Raoul Triller

Recommendations for adjunctive basic skin care in patients with psoriasis

BackgroundPsoriasis is a multifactorial disease involving both genetic predisposition and external triggers, resulting in epidermal and immune dysfunctions. Regardless of the severity of the disease, patients require additional basic topical treatment with emollients. Basic skin care products are well known for their role in moisture retention and symptom control in psoriasis, yet patients underuse them. Dry skin and cutaneous inflammation are associated with an impaired epidermal barrier function. This breakdown of the skin barrier causes the release of proinflammatory mediators that exaggerate inflammation.Objectivesto provide recommendations for the use of emollients (including ceramides, urea, keratolytic agents, zinc salts, niacinamide), thermal water and skin care products in psoriasis.MethodsA review of the current literature from 2000 to 2012 using Medline and Ovid was performed by a working group of five European Dermatologists with clinical and research experience in psoriasis.ResultsEither alone or used adjunctively, basic topical therapy can restore and protect skin barrier function, increase remission times between flare-ups and enhance the effects of pharmaceutical therapy.ConclusionWe provide physicians with a tool to assist them in implementing basic skin care in an integrated disease management approach.

Algorithm for dermocosmetic use in the management of cutaneous side‐effects associated with targeted therapy in oncology

Currently, numerous patients who receive targeted chemotherapy for cancer suffer from disabling skin reactions due to cutaneous toxicity, which is a significant problem for an increasing number of patients and their treating physicians. In addition, using inappropriate personal hygiene products often worsens these otherwise manageable side‐effects. Cosmetic products for personal hygiene and lesion camouflage are part of a patients’ well‐being and an increasing number of physicians feel that they do not have adequate information to provide effective advice on concomitant cosmetic therapy. Although ample information is available in the literature on pharmaceutical treatment for cutaneous side‐effects of chemotherapy, little is available for the concomitant use of dermatological skin‐care products with medical treatments. The objective of this consensus study is to provide an algorithm for the appropriate use of dermatological cosmetics in the management of cutaneous toxicities associated with targeted chemotherapy such as epidermal growth factor receptor inhibitors and other monoclonal antibodies. These guidelines were developed by a French and German expert group of dermatologists and an oncologist for oncologists and primary care physicians who manage oncology patients. The information in this report is based on published data and the expert groups opinion. Due to the current lack of clinical evidence, only a review of published recommendations including suggestions for concomitant cosmetic use was conducted.

Ugly Duckling Sign as a Major Factor of Efficiency in Melanoma Detection

Importance Understanding the contribution of the ugly duckling sign (a nevus that is obviously different from the others in a given individual) in intrapatient comparative analysis (IPCA) of nevi may help improve the detection of melanoma. Objectives To assess the agreement of dermatologists on identification of the ugly duckling sign and estimate the contribution of IPCA to the diagnosis of melanoma. Design, Setting, and Participants The same 2089 digital images of the nevi of a sample of 80 patients (mean age, 42 years [range, 19-80 years]; 33 men and 47 women), as well as 766 dermoscopic images from a subset of 30 patients (mean age, 40 years [range, 21-75 years]; 12 men and 18 women), were randomly presented to the same 9 dermatologists for blinded assessment from September 22, 2011, to April 1, 2013. The first experiment was designed to mimic an IPCA situation, with images of all nevi of each patient shown to the dermatologists, who were asked to identify ugly duckling nevi (UDN). The second experiment was designed to mimic a lesion-focused analysis to identify morphologically suspicious nevi. Data analysis was conducted from November 1, 2012, to June 1, 2013. Main Outcomes and Measures Number of nevi labeled UDN and morphologically suspicious nevi, specificity of lesion-focused analysis and IPCA, and number of nevi identified for biopsy. Results Of the 2089 clinical images of nevi from 80 patients (median number of nevi per patient, 26 [range, 8-81]) and 766 dermoscopic images (median number of nevi per patient, 19 [range, 8-81]), all melanomas were labeled UDN and as morphologically suspicious nevi by the 9 dermatologists. The median number of UDN detected per patient was 0.8 among the clinical images of nevi (mean, 1.0; range, 0.48-2.03) and 1.26 among the dermoscopic images (mean, 1.4; range, 1.00-2.06). The propensity to consider more or fewer nevi as having ugly duckling signs was independent of the presentation (clinical or dermoscopic). The agreement among the dermatologists regarding UDN was lower with dermoscopic images (mean pairwise agreement, 0.53 for clinical images and 0.50 for dermoscopic images). The specificity of IPCA was 0.96 for clinical images and 0.95 for dermoscopic images vs 0.88 and 0.85, respectively, for lesion-focused analysis. When both IPCA and lesion-focused analyses were used, the number of nevi considered for biopsy was reduced by a factor of 6.9 compared with lesion-focused analysis alone. Conclusions and Relevance Intrapatient comparative analysis is of major importance to the effectiveness of the diagnosis of melanoma. Introducing IPCA using the ugly duckling sign in computer-assisted diagnosis systems would be expected to improve performance.

Daily baseline skin care in the prevention, treatment, and supportive care of skin toxicity in oncology patients: recommendations from a multinational expert panel.

Skin reactions due to radiotherapy and chemotherapy are a significant problem for an important number of cancer patients. While effective for treating cancer, they disturb cutaneous barrier function, causing a reaction soon after initiation of treatment that impacts patient quality of life. Managing these symptoms with cosmetics and nonpharmaceutical skin care products for camouflage or personal hygiene may be important for increasing patient self-esteem. However, inappropriate product choice or use could worsen side effects. Although recommendations exist for the pharmaceutical treatment of skin reactions, there are no recommendations for the choice or use of dermatologic skin care products for oncology patients. The present guidelines were developed by a board of European experts in dermatology and oncology to provide cancer care professionals with guidance for the appropriate use of non-pharmaceutical, dermocosmetic skin care management of cutaneous toxicities associated with radiotherapy and systemic chemotherapy, including epidermal growth factor inhibitors and monoclonal antibodies. The experts hope that these recommendations will improve the management of cutaneous side effects and hence quality of life for oncology patients.

Recommendations for managing cutaneous disorders associated with advancing age

The increasingly aged population worldwide means more people are living with chronic diseases, reduced autonomy, and taking various medications. Health professionals should take these into consideration when managing dermatological problems in elderly patients. Accordingly, current research is investigating the dermatological problems associated with the loss of cutaneous function with age. As cell renewal slows, the physical and chemical barrier function declines, cutaneous permeability increases, and the skin becomes increasingly vulnerable to external factors. In geriatric dermatology, the consequences of cutaneous aging lead to xerosis, skin folding, moisture-associated skin damage, and impaired wound healing. These problems pose significant challenges for both the elderly and their carers. Most often, nurses manage skin care in the elderly. However, until recently, little attention has been paid to developing appropriate, evidence-based, skincare protocols. The objective of this paper is to highlight common clinical problems with aging skin and provide some appropriate advice on cosmetic protocols for managing them. A review of the literature from 2004 to 2014 using PubMed was performed by a working group of six European dermatologists with clinical and research experience in dermatology. Basic topical therapy can restore and protect skin barrier function, which relieves problems associated with xerosis, prevents aggravating moisture-associated skin damage, and enhances quality of life. In conclusion, the authors provide physicians with practical recommendations to assist them in implementing basic skin care for the elderly in an integrated care approach.

Application of GHA neural network to the characterization of skin tumors

The prognosis of malignant melanoma strongly relies on tumor early detection. Unfortunately, differentiating early melanomas from other less dangerous pigmented lesions is a difficult task since they have near physical characteristics. Dermatoscopy is a new non-invasive technique, which, by oil immersion, makes subsurface structures of skin accessible to in vivo examination. Our objective is to develop a computer diagnosis system applied to dermatoscopic images of skin tumors. Most of the signs for the visual diagnosis of melanoma only require the examination of part of the tumors. Our approach consists in classifying windows taken from images of skin tumors by a two-stage procedure. First, a Generalized-Hebbian-Algorithm- based network operates a Principal Component-like Analysis of windows. Sets of primitive windows fitted to various contexts allow both contextual coding and compression of windows. The second stage involves a classical feedforward network, which performs the classification of windows on the basis of the contribution of each primitive window to the reconstruction of windows under consideration. It was shown that classification was properly achieved when 20 primitive windows at least were considered. Application to the classification of skin tumors is in progress and preliminary results dealing with the characterization of borders of lesions are presented.

Characterization of skin tumors in dermatoscopic images

Purpose: The prognosis of melanoma, an invasive and malignant skin tumor, strongly relies on early detection. Unfortunately differentiating early melanomas from other less dangerous pigmented lesions is a difficult task even for trained observers since they may have near physical characteristics. Dermatoscopy, a new non-invasive technique which makes subsurface structures of skin accessible to in vivo examination provides standardized images of black tumors that seem convenient for numerical analysis. The objective of this project is to develop a computer-based diagnostic system which takes advantage of dermatoscopic images to characterize black tumors and help to detect melanoma. Methods: Dermatologists ground their diagnosis on the observation of some characteristic features in images of black tumors. Similarly, our approach consists in classifying parts of images of skin tumors (called windows thereafter) by a two-stage procedure. First, a contextual coding of widows is achieved by GHA network (Generalized Hebbian Algorithm). The second stage involves a classical feedforward network (a multilayer perceptron) which performs a classification of coded windows. Both stages rely on learning to achieve their task. The GHA network operates a Principal Component-like analysis of windows. During that phase, sets of primitive images fitted to various contexts are constituted, each set being appropriate for the description of some aspects of the windows (contrast, texture, border, color, ...). Windows can subsequently be coded by projection on these bases. Finally, a supervised learning is carried out to build up the classifier, using parts of characterized images with respect to the features under consideration. Results: Most of the interesting features detectable in black tumors can be observed in 16*16 pixel windows, providing resolution is properly chosen. The analysis of such windows by our system shows that classification is properly achieved when 20 primitive windows at least are considered for windows coding. Preliminary results dealing with the detection of several features of lesions have been found encouraging. Conclusion: The use of model-free approach, directly applied on image and based on learning by sample has been found efficient. Adapting this approach to the detection of melanoma appears a promising way.