Azura Mohd Affandi

Area assessment of psoriasis lesions for PASI scoring

Psoriasis is a skin disorder which is caused by a genetic fault. Although there is no cure for psoriasis, there are many treatment modalities to help control the disease. To evaluate treatment efficacy, the current gold standard method, PASI (Psoriasis Area and Severity Index), is used to measure psoriasis severity by evaluating the area, erythema, scaliness and thickness of the plaques. However, the determination of PASI can be tedious and subjective. In this work, we develop a computer vision method that determines one of the PASI parameters, the lesion area. The method isolates healthy and healed skin areas from lesion areas by analysing the hue and chroma information in the CIE L*a*b* colour space. Centroids of healthy skin and psoriasis in the hue–chroma space are determined from selected sample. The Euclidean distance of all pixels from each centroid is calculated. Pixels are assigned to either healthy skin or psorasis lesion classes based on the minimum Euclidean distance. The study involves patients from different ethnic origins having three different skin tones. Results obtained show that the proposed method is able to determine lesion areas with accuracy higher than 90% for 28 out of 30 cases.

Area Assessment of Psoriasis Lesion for PASI Scoring

Psoriasis is a skin disorder which is caused by genetic fault. There is no cure for psoriasis, however, there are many treatment modalities to help control the disease. To evaluate treatment efficacy, PASI (Psoriasis Area and Severity Index) which is the current gold standard method is used to measure psoriasis severity by evaluating the area, erythema, scaliness and thickness of the plaques. However, the calculation of PASI can be tedious and subjective. In this work, we develop a computer vision method that determines one of the PASI parameter, the lesion area. The method isolates healthy (or healed) skin areas from lesion areas by analyzing the hue and chroma information in the CIE L*a*b* colour space. Centroids of healthy skin and psoriasis in the hue-chroma space are determined from selected sample. Euclidean distance of all pixels from each centroid is calculated. Each pixel is assigned to the class with minimum Euclidean distance. The study involves patients from three different ethnic origins having different skin tones. Results obtained show that the proposed method is comparable to the dermatologist visual approach.

Body surface area measurement and soft clustering for PASI area assessment

Psoriasis is a common skin disorder with a prevalence of 0.6 - 4.8% around the world. The most common is plaques psoriasis and it appears as red scaling plaques. Psoriasis is incurable but treatable in a long term treatment. Although PASI (Psoriasis Area and Severity Index) scoring is recognised as gold standard for psoriasis assessment, this method is still influenced by inter and intra-rater variation. An imaging and analysis system called α-PASI is developed to perform PASI scoring objectively. Percentage of lesion area to the body surface area is one of PASI parameter. In this paper, enhanced imaging methods are developed to improve the determination of body surface area (BSA) and lesion area. BSA determination method has been validated on medical mannequin. BSA accuracies obtained at four body regions are 97.80% (lower limb), 92.41% (trunk), 87.72% (upper limb), and 83.82% (head). By applying fuzzy c-means clustering algorithm, the membership functions of lesions area for PASI area scoring have been determined. Performance of scoring result has been tested with double assessment by α-PASI area algorithm on body region images from 46 patients. Kappa coefficients for α-PASI system are greater than or equal to 0.72 for all body regions (Head -0.76, Upper limb - 0.81, Trunk - 0.85, Lower limb -0.72). The overall kappa coefficient for the α-PASI area is 0.80 that can be categorised as substantial agreement. This shows that the α-PASI area system has a high reliability and can be used in psoriasis area assessment.

High order polynomial surface fitting for measuring roughness of psoriasis lesion

Scaliness of psoriasis lesions is one of the parameters to be determined during Psoriasis Area and Severity Index (PASI) scoring. Dermatologists typically use their visual and tactile senses to assess PASI scaliness. However, it is known that the scores are subjective resulting in inter- and intra-rater variability. In this paper, an objective 3D imaging method is proposed to assess PASI scaliness parameter of psoriasis lesions. As scales on the lesion invariably causes roughness, a surface-roughness measurement method is proposed for 3D curved surfaces. The method applies a polynomial surface fitting to the lesion surface to extract the estimated waviness from the actual lesion surface. Surface roughness is measured from the vertical deviations of the lesion surface from the estimated waviness surface. The surface roughness algorithm has been validated against 328 lesion models of known roughness on a medical mannequin. The proposed algorithm is found to have an error 0.0013 ± 0.0022 mm giving an accuracy of 89.30%. The algorithm is invariant to rotation of the measured surface. Accuracy of the rotated lesion models is found to be greater than 95%. System repeatability has been evaluated to successive measurements of 456 psoriasis lesions. The system repeatability can be accepted since 95.27% of the measurement differences are less than two standard deviation of measurement difference.

Clinical characteristics of patients with facial psoriasis in Malaysia.

Psoriasis involving the face is visible and can cause considerable emotional distress to patients. Its presence may also confer a poorer prognosis for the patient. This study sought to evaluate the characteristics of facial psoriasis in Malaysia.

Segmentation of acne lesion using fuzzy C-means technique with intelligent selection of the desired cluster.

Segmentation is the basic and important step for digital image analysis and understanding. Segmentation of acne lesions in the visual spectrum of light is very challenging due to factors such as varying skin tones due to ethnicity, camera calibration and the lighting conditions. In this approach the color image is transformed into various color spaces. The image is decomposed into the specified number of homogeneous regions based on the similarity of color using fuzzy C-means clustering technique. Features are extracted for each cluster and average values of these features are calculated. A new objective function is defined that selects the cluster holding the lesion pixels based on the average value of cluster features. In this study segmentation results are generated in four color spaces (RGB, rgb, YIQ, I1I2I3) and two individual color components (I3, Q). The number of clusters is varied from 2 to 6. The experiment was carried out on fifty images of acne patients. The performance of the proposed technique is measured in terms of the three mostly used metrics; sensitivity, specificity, and accuracy. Best results were obtained for Q and I3 color components of YIQ and I1I2I3 color spaces with the number of clusters equal to three. These color components show robustness against non-uniform illumination and maximize the gap between the lesion and skin color.

3D surface roughness measurement for scaliness scoring of psoriasis lesions

Psoriasis is an incurable skin disorder affecting 2-3% of the world population. The scaliness of psoriasis is a key assessment parameter of the Psoriasis Area and Severity Index (PASI). Dermatologists typically use visual and tactile senses in PASI scaliness assessment. However, the assessment can be subjective resulting in inter- and intra-rater variability in the scores. This paper proposes an assessment method that incorporates 3D surface roughness with standard clustering techniques to objectively determine the PASI scaliness score for psoriasis lesions. A surface roughness algorithm using structured light projection has been applied to 1999 3D psoriasis lesion surfaces. The algorithm has been validated with an accuracy of 94.12%. Clustering algorithms were used to classify the surface roughness measured using the proposed assessment method for PASI scaliness scoring. The reliability of the developed PASI scaliness algorithm was high with kappa coefficients>0.84 (almost perfect agreement).

Sample area for surface roughness determination of skin surfaces

A surface roughness algorithm has been developed and validated for determining roughness of psoriasis lesions. The algorithm extracts an estimated waviness surface from 3D rough surface of psoriasis lesion by applying high order polynomial surface fitting. Vertical deviations of the lesion are determined by subtracting its 3D surface from the estimated waviness surface. However, the performance of the algorithm is dependent on the area of skin surface. The objective of this paper is to determine the minimum area for optimal performance of the skin surface roughness algorithm. In the determined sample area, all significant roughness components must be covered for surface roughness determination. To find the minimum size of sampled area, skin surface roughness has been determined at several sampling area variations. Normal skin surfaces are used as input data in this evaluation. By referring to the plot of surface roughness dependency on sampled area variation, it can be shown that the threshold area is found to be 4.9×4.9 mm2 for skin surface roughness stability. Skin surface roughness variation is less for the sample areas larger than this threshold. However, there is a small surface roughness increment after the surface roughness stability. It is caused by fitting error at border regions of very large sample size.

Thickness Characterization of 3D Skin Surface Images Using Reference Line Construction Approach

Irregular elevation is commonly formed in skin surface during dermatological diseases. Thickness is one of the parameters to assess the severity. In this research, the thickness is defined as the elevation of lesion surface from its constructed reference line which is generated by smoothing the lesion surface using moving average filter. This method is applied in dermatological disease which caused by disorder cell growth. In the clinical trial, Dermatologist classifies the thickness severity into 4 classes. The classes are divided by its thickness appearance. Dermatologist assesses 40 3D images of skin lesion taken from 16 patients. The quantitative and objective measurement of the lesions performed in this research has characterized the thickness range of each class as well as met the doctors thickness classification.

Objective assessment of psoriasis erythema for PASI scoring

Skin colour is vital information in dermatological diagnosis. It reflects pathological condition beneath the skin and commonly being used to indicate the extent of a disease. Psoriasis is a skin disease which is indicated by the appearance of red plaques. Although there is no cure for psoriasis, there are many treatment modalities to help control the disease. To evaluate treatment efficacy, PASI (Psoriasis Area and Severity Index) which is the current gold standard method is used to determine severity of psoriasis lesion. Erythema (redness) is one parameter in PASI. Commonly, the erythema is assessed visually, thus leading to subjective and inconsistent result. In this work, we proposed an objective assessment of psoriasis erythema for PASI scoring. The colour of psoriasis lesion is analyzed by DeltaL, Deltahue, and Deltachroma of CIELAB colour space. References of lesion with different scores are obtained from the selected lesions by two dermatologists. Results based on 38 lesions from 22 patients with various level of skin pigmentation show that PASI erythema score can be determined objectively and consistent with dermatology scoring.