Researches And Applications Of New Dermatological Diagnosis And Treatment Strategies Based On Skin Imaging Technology

Part Ⅰ:Dermoscopic Features Summarization and Comparison of Four Types of Cutaneous Vascular AnomaliesBackground:Dermoscopic features of cutaneous vascular anomalies have been reported,but the described features currently known are limited and not well-understood.Objective:To comprehensively summarize and compare the dermoscopic features of the four different types of cutaneous vascular anomalies[infantile hemangiomas(IH),cherry angioma(CA),angiokeratomas(AK),and pyogenic granuloma(PG)]in the Chinese Han population.Methods:Dermoscopic features of 31 IH,172 CA,31 AK,and 45 PG were collected based on the contact non-polarized mode of dermoscopy at 20-fold magnification.Dermoscopic features including background,lacunae,vessel morphology and distribution were collected and summarized.Additionally,we compared these features by age stage,gender,and anatomical locations in CA.Results:The dermoscopic features of IH included the red lacunae,red/red-blue/redwhite backgrounds,and vessel morphology such as linear curved vessels,serpiginous vessels,coiled vessels.For CA,the lacunae appeared reddish brown to reddish blue or only red.In terms of vascular morphology,serpentine vessels,coiled vessels,looped vessels,and curved vessels could be seen in the lesions.A few lesions were black or presented with a superficial white veil.There were statistical differences in red background(P=0.021),unspecific vessel distribution(P=0.030),black area(P=0.029),and white surface(P=0.042)among different age groups.Red-brown lacunae(P=0.039),red-blue(P=0.013),red-white background(P=0.015),black area(P=0.016),and white surface(P=0.046)were of statistical difference in terms of the locations of lesions.Lacunae were also observed in AK,which presented with red,dark purple,dark blue,black.Global dermoscopic patterns that were characterized by a homogeneous area were obvious in all PG lesions,among which 30(66.7%)were red-white and 15(33.3%)were red.As for Gao et al.Dermoscopic Features of Vascular Anomalies local features,"white rail" lines were detected in 19(42.2%)lesions and white collarette was seen in 34(75.6%)lesions.Conclusions:Dermoscopy is an applicable diagnostic tool for the diagnosis of cutaneous vascular anomalies.It is necessary to take into account the age stage and lesion location when we diagnose CA using dermoscopy.Part Ⅱ:Summarizations and Comparisons of Dermoscopic features on Different Subtypes of RosaceaBackground:The dermoscopic features of rosacea have already been reported.However,the current findings are incomplete,and little is known about phymatous rosacea.Objective:To summarize and compare the dermoscopic features and patterns of three rosacea subtypes-erythematotelangiectatic,papulopustular,phymatous-in the Chinese Han population and to evaluate whether these features differ with patients’ genders,ages,and durations.Methods:Dermoscopic images of 87 rosacea patients were collected in non-polarized and polarized dermoscopy contact modes at 20-fold magnification.Dermoscopic features,including vessels,scales,follicular findings,and other structures,were summarized and evaluated.Results:The reticular linear vessels and red diffuse structureless areas of erythematotelangiectatic rosacea were distinctive.For papulopustular,red diffuse structureless areas,reticular linear vessels,yellow scales,follicular plugs,and follicular pustules were typical dermoscopic criteria.The common dermoscopic features of phymatous rosacea were as follows:orange diffuse structureless areas,linear vessels with branches,perifollicular white color,orange focal structureless areas,and white lines.The following features statistically differed among the three rosacea subtypes:reticular linear vessels(P<0.001),unspecific linear vessels(P=0.005),linear vessels with branches(P<0.001),yellow scales(P=0.001),follicular plugs(P<0.001),perifollicular white color(P<0.001),red diffuse structureless areas(P=0.022),orange diffuse structureless areas(P<0.001),red focal structureless areas(P=0.002),orange focal structureless areas(P=0.003),white lines(P<0.001),follicular pustules(P<0.001),and black vellus hairs(P<0.001).Between females and males,we detected statistical differences for reticular linear vessels(P=0.021),unspecific linear vessels(P=0.046),linear vessels with branches(P=0.002),orange diffuse structureless areas(P=0.021),orange focal structureless areas(P=0.032),and white lines(P=0.034).Follicular red dots(P=0.015)and follicular pustules(P=0.035)were statistically significant between different age group.Linear vessels with branches(P<0.001),follicular plugs(P=0.018),orange diffuse structureless areas(P=0.009),and black vellus hairs(P=0.035)were more common in patients with a disease course of more than two yearsConclusions:The dermoscopic patterns of erythematotelangiectatic rosacea are red diffuse structureless areas and reticular linear vessels.For papulopustular rosacea,the pattern comprehends combinations of red diffuse structureless areas,reticular linear vessels,yellow scales,follicular plugs,and follicular pustules.Meanwhile,phymatous rosacea is characterized by remarkable orange diffuse structureless areas,linear vessels with branches,perifollicular white color,orange focal structureless areas,and white lines.Part Ⅲ:Efficacy of microneedle combined with topical 2%hydroquinone cream for melasmaBackground:Hydroquinone cream has been recommended as the first-line treatment of melasma but the efficacy isn’t so satisfactory as patients’and dermatologists’expectations.Microneedle,one of physical transdermal delivery technologies,has been shown to improve the transdermal absorption of topical drugs and further increase the efficacy.However,existed microneedles are professional devices,which limit the practical clinical application.We developed a new kind of polylactic acid microneedle and confirmed its safety and therapeutic effect on common skin diseases in previous studies with Beijing University of Chemical Technology.Objective:To evaluate the clinical efficacy and safety of polylactic acid microneedles combined with 2%hydroquinone cream in the treatment of melasma.Methods:Forty-five subjects with facial symmetry melasma were enrolled.The left and right cheek were randomly selected as the experimental side.The lesion on this side was pretreated with polylactic acid solid microneedles and then 2%hydroquinone cream was applied externally.The other side was set as control side,and only 2%hydroquinone cream was applied to the lesions.MASI score,RCM examination,non-invasive skin physiological function test and CBS Mindscan examination were evaluated before treatment for each subject.Follow-up visits were conducted at 2 weeks,4 weeks,6 weeks and 8 weeks for RCM,non-invasive skin physiological function test and CBS Mindscan examination.MASI score and PGA score were performed at the 4 weeks and 8 weeks of treatment.Results:A total of 25 patients(55.56%)completed the study.At T2 and T4,MASI scores between the experimental and control side were significantly different(P<0.001),MASI scores of the experimental side before and after treatment were statistically significant(T2 vs T0:P=0.047,T4 vs T0:P<0.001).There was no statistical difference in PGA between experimental and control side at T2,and PGA score of the experimental side at T4 was lower than that of the control side with statistically significant difference.There were significant differences in the mean gray values of the stratum spinosum(P=0.021)and dermal-epidermal junction(P=0.012)between the experimental side and the control side,while the result was opposite of the superficial dermis on both sides(P=0.097).There was no significant difference in the mean gray values of the stratum spinosum(P=0.083)between the experimental and the control side at T2,but the differences on dermalepidermal junction(P=0.041)and the superficial dermis(P=0.012)were significant.All the mean gray values of the stratum spinosum,dermal-epidermal junction and the superficial dermis on both sides were statistically significant at T3 and T4(P<0.05).Melanin index in the experimental side were lower than that in the control side at each follow-up and the difference were statistically significant(all P<0.001),while there was no difference in erythema index on both sides.According to CBS Mindscan examination,the remission degree of brown area on the experimental side was significantly stronger than that on the control side(P<0.05).Two patients developed papules and one patient developed mild desquamation on the experimental side.Conclusions:Poly lactic acid microneedle can increase the transdermal drug delivery of hydroquinone cream,thus increasing the therapeutic effect of hydroquinone cream in the treatment of melasma.RCM combined with the software of ImageJ can achieve quantitative evaluation of pigmented lesions.