Skin Deep - Clinical & Cosmetic Dermatology Blog

Skin Deep is a blog for dermatologists and skin care professionals with focus on theoretical, cosmetic and aesthetic dermatology. This blog is associated with ‘Dermatologists Sans Borders’ one of the largest curated groups of skin care professionals on facebook. If you are looking for non-technical information, please visit http://skinhelpdesk.com


How to improve the lines on your face

When I concluded my post on Argireline I mentioned that Argireline is unlikely to have significant muscle relaxant effect like Botulinum Neurotoxin (BoNT). But how do you objectively measure the ‘therapeutic’ muscle weakness induced by cosmetic treatments like BoNT injections. Surely we cannot rely on electromyography for such mundane indications.

Finally, scientists from Stony Brook University has adapted an image processing algorithm for this purpose.[1] Basically Digital Image Speckle Correlation (DISC) is an optical method to measure deformation on an object surface as the wrinkles formed on muscle contraction. Confused? Let me try to explain the concept in simple terms. Imagine a rubber sheet with a grid printed on it. If you pull this rubber sheet in various directions, the grid will get deformed. You can measure the movement and indirectly the pulling force by studying the deformity in the grid pattern. Now replace the rubber sheet with the skin and the grid with the pore pattern. Now you get the idea, don't you?
East Campus: Stony Brook University Medical Center
East Campus: Stony Brook University Medical Center (Photo credit: Wikipedia)

The authors have done a pilot study to assess the clinical relevance by comparing the results of the algorithm with a plastic surgeon’s assessment score (SGA) and the patients self assessment (FLO-11) and found some interesting findings (though it is a pilot study with insufficient power to prove anything). The muscles show a phase of hyperkinesis when the effect of BoNT wears off! A common question asked by the patients in our practice is whether ‘not taking’ regular BOTO@ can worsen existing wrinkles once you initiate treatment. We always say an emphatic NO. Now think again!

speckled leaf
speckled leaf (Photo credit: psyberartist)
The patient assessments were positive even during the hyperkinesis phase. Cosmetic dermatology is a specialty where patients can be happy for wrong reasons! If you are new to BoNT injections there is good news for you too. The algorithm can predict for you the best site and quantity of BoNT/A to inject!

So is this algorithm a game changer? Though the algorithm is objective, there is still a subjective component that we cannot avoid. When you instruct a patient to raise the eyebrows, frown or smile for the pre-procedure assessment, how and to what extent he does that is still up to him. So the pretreatment evaluation is still subjective. I believe that is the reason for the gross perceived hyperkinesis after 4-6 months.

Bottom line: This is a good research tool. A sufficiently powered study using this method could call Argireline’s  bluff and find the winner in the Boto@ v/s Dyspo@@ war. It could even be a patient education tool. But it is unlikely to replace your subjective judgement regarding site and quantity of injection. Some things in cosmetic dermatology are meant to be subjective!

Special thanks to Divya Bhatnagar, the main author[2] and the rest of the research team (Nicole Conkling, Miriam Rafailovich, Brett T. Phillips, Duc T. Bui, Sami U. Khan and Alexander B. Dagum).

Disclaimer: Argireline is a registered trademark.

References:

1. An in vivo analysis of the effect and duration of treatment with ..." 2013. 16 Apr. 2013
http://www.ncbi.nlm.nih.gov/pubmed/23565582

2. Bhatnagar, Divya et al. "An in vivo analysis of the effect and duration of treatment with botulinum toxin type A using digital image speckle correlation." Skin Research and Technology (2013).



GulfDoctor.net peel rating
What is peel score?


Digital image speckle correlation (DISC) algorithm for analysis of the effect and duration of treatment with BoNT.
Reviewed by Bell Eapen on .
An in vivo analysis of the effect and duration of treatment with botulinum toxin type A using digital image speckle correlation.
The authors have done a pilot study to assess the clinical relevance by comparing the results of the algorithm with a plastic surgeon’s assessment score (SGA) and the patient’s self assessment (FLO-11) and found some interesting findings.
PeelScore rating: 4

Labels: , , ,



Post a Comment

All comments, questions and criticisms welcome. Relevant comments with hyperlinks will be accepted. Though this form is not CommentLuv enabled, interesting and useful comments will be acknowledged with DoFollow links in the body of the post. Irrelevant comments and spam will be deleted.

Links to this post:

Create a Link

<< Home

About Me

As a Dermatologist and Informatician my research mainly involves application of bioinformatics techniques and tools in dermatological conditions. However my research interests are varied and I have publications in areas ranging from artificial intelligence, sequence analysis, systems biology, ontology development, microarray analysis, immunology, computational biology and clinical dermatology. I am also interested in eHealth, Health Informatics and Health Policy.

Address

Bell Raj Eapen
Hamilton, ON
Canada