lesions. Results: Reflectance spectroscopy detected little difference in spectral shape between skin sites affected by blue vitiligo vs. vitiligo. Autofluorescence spectroscopy detected an apparent difference between the two types of lesions, with the blue–gray lesions (blue vitiligo) showing lower fluorescence intensity and spectral maximum position red-shifted compared with regular vitiligo, whereas regular vitilgo showed more intense hemoglobin absorption than the blue vitiligo. Conclusions: Dermal melanin present in blue vitiligo can be well characterized by autofluorescence spectroscopy, while little difference in reflectance spectral shape exists between vitiligo and blue vitiligo. Thus, autofluorescence spectroscopy may better identify deeper structures in skin tissue, such as melanin, than reflectance spectroscopy [ABSTRACT FROM AUTHOR]