Steven Daveluy

A Review of Vitamin B12 in Dermatology

Vitamin B12, also known as cobalamin, is a water-soluble vitamin that is important in the hematological and nervous systems, and it has a complex relationship with the skin. Altered cobalamin levels can lead to dermatological manifestations, which may indicate a deficiency or excess of this vitamin. The biochemistry and metabolism of cobalamin is complex, and diseases can be associated with alterations of this metabolic pathway. The cutaneous manifestations of cobalamin deficiency include hyperpigmentation (most commonly); hair and nail changes; and oral changes, including glossitis. Additionally, several dermatologic conditions, including vitiligo, aphthous stomatitis, atopic dermatitis, and acne are related to cobalamin excess or deficiency. The cutaneous complications of cobalamin therapy include acne, rosacea, and allergic site reactions, or anaphylaxis with cobalamin injections. As cobalt is a component of cobalamin, patients with cobalt sensitivity have been reported to have cutaneous manifestations when receiving cobalamin replacement therapy.

Universal in vivo Textural Model for Human Skin based on Optical Coherence Tomograms

Currently, diagnosis of skin diseases is based primarily on the visual pattern recognition skills and expertise of the physician observing the lesion. Even though dermatologists are trained to recognize patterns of morphology, it is still a subjective visual assessment. Tools for automated pattern recognition can provide objective information to support clinical decision-making. Noninvasive skin imaging techniques provide complementary information to the clinician. In recent years, optical coherence tomography (OCT) has become a powerful skin imaging technique. According to specific functional needs, skin architecture varies across different parts of the body, as do the textural characteristics in OCT images. There is, therefore, a critical need to systematically analyze OCT images from different body sites, to identify their significant qualitative and quantitative differences. Sixty-three optical and textural features extracted from OCT images of healthy and diseased skin are analyzed and, in conjunction with decision-theoretic approaches, used to create computational models of the diseases. We demonstrate that these models provide objective information to the clinician to assist in the diagnosis of abnormalities of cutaneous microstructure, and hence, aid in the determination of treatment. Specifically, we demonstrate the performance of this methodology on differentiating basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) from healthy tissue.

Exaggerated Earlobe Ptosis Due to Habitual Ear Pulling

Report of a Case | A woman in her 90s presented with considerable drooping of the earlobes. On examination, the patient appeared well. The bilateral earlobes demonstrated thinning and elongation, also known as earlobe ptosis (Figure, A and B). After further questioning, she reported a habit of pulling at her earlobes. She stated that she initially pulled at them to relieve anxiety (Figure, C), but it eventually became a chronic behavior. After being advised that her behavior was likely the cause of her ptosis, she was able to discontinue it. She was not concerned cosmetically enough to accept corrective treatments when offered.

The use of optical coherence tomography to evaluate the efficiency of skin care products

In this study, we assess the applicability of optical coherence tomography (OCT) for non-invasive imaging of skin morphology for the assessment of efficacy of cosmetic skin wrinkle-reduction products in humans. Evaluation of skin care products for reduction of facial wrinkles is largely limited to photographic (non-quantitative) comparison of skin surface texture before and after either single or prolonged application of skin care product. OCT could be a technique for monitoring changes in cross-sectional skin morphology. An optical attenuation coefficient analysis is also carried out to quantitatively study the changes in different layers of the skin.

Refractive index correction in optical coherence tomography images of multilayer tissues

We propose an algorithm to compensate for the refractive index error in the optical coherence tomography (OCT) images of multilayer tissues, such as skin. The performance of the proposed method has been evaluated on one- and two-layer solid phantoms, as well as the skin of rat paw.

Acquired lymphangioma circumscriptum of the genitals in an individual with chronic hidradenitis suppurativa

HS: hidradenitis suppurativa LC: lymphangioma circumscriptum PP: pseudoverrucous papules SCC: squamous cell carcinoma INTRODUCTION Acquired lymphangioma circumscriptum (LC), also known as localized LC, is characterized by small, clear, fluid-filled, clustered vesicles and papules that resemble a gelatinous mass of ‘‘frog spawn’’ on the surface of the skin. We present a case of genital LC associated with hidradenitis suppurativa (HS), which is significant because it represents a rare causal relationship.

A novel dermo-epidermal localization algorithm for swept source OCT images of human skin

Optical coherence tomography (OCT) is a noninvasive diagnostic method that offers a view into the superficial layers of the skin in vivo in real-time. OCT delivers morphological images of microstructures within the skin. Epidermal thickness in OCT images is of paramount importance, since dermo-epidermal junction (DEJ) location alteration is the start of several skin abnormalities. Due to the presence of speckle noise, devising an algorithm for locating DEJ in the OCT images is challenging. In this study we propose a semi-automatic DEJ detection algorithm based on graph theory that is resistant to speckle. In this novel approach we use attenuation map as a complementary feature compared to the previous methods that are mainly based on the intensity information. The method is based on converting border segmentation problem to the shortest path problem using graph theory. To smooth borders, we introduced a thinning fuzzy system enabling closer match to manual segmentation. Subsequently, an averaged A-scan analysis is performed to obtain the mean epidermal thickness. The DEJ detection method is performed on 96 B-Scan OCT skin images taken from different sites of body of healthy individuals. The results are evaluated based on several expert’s visual analysis.

Textural analysis of optical coherence tomography skin images: quantitative differentiation between healthy and cancerous tissues

Optical Coherence Tomography (OCT) offers real-time high-resolution three-dimensional images of tissue microstructures. In this study, we used OCT skin images acquired from ten volunteers, neither of whom had any skin conditions addressing the features of their anatomic location. OCT segmented images are analyzed based on their optical properties (attenuation coefficient) and textural image features e.g., contrast, correlation, homogeneity, energy, entropy, etc. Utilizing the information and referring to their clinical insight, we aim to make a comprehensive computational model for the healthy skin. The derived parameters represent the OCT microstructural morphology and might provide biological information for generating an atlas of normal skin from different anatomic sites of human skin and may allow for identification of cell microstructural changes in cancer patients. We then compared the parameters of healthy samples with those of abnormal skin and classified them using a linear Support Vector Machines (SVM) with 82% accuracy.

A spatially-variant deconvolution method based on total variation for optical coherence tomography images

Optical Coherence Tomography (OCT) has a great potential to elicit clinically useful information from tissues due to its high axial and transversal resolution. In practice, an OCT setup cannot reach to its theoretical resolution due to imperfections of its components, which make its images blurry. The blurriness is different alongside regions of image; thus, they cannot be modeled by a unique point spread function (PSF). In this paper, we investigate the use of solid phantoms to estimate the PSF of each sub-region of imaging system. We then utilize Lucy-Richardson, Hybr and total variation (TV) based iterative deconvolution methods for mitigating occurred spatially variant blurriness. It is shown that the TV based method will suppress the so-called speckle noise in OCT images better than the two other approaches. The performance of proposed algorithm is tested on various samples, including several skin tissues besides the test image blurred with synthetic PSF-map, demonstrating qualitatively and quantitatively the advantage of TV based deconvolution method using spatially-variant PSF for enhancing image quality.

Noise reduction in OCT skin images

OCT skin images suffer from artifacts. Speckle is the main artifact while the other one is called background noise. In this study, we propose an algorithm that significantly reduces the background noise before applying a speckle reduction method. The results show that the diagnostically relevant features in the images become clearer after applying the proposed method. We used sub-pixel weighted median filtering for speckle reduction. The results from background noise removal in combination with the proposed speckle reduction algorithm show a significant improvement in the clarity of diagnostically relevant features in in-vivo human skin images.