Skin imaging modalities quantify progression and stage of infantile haemangiomas

Abstract

DEAR EDITOR, Infantile haemangiomas (IH) are deep, superficial or mixed vascular neoplasms with rapidly proliferating endothelial cells that stabilize and involute with diminishing cellular activity, apoptosis and resolution over 7-10 years. Clinicians evaluate progression, treatment response and stage by inspection, photography (colour, size, shape) and palpation (temperature, deformability). Lightening, flattening, reduced temperature and softness signal involution. 1 The limitations of subjective methods and need for objective metrics are recognized. 2 Colour, infrared (IR) 3 and three-dimensional (3D) imaging have been applied to IHs. 4 Photographs are compared for improvement as stable/worse (0%), slight (< 25%), moderate (25-50%), good (50-75%) and excellent (> 75%) using the Visual Analog Scale. 5 However, images may be nonstandardized (position, lighting) and results subjective as improvement criteria may be inconsistently applied. 5 IR surface intensity and distribution are affected by tumour depth, size, metabolism, vasculature and perfusion. Dynamic IR applies a temperature stress and the rewarming pattern provides physiological information. 6 We conducted a prospective observational proof of concept study to determine the utility of standardized skin imaging of colour, IR thermography and 3D shape for quantifying IH progression [Clinical Trial Registration: www.clinicaltrials.gov (Identifier NCT02061735)]. We compared these measurements to clinical stage (proliferating, stable, involuting). Data were stratified by age at evaluation, i.e. 1-2, 3-5, 6-9, 10-19 and ≥ 19 months corresponding to expected growth. 7 Fifty-nine patients with 67 superficial or mixed IHs and at least two visits yielded 250 evaluations over 18 months. Deep IHs were excluded due to the small number. Clinicians from our multidisciplinary Hemangioma and Vascular Malformation Center decided the treatment: propranolol (1-2 mg kg À1 daily), topical timolol (one drop 0Á5% gel twice daily) 8 or no treatment, and assessed patients in person. The Institutional Review Board approved the research and parents/guardians provided written informed consent.Standardized colour, IR and 3D images of the IH and contralateral controls were taken (Nikon D90 camera, 60-mm lens, 12Á3 megapixels, cross polarization, wireless flash; Nikon Corporation, Tokyo, Japan; FLIR T400 IR camera; FLIR Inc., Wilsonville, OR, U.S.A.; 3D scanner; Artec MHT, Artec Group,

Infant skin maturation: Preliminary outcomes for color and biomechanical properties

“…The study was conducted among two subsets of patients from the Hemangioma and Vascular Malformation Center enrolled in a trial to quantify the progression of infantile hemangiomas over time and relative to clinical stage . The Institutional Review Board approved the protocol and parents/guardians provided written informed consent.…”

“…The literature on postnatal dermal changes is sparse, as most of the structural, histological, and compositional research has been on fetal vs. adult skin and not on newborns. We aimed to further characterize infant skin maturational changes in color and biomechanics via a descriptive, retrospective study on normal skin from data collected in a trial to assess the progression infantile hemangiomas . The parent trial: (1) quantified hemangioma features of color, size, and volume and responses to thermal and mechanical stress, (2) evaluated changes in hemangiomas over time (age) and with treatment, (3) compared quantitative measures to clinical state, and (4) established a quantitative database for hemangiomas.…”

Biomechanical properties of infantile hemangiomas: clinical stage and effect of age

“…Clinicians decided treatment: propranolol (1–2 mg/kg/day), topical timolol (one drop 0.5% gel twice daily) or untreated. Standardized high resolution color images were taken and IH volume and maximum height quantified with three‐dimensional skin imaging and analysis, as previously described .…”

Physiological changes in newborn skin after natural oil massage in rural Nepal

“…Digital imaging has been applied in clinical settings to improve objectivity, quantify particular skin features (e.g., erythema) [11][12][13] and to assess treatment effects. [14][15][16] We obtained standardized high-resolution digital images from a subset of 216 subjects during their regular visits. These babies were enrolled after the high occurrence of visual rash became evident to the investigators.…”