S.H. Hussein

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.

Drug-Induced Urticaria and Angioedema: Pathomechanisms and Frequencies in a Developing Country and in Developed Countries

A careful drug history should be obtained from all patients with acute or chronic urticaria/angioedema, especially in the elderly. Although strictly comparable data are lacking, drug-induced urticaria appears to be more common in developed countries than in Malaysia, at least in a Hospital setting. Culprit drugs include antibiotics, analgesics and contrast media. Pseudoallergic drug-induced urticaria mimicks true allergic urticaria, but without an evident immunological basis, and is at least as common as the allergic type. In Malaysia, and in many other countries compulsory, ingredient labelling of ‘traditional’ medicines would do much to reduce the frequency of drug-induced urticaria.

Assessment of Ulcer Wounds Size Using 3D Skin Surface Imaging

In this work 3D surface scans of wounds are used to obtain several measurement including wound top area, true surface area (rue area), depth, and volume for the purpose of assessing the progress of ulcer wounds throughout treatment. KONICA MINOLTA 910 laser scanner is used to obtain the surface scans. The algorithm for estimating top area and true surface area from surface scan can reduce the inaccuracy that might result when using manual method. Two methods for solid construction and volume computation were considered; namely mid-point projection and convex hull approximation (Delaunay tetrahedralization). The performance of convex hull approximation method for volume estimation is improved by performing surface subdivision prior to the approximation. The performance of these algorithms on different patterns of simulated wound models is presented. Furthermore the algorithms are tested in two molded wounds printed using rapid prototyping (RP) technique.

In vivo 3D thickness measurement of skin lesion

Thickness is one of the morphological characteristic of skin lesion that represents severity condition. Dermatologists use tactile inspection to subjectively assess the thickness by feeling the alteration of the lesion from its surrounding normal skin. In this paper, a method to objectively measure the abnormal elevation occurs in skin lesions is presented. A 3D fringe projection scanner is used to obtain 3D surface profile of the lesion. Thickness of a lesion is defined as the elevations of lesion surface from its lesion base. The lesion base is determined from the neighboring normal skin using a 3D surface interpolation technique. The lesion elevations are determined in a 3D space grid by subtracting the elevation of the lesion surface profile from the interpolated lesion base profile at all corresponding locations thus giving lesion thickness as the average value of the elevations. The algorithm has been validated using 3D surface samples with an error of 0.031 mm ± SD 0.014 mm (95% Confidence Interval: ±0.0011 mm). The validated algorithm has been successfully applied to measure thicknesses of 450 psoriasis plaque lesions with severity level ranging from mild to severe and thickness ranging from 0.021 mm to 0.883 mm. From the measured thicknesses, Psoriasis Area and Severity Index (PASI) thickness scores 0 to 4 are then determined using unsupervised K-means Clustering.

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.

Computerised image analysis of vitiligo lesion: evaluation using manually defined lesion areas

Vitiligo is a cutaneous pigmentary disorder characterized by depigmented macules and patches that result from loss of epidermal melanocytes. Physician evaluates the efficacy of treatment by comparing the extent of vitiligo lesions before and after treatment based on the overall visual impression of the treatment response. This method is called the physicians global assessment (PGA) which is subjective. In this article, we present an innovative digital image processing method to determine vitiligo lesion area in an objective manner.

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).

Automatic PASI area 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. There have been many attempts in assessing psoriasis lesion area in order to calculate PASI area score. Segmentation on hue-chroma plane of CIE L*a*b* colour space is found to be effective method to extract psoriasis lesion from normal skin. However, centroids of normal skin and psoriasis lesion in hue-chroma plane must be calculated for each patient (local centroids). In this work, we investigate the possibility of using centroids obtained from three different groups based on their skin colour to avoid calculating centroids for each patient. First, patients were grouped according to their skin colour (fair, brown, and dark). For each group, the centroids of four body regions (head, trunk, arm, and leg) are calculated from normal skin and lesion samples of all patients in the group. The study involves patients from three different ethnic origins having different skin tones. Results of segmentation using global centroids are comparable with segmentation using local centroids.