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Dermatology Practical & Conceptual Oct 2023Hair and scalp disorders are of significant interest for physicians dealing with dark phototypes due to their prevalence and potential aesthetic impact resulting from a... (Review)
Review
Hair and scalp disorders are of significant interest for physicians dealing with dark phototypes due to their prevalence and potential aesthetic impact resulting from a higher tendency for scarring. In order to facilitate their non-invasive diagnosis, several dermoscopic studies have been published, yet data are sparse and no systematic analysis of the literature has been performed so far. This systematic literature review summarizes published data on trichoscopy of hair and scalp diseases (trichoscopic findings, used setting, pathological correlation, and level of evidence of studies). A total of 60 papers addressing 19 different disorders (eight non-cicatricial alopecias, nine cicatricial alopecias, and two hair shaft disorders) were assessed, for a total of 2636 instances. They included one cross-sectional analysis, 20 case-control studies, 25 case-series, and 14 single case-reports, so the level of evidence was V and IV in 65% and 33% of cases, respectively, with only one study showing a level of evidence of III. Notably, although there is a considerable body of literature on trichoscopy of hair/scalp diseases, our review underlined that potentially significant variables (e.g., disease stage or hair texture) are often not taken into account in published analyses, with possible biases on trichoscopic patterns, especially when it comes to hair shaft changes. Further analyses considering all such issues are therefore needed.
PubMed: 37874991
DOI: 10.5826/dpc.1304S1a310S -
Dermatology Practical & Conceptual Oct 2023Over the last few decades, dermoscopy has been showed to facilitate the non-invasive diagnosis of both benign and malignant skin tumors, yet literature data mainly comes... (Review)
Review
Over the last few decades, dermoscopy has been showed to facilitate the non-invasive diagnosis of both benign and malignant skin tumors, yet literature data mainly comes from studies on light photo-types. However, there is growing evidence that skin neoplasms may benefit from dermoscopic assessment even for skin of color. This systematic literature review evaluated published data in dark-skinned patients (dermoscopic features, used setting, pathological correlation, and level of evidence of studies), also providing a standardized and homogeneous terminology for reported dermoscopic findings. A total of 20 articles describing 46 different tumors (four melanocytic neoplasms, eight keratinocytic tumors, 15 adnexal cutaneous neoplasms, seven vascular tumors, four connective tissue tumors, and eight cystic neoplasms/others) for a total of 1724 instances were included in the analysis. Most of them showed a level of evidence of V (12 single case reports and six case series), with only two studies featuring a level of evidence of IV (case-control analysis). Additionally, this review also underlined that some neoplasms and phototypes are underrepresented in published analyses as they included only small samples and mainly certain tones of "dark skin" spectrum (especially phototype IV). Therefore, further studies considering such limitations are required for a better characterization.
PubMed: 37874990
DOI: 10.5826/dpc.1304S1a308S -
Cancers Sep 2023Melanoma, the deadliest form of skin cancer, poses a significant public health challenge worldwide. Early detection is crucial for improved patient outcomes.... (Review)
Review
BACKGROUND
Melanoma, the deadliest form of skin cancer, poses a significant public health challenge worldwide. Early detection is crucial for improved patient outcomes. Non-invasive skin imaging techniques allow for improved diagnostic accuracy; however, their use is often limited due to the need for skilled practitioners trained to interpret images in a standardized fashion. Recent innovations in artificial intelligence (AI)-based techniques for skin lesion image interpretation show potential for the use of AI in the early detection of melanoma.
OBJECTIVE
The aim of this study was to evaluate the current state of AI-based techniques used in combination with non-invasive diagnostic imaging modalities including reflectance confocal microscopy (RCM), optical coherence tomography (OCT), and dermoscopy. We also aimed to determine whether the application of AI-based techniques can lead to improved diagnostic accuracy of melanoma.
METHODS
A systematic search was conducted via the Medline/PubMed, Cochrane, and Embase databases for eligible publications between 2018 and 2022. Screening methods adhered to the 2020 version of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies utilized AI-based algorithms for melanoma detection and directly addressed the review objectives.
RESULTS
We retrieved 40 papers amongst the three databases. All studies directly comparing the performance of AI-based techniques with dermatologists reported the superior or equivalent performance of AI-based techniques in improving the detection of melanoma. In studies directly comparing algorithm performance on dermoscopy images to dermatologists, AI-based algorithms achieved a higher ROC (>80%) in the detection of melanoma. In these comparative studies using dermoscopic images, the mean algorithm sensitivity was 83.01% and the mean algorithm specificity was 85.58%. Studies evaluating machine learning in conjunction with OCT boasted accuracy of 95%, while studies evaluating RCM reported a mean accuracy rate of 82.72%.
CONCLUSIONS
Our results demonstrate the robust potential of AI-based techniques to improve diagnostic accuracy and patient outcomes through the early identification of melanoma. Further studies are needed to assess the generalizability of these AI-based techniques across different populations and skin types, improve standardization in image processing, and further compare the performance of AI-based techniques with board-certified dermatologists to evaluate clinical applicability.
PubMed: 37835388
DOI: 10.3390/cancers15194694 -
Frontiers in Medicine 2023Vitiligo is a multifaceted autoimmune depigmenting disorder affecting around 0.5 to 2.0% of individuals globally. Standardizing diagnosis and therapy tracking can be...
UNLABELLED
Vitiligo is a multifaceted autoimmune depigmenting disorder affecting around 0.5 to 2.0% of individuals globally. Standardizing diagnosis and therapy tracking can be arduous, as numerous clinical evaluation methods are subject to interobserver variability and may not be validated. Therefore, there is a need for diagnostic tools that are objective, dependable, and preferably non-invasive.
AIMS
This systematic review provides a comprehensive overview of the non-invasive objective skin measurement methods that are currently used to evaluate the diagnosis, severity, and progression of vitiligo, as well as the advantages and limitations of each technique.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was used for the systematic review. Scopus, Embase, Cochrane Library, and Web of Science databases were comprehensively searched for non-invasive imaging and biophysical skin measuring methods to diagnose, evaluate the severity of, or monitor the effects of vitiligo treatment. The risk of bias in included articles was assessed using the QUADAS-2 quality assessment scale.
RESULTS
An extensive literature search resulted in 64 studies for analysis, describing eight imaging techniques (reflectance confocal microscopy, computer-aided imaging analysis, optical coherence tomography, infrared photography, third-harmonic generation microscopy, multiphoton microscopy, ultraviolet light photography, and visible light/digital photograph), and three biophysical approaches (dermoscopy, colorimetry, spectrometry) used in diagnosing and assessing vitiligo. Pertinent information about functionality, mechanisms of action, sensitivity, and specificity was obtained for all studies, and insights into the strengths and limitations of each diagnostic technique were addressed. Methodological study quality was adequate; however, statistical analysis was not achievable because of the variety of methods evaluated and the non-standardized reporting of diagnostic accuracy results.
CONCLUSIONS
The results of this systematic review can enhance clinical practice and research by providing a comprehensive overview of the spectrum of non-invasive imaging and biophysical techniques in vitiligo assessment. Studies with larger sample sizes and sound methodology are required to develop verified methods for use in future practice and research.
SYSTEMATIC REVIEW REGISTRATION
(PROSPERO) database, (CRD42023395996).
PubMed: 37575985
DOI: 10.3389/fmed.2023.1200963 -
Frontiers in Artificial Intelligence 2023Detecting and accurately diagnosing early melanocytic lesions is challenging due to extensive intra- and inter-observer variabilities. Dermoscopy images are widely used...
INTRODUCTION
Detecting and accurately diagnosing early melanocytic lesions is challenging due to extensive intra- and inter-observer variabilities. Dermoscopy images are widely used to identify and study skin cancer, but the blurred boundaries between lesions and besieging tissues can lead to incorrect identification. Artificial Intelligence (AI) models, including vision transformers, have been proposed as a solution, but variations in symptoms and underlying effects hinder their performance.
OBJECTIVE
This scoping review synthesizes and analyzes the literature that uses vision transformers for skin lesion detection.
METHODS
The review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Revise) guidelines. The review searched online repositories such as IEEE Xplore, Scopus, Google Scholar, and PubMed to retrieve relevant articles. After screening and pre-processing, 28 studies that fulfilled the inclusion criteria were included.
RESULTS AND DISCUSSIONS
The review found that the use of vision transformers for skin cancer detection has rapidly increased from 2020 to 2022 and has shown outstanding performance for skin cancer detection using dermoscopy images. Along with highlighting intrinsic visual ambiguities, irregular skin lesion shapes, and many other unwanted challenges, the review also discusses the key problems that obfuscate the trustworthiness of vision transformers in skin cancer diagnosis. This review provides new insights for practitioners and researchers to understand the current state of knowledge in this specialized research domain and outlines the best segmentation techniques to identify accurate lesion boundaries and perform melanoma diagnosis. These findings will ultimately assist practitioners and researchers in making more authentic decisions promptly.
PubMed: 37529760
DOI: 10.3389/frai.2023.1202990 -
Skin Research and Technology : Official... Jun 2023The incidence of alopecia areata (AA) has increased over the last few decades. Trichoscopy is a noninvasive procedure performed in dermatology clinics and is a helpful... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The incidence of alopecia areata (AA) has increased over the last few decades. Trichoscopy is a noninvasive procedure performed in dermatology clinics and is a helpful tool in determining the correct diagnosis of hair loss presentations.
OBJECTIVE
Through mapping the researches that have been done to represent the spectrum of trichoscopic findings in AA and to identify the most characteristic patterns.
METHODS
Thirty-nine studies were eligible for the quantitative analysis. Meta-analysis and subgroup analysis were performed.
RESULTS
Thirty-nine studies (29 cross-sectional, five retrospective, two descriptive, one case series, one observational, and one cohort) with a total of 3204 patients were included. About 66.7% of the studies were from Asia, 25.6% from Europe, and 7.7% from Africa. The most characteristic trichoscopic findings of AA were as follows; yellow dots, black dots, broken hairs, short vellus hairs, and tapering hairs.
CONCLUSION
There is no single pathognomonic diagnostic trichoscopic finding in AA rather than a constellation of characteristic findings. The five most characteristic trichoscopic findings in AA are: yellow dots, black dots, broken hairs, short vellus hairs, and tapering hairs. Yellow dots and short vellus hairs considered the most sensitive clues for AA, while black dots and tapering hairs are the most specific ones. Furthermore, trichoscopy is a useful tool that allows monitoring of response during the treatment of AA. Treatment responded cases will show an increase in short vellus hairs, but loss of tapering hairs, broken hairs, and black dots, while yellow dots are the least responsive to the treatment.
Topics: Alopecia Areata; Dermoscopy; Vitamin D Deficiency; Humans
PubMed: 37357664
DOI: 10.1111/srt.13378 -
Dermatology Practical & Conceptual Jan 2023Onychomycosis represents a global burden accounting for about 50% of nail consultations. Several studies have tried to assess the dermoscopic features of onychomycosis.... (Review)
Review
INTRODUCTION
Onychomycosis represents a global burden accounting for about 50% of nail consultations. Several studies have tried to assess the dermoscopic features of onychomycosis. With the multiplication of papers, several "new" dermoscopic signs keep being added leading to some inconsistency in onychoscopic terminology.
OBJECTIVE
This study aimed to summarize the existing literature on the dermoscopic features of onychomycosis and propose a unified onychoscopic terminology.
METHODS
The literature search was performed using PubMed and Scopus databases up to October 30, 2021 to identify eligible contributions. In total, 33 records (2111 patients) were included.
RESULTS
The main dermoscopic signs of onychomycosis are "ruin appearance", "longitudinal striae" and "spikes" on the proximal margin of onycholytic areas, with a specificity of 99.38%, 83.78%, and 85.64% respectively. The "aurora borealis" sign had the highest sensitivity and specificity.
CONCLUSIONS
The current review provides a framework for issues related to the onychoscopic terminology of onychomycosis and is intended to serve as an aid for students, teachers, and researchers. We proposed a unifying terminology to describe dermoscopic signs of onychomycosis. Dermoscopic signs of onychomycosis show good specificity and are useful in distinguishing nail psoriasis, trauma, and onychomycosis. It helps differentiate fungal melanonychia from nail melanoma, nevi, and melanocytic activation.
PubMed: 36892372
DOI: 10.5826/dpc.1301a72 -
Journal of the American Board of Family... Feb 2023This issue's teasers: A broad scope of care by family physicians could be incentivized and has positive outcomes. Family physicians could do more dermoscopy-a mixed...
This issue's teasers: A broad scope of care by family physicians could be incentivized and has positive outcomes. Family physicians could do more dermoscopy-a mixed specialty group of experts provide information on diagnosis with associated features and proficiency standards for primary care clinicians. Clinicians could trust more, and do less, such as adult measles-mumps-rubella boosters. Family physicians differ from pediatricians on how to deliver vitamin D to newborns. Practice scope varies by location. Is monetary incentive a key to incentivize COVID vaccination? A new, useful, easy functional status questionnaire. This issue also includes articles on both adult and pediatric obesity, a systematic review of social determinants of health and documentation thereof, plus more.
Topics: Infant, Newborn; Child; Adult; Humans; Rubella; Physicians, Family; Mumps; COVID-19; Measles; Vaccination; Measles-Mumps-Rubella Vaccine
PubMed: 36759131
DOI: 10.3122/jabfm.2022.220413R0 -
Microvascular Research May 2023Up to 30 % of patients with psoriasis (PsO) develop psoriatic arthritis (PsA), and diagnosis can be difficult. Nailfold capillaroscopy (NC) is an easily applicable,... (Review)
Review
Up to 30 % of patients with psoriasis (PsO) develop psoriatic arthritis (PsA), and diagnosis can be difficult. Nailfold capillaroscopy (NC) is an easily applicable, non-invasive procedure to assess skin microcirculation. This systematic review investigates NC as diagnostic tool for PsO and PsA, including correlations between NC outcome measures to clinical and laboratory outcome measures. This systematic review was built on the PICO and PRISMA guidelines. In total 22 relevant studies were found Searching in the Web of Science, PubMed and Embase, latest update June 13th, 2022. The following NC outcome measures are found to be significantly more prevalent in PsO patients than healthy controls: reduced density, reduced length and more abnormal morphology. Likewise, in PsA patients, reduced density, more abnormal morphology, more microhaemorrhages and fewer hairpin shapes are found to be significantly more prevalent. Results were non-conclusive in terms of disease activity and duration with NC findings. Random-effects meta-analysis showed a significant reduction of density in PsO patients compared to healthy controls (studies: 6, n = 249; SMD = -0.91; 95 % CI [-1.41, -0.40], p = 0.0058, heterogeneity I=74 %, AUC = 0.740) and in PsA patients compared to healthy controls (studies: 5, n = 130; SMD = -1.22; 95 % CI [-2.38, -0.06], p = 0.0432, heterogeneity I=89 %, AUC = 0.806). No NC outcome measures were overall conclusive in differentiating PsO from PsA. Considering the conflicting results and small sample sizes further large-scale research on the identification of capillaroscopic changes in PsO and PsA and correlations with standardised clinical and laboratory outcome measures are necessary.
Topics: Humans; Arthritis, Psoriatic; Diagnostic Tests, Routine; Health Status; Microscopic Angioscopy; Psoriasis
PubMed: 36657709
DOI: 10.1016/j.mvr.2023.104476 -
Dermatology Practical & Conceptual Nov 2022Differentiating early melanoma from other flat pigmented lesions on the head and neck is challenging both clinically and dermoscopically, partly due to the wide... (Review)
Review
INTRODUCTION
Differentiating early melanoma from other flat pigmented lesions on the head and neck is challenging both clinically and dermoscopically, partly due to the wide differential diagnosis and the lack of specific diagnostic algorithms.
OBJECTIVES
To review publications covering the dermoscopic features of pigmented macules on the head and neck.
METHODS
Embase and PubMed (Medline) database from January 2015 to January 2021 were searched using a four-step search. Keywords used were dermoscopy/dermatoscopy or epiluminescence microscopy, lentigo maligna, lentigo maligna melanoma, lichen-planus-like-keratosis, solar lentigo, seborrheic keratosis, pigmented actinic keratosis (PAK), pigmented Bowen disease (pBD), pigmented intraepidermal carcinoma (pIEC) and head and neck.
RESULTS
The commonest reported dermoscopic features of facial melanoma were irregular dots, atypical dots/globules, asymmetric pigmented follicular openings, rhomboid gray/black structures, increased vascular network, brown globules/dots and a pattern of circles. Pseudopods, radial streaming, blue white veil, irregular blotches, scar-like depigmentation and atypical pigment network were recorded in low frequencies. For PAK, pBD and pIEC perifollicular erythema, white/yellow surface scale, linear wavy vessels around hair follicles, hair follicular openings surrounded by a white halo, evident follicles or follicular or keratotic plugs, rosette sign and sharply demarcated borders were the salient features.
CONCLUSIONS
Further studies are needed to determine the dermoscopic criteria for pigmented melanocytic and non-melanocytic lesions on the head and neck. Furthermore, there is a gap in the knowledge of site-specific dermoscopic features on specific sites, namely ears, nose, cheeks, scalp and neck which will also benefit from further studies.
PubMed: 36534577
DOI: 10.5826/dpc.1204a194