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Noninvasive Surface Imaging
Supenya Varothai, M.D.Department of Dermatology,Faculty of Medicine Siriraj Hospital,Mahidol University
Researches in Dermatology
Studies in change of skinSkin biopsy, special stain invasiveSubjective scoring systems qualitative
Noninvasive techniqueObjective measurementQuantification
Skin Bioengineering
Skin BioengineeringDefinition
Biophysical methods for noninvasivequantification of the qstructures and functions of diseased, abnormal and normal skin
Advantages– Noninvasive– Quantitative (objective) measurement– Multiple measurement
Multi disciplinary
Skin Bioengineering
– Multi-disciplinary
Skin Bioengineering
TEWA meter
Skin pH meterCorneometer
ApplicationsSkin barrier functionSkin pHCutaneous hydration
MexameterCutometer
Visiometer, visioscan
hydrationSkin colorSkin biomechanical propertiesSkin surface imaging
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Skin Surface Appearance
Background
Human perception based on visualization of surfaceOuter most skin = stratum corneum (SC)Physical state of SC often reflects changes
d b l bloccurred below in viable tissues
Skin Surface Appearance
– Acanthosis– Atrophy– Post Inflammation
Epidermal pigment
Examples– Thickening– Thinning– Scaling
Brown – Epidermal pigment
– Dermal pigment– Hyperkeratosis
– Brown pigmentation
– Blue pigmentation– Rough, dry,
cracked
Factors Defines Skin Surface Appearance
TextureMicroreliefWrinklesScaling
PigmentBlood flowScalingSurface lipid
Color Physiologic properties
Skin elasticityPliability of SCSweat productionSebum productionSkin temperature
Factors Defines Skin Surface Appearance
TextureMicroreliefWrinklesScaling
PigmentBlood flowScalingSurface lipid
Color Physiologic properties
Skin elasticityPliability of SCSweat productionSebum productionSkin temperature
Microrelief (Glyphic pattern)
Genetically determinedPatterns: loops, whorls and arches on the fingertips
Palms & soles: dermatoglyphics
arches on the fingertipsIrregular criss-crossed by straight or slightly curved, deeper lines on the palms
Useful in studying chromosomal abberation and skin disorders
รูปลายมือ
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Microrelief (Glyphic pattern)
Palms & soles: dermatoglyphics
Microrelief (Glyphic pattern)
Genetically determinedGlabrous skin: furrows that cross each others to form squares, rectangles, trapezoidsMorphology of skin lines related to dermal elastic networkGood indicator for skin aging process
Microrelief (Glyphic pattern)
Functions of linesRetention and drainage canals of sebum & sweat and topically applied substances preferential sites of ppercutaneous absorption (reservoir)
Mechanical results from decrease of collagen elasticity along tension of skin (Langer’s line)
Microrelief (Glyphic pattern)
Primary line: parallel, 20-100 μm in depthAlways longer, broader, deeperForm in superficial dermis, related with elastic network
Secondary line5-40 μm in depthForm diagonal with primary lines triangles, rhomboids, trapezoidsEpidermic orgin
Microrelief (Glyphic pattern)Microrelief patterns
Primary lines
Secondary lines
Microrelief pattern
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Microrelief (Glyphic pattern)
Tertiary lineBoundary of corneocytes, 0.5 μm in depth
Quaternary lineSurface marking on individual corneocytes, g y ,0.05 μm in depth
Tertiary lines
Microrelief (Glyphic pattern)
Quaternary line
Microrelief (Glyphic pattern)
Difference in microrelief patternBody siteAge
Incresed and prominent primary linesDecreased fine lines
Skin diseases
รูปผิวเด็ก รูปผิวคนแก
20 years old 50 years old
WrinklesAcquired after adult lifeReflecting deterioration of the dermal matrix: loss of elasticityLoss of collagen and clumping of degraded elastic fiber in amorphous massAppears in the direction of skin tensionAppears in the direction of skin tensionResult of both intrisic and extrinsic aging
Scaling
Scales= corneocyte aggregation that break from the skin surface Many variety of scaling– Diseases of abnormal keratinization:
PsoriasisIchthyosis vulgarisPityriasis versicolor
– Ordinary dry skin: Most common formXerotic vulgaris, winter xerosis
Scaling
Enzymatic degradation of corneodesmosome
Corneocyte desquamation process
Hydrolytic enzymes require high
water activity
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Scaling
Shedding of “Clumps” of corniocytesNormal shedding
Flakes or Scales
Factors Influence on Skin RoughnessPhysiological factors
Water content (hydrolipidic barrier)Body siteAgeSkin diseases and internal diseasesHealing of wounds and scars
Environmental factorsUV radiation LifestylePharmaceuticals and cosmetic productsAir humidity and temperature (Season and climate)
Skin Texture Measurement
Skin texture measurement
“Surface contour and roughness assessment”
1. Indirect assessment of skin replication
2. In vivo direct measurement of the skin
Indirect assessment of skin replication– Skin replication by
Carbon and metal/carbon Plastic impression techniqueSilicone elastomer replication
Skin texture measurement
Silicone elastomer replicationdental impression material
Skin Replication
Negative replica
Positive replica
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Skin Replication
Silicone replica capture pore refinement at baseline and eight week
Indirect assessment of skin replication
1. Profilometry (stylus method)M h i l
Skin texture measurement
– Mechanical– Optical
2. Image analysis
Mechanical stylus
Conventional methodA stylus traversed across the replica surface
Vertical displacement of stylus
Digital signals
Computerized analysis of skin roughness
Mechanical stylus
Skin replica before and after 3 wks after therapy
Mechanical stylus
LimitationsDirect contact to the skin pressure of the spheric head crates deformation of skin surfaceSlow data acquisition: very slow scanning speed (2 hr for 5.12x5.12 mm2)2-D results
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Optical stylus
Use laser beams for surface measurementComputer-assisted structural analysisResults: 3-D profile of the surfaceFaster scanning speed ( 5 min for 5 12x5 12 Faster scanning speed ( 5 min for 5.12x5.12 mm2)
Optical stylus
Mechanical VS Optical Stylus Optical ProfilometryVisioscan SV 600
Image analysis
Skin surface contourDigital camera take image of replica
Binary image
Linearized image
Extract characteristics of skin furrows
Calculate for change in skin furrows
Image analysis
(a) Camera image of skin relief (b) Binary image
(c) Thinned image (d) Linearized image Pattern analysis
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Change in Skin surface pattern at cheek site with aging
Average of skin roughness
Anisotrophy of skin furrows
Image analysis
Wrinkle measurement (shadowing method)Replica illuminated by oblique light
Analyze peak height and area of shadows from oblique light Analyze peak height and area of shadows from oblique light
Define characters of wrinkles
LimitationHide a small shadowTilt replica ↓peak height
In vivo direct measurement of the skinQuite promisingAdvantage:
Avoid skin hydration effect induced by li i i t i l d
Skin texture measurement
replica impression materials and morphological changes in skin surface induced by hydrationScaliness measurement
Limitation: high variation due to Pulsation of minor skin arteriesBody movementTremble of subjects
In vivo direct skin surface measurement
FOITSTM: based on a touch-free fringe projectionPRIMOSTM: based on active triangulation in conjunction with phase-shift techniqueshift technique
Indentify+readjust previously recorded skin area at VDO rate, measure surface configuration in 3-D
Skin Texture Measurement
Comparison of methodologies
Method Instruments Advantages Disadvantages
Image analysis of replica
Combination of light source and digital camera
Low cost of instrumentSimple manipulationSpatially analyze
Artifact when making replicaNot obtain exact peak height
orientation of skin texture
Lose lower peaks behind higer peak
Optcal profilometry Optical focus profilometerConfocal scanning laser microscopeTriangulation optical profilometer
High accuracyFast analysisReproducible
Artifact when making replica
In vivo measurement
FOITSPRIMOS
Not necessary to take replicaFast analysisRepeated measurement at the same area
Affected by body movement
Skin visiometer SV600 (Courage+Khazaka electronic, Germany)
UV-A light video camera with high resolution to study skin surface directly
Ring shape UVA light source
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Skin visiometer SV600 (Courage+Khazaka electronic, Germany)
Camera connected to computerSpecial sofware calculate a variety of surface skin parameters
Skin smoothness (Se sm)Skin roughness (Se r)Skin roughness (Se r)Scaliness (Se sc)Wrinkles (Se w)
Application to Clinical Research
Application in Clinical ResearchTreatment of acne scars with ablative laser resurfacing
Wk 0
Wk 4
Wk 8
Application in Clinical ResearchStriae treatment with a radiofrequency device
Wk 0
Wk 2
Wk 6
Application in Clinical ResearchEfficacy and Safety of Topical Argireline in the Treatment of Periorbital Wrinkles
Left eye
Right eye
Wk 0 Wk 12
Results obtained from Visioscan and Corneometer showed significant improvement in smoothness and hydration, respectively
Facial mapping
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Application in Clinical Research
Hair study
Target area hair count
Pitfalls
Accurate site mappingStandard environmental controlConfounding factors
Systemic and topical medicationTopical emoillient /cosmeceuticalBathing
References
Serup J, Gemec GBE, Grove GL, eds.Handbook of non-invasive methods and the skin, second edition (2006), New York, CRC press. Wilhelm KP, Berardesca E, Elsner P, Maibach Wilhelm KP, Berardesca E, Elsner P, Maibach HI, eds. Bioengineering of the skin: skin imaging and analysis, second edition (2007), New York, Informa healthcare
Elsner P, Berardesca E, Wilhelm KP, Maibach HI, eds. Bioengineering of the skin: skin biomechanics 2002, New York, CRC press.