Investigating the clinical implication of corneometer and mexameter readings towards objective, efficient evaluation of psoriasis vulgaris severity
Chao-Kai Hsu, Nan-Yu Cheng, Chao-Chun Yang, Yun-Yo Yen, Sheng-Hao Tseng, Chao-Kai Hsu, Nan-Yu Cheng, Chao-Chun Yang, Yun-Yo Yen, Sheng-Hao Tseng
Abstract
In clinical settings, although Psoriasis Area and Severity Index (PASI) scoring system can provide a quick visual assessment of the severity of psoriasis vulgaris, there is still a strong demand for higher efficiency and accuracy in quantifying the inflammation status of psoriatic lesions. Currently, there are already commercial systems, such as the Courage + Khazaka Corneometer and Mexameter that measure skin capacitance and optical reflectance, for conveniently quantifying the status of skin barrier function and erythema of skin. Despite numerous comparisons of the Courage + Khazaka system with the PASI scoring system, they are rarely compared on parity with diffuse reflectance spectroscopy (DRS) based systems. In this study, we employed a custom-built DRS system shown to be able to determine the skin water-protein binding status and the hemoglobin concentration, and we performed cross-validation of the DRS measurement results with the readings derived from the Corneometer and Mexameter as well as a portion of the PASI scores. Our results revealed that the erythema readings from the Mexameter were a good representation of skin oxygenated hemoglobin but not the deoxygenated hemoglobin. On the other hand, the dermatologists recruited in this study were inclined to rate higher scores on the "erythema" category as skin's deoxygenated hemoglobin level was higher. Thus, the Mexameter derived erythema readings may not be coherent with the PASI erythema scores. Further, the Corneometer derived skin capacitance readings were well correlated to the PASI "desquamation" and "thickness" scores, while the PASI "desquamation" evaluation was a dominating factor contributing to the DRS deduced water-protein binding status. We conclude that the DRS method could be a valuable addition to existing skin capacitance/reflectance measurement systems and the PASI scoring system toward achieving a more efficient and objective clinical psoriasis vulgaris severity evaluation.
Conflict of interest statement
The authors declare no competing interests.
© 2022. The Author(s).
Figures
References
- WHO . Global Report on Psoriasis. Report No. 9789241565189. World Health Organization; 2016.
- Fink C, et al. Intra- and interobserver variability of image-based PASI assessments in 120 patients suffering from plaque-type psoriasis. J. Eur. Acad. Dermatol. Venereol. 2018;32:1314–1319. doi: 10.1111/jdv.14960.
- Nakajima K, et al. Barrier abnormality due to ceramide deficiency leads to psoriasiform inflammation in a mouse model. J. Invest. Dermatol. 2013;133:2555–2565. doi: 10.1038/jid.2013.199.
- Takahashi H, Tsuji H, Minami-Hori M, Miyauchi Y, Iizuka H. Defective barrier function accompanied by structural changes of psoriatic stratum corneum. J. Dermatol. 2014;41:144–148. doi: 10.1111/1346-8138.12393.
- Li HJ, Wu NL, Lee GA, Hung CF. The therapeutic potential and molecular mechanism of isoflavone extract against psoriasis. Sci. Rep. 2018;8:6335. doi: 10.1038/s41598-018-24726-z.
- Fajuyigbe D, Coleman A, Sarkany RPE, Young AR, Schmalwieser AW. Diffuse reflectance spectroscopy as a reliable means of comparing ultraviolet radiation-induced erythema in extreme skin colors. Photochem. Photobiol. 2018;94:1066–1070. doi: 10.1111/php.12947.
- Tseng SH, et al. Noninvasive evaluation of collagen and hemoglobin contents and scattering property of in vivo keloid scars and normal skin using diffuse reflectance spectroscopy: Pilot study. J. Biomed. Opt. 2012;17:077005. doi: 10.1117/1.JBO.17.7.077005.
- Wright CY, et al. Diffuse reflectance spectroscopy versus mexameter((R)) MX18 measurements of melanin and erythema in an African population. Photochem. Photobiol. 2016;92:632–636. doi: 10.1111/php.12607.
- Tzeng SY, et al. Portable handheld diffuse reflectance spectroscopy system for clinical evaluation of skin: A pilot study in psoriasis patients. Biomed. Opt. Express. 2016;7:616–628. doi: 10.1364/BOE.7.000616.
- Yang CC, et al. Investigation of water bonding status of normal and psoriatic skin in vivo using diffuse reflectance spectroscopy. Sci. Rep. 2021;11:8901. doi: 10.1038/s41598-021-88530-y.
- Montero-Vilchez T, et al. Erythema increase predicts psoriasis improvement after phototherapy. J. Clin. Med. 2021;10:3897. doi: 10.3390/jcm10173897.
- Rocha-Pereira P, et al. Erythrocyte damage in mild and severe psoriasis. Br. J. Dermatol. 2004;150:232–244. doi: 10.1111/j.1365-2133.2004.05801.x.
- Zhu WJ, Li P, Wang L, Xu YC. Hypoxia-inducible factor-1: A potential pharmacological target to manage psoriasis. Int. Immunopharmacol. 2020;86:106689. doi: 10.1016/j.intimp.2020.106689.
- Cibrian D, de la Fuente H, Sanchez-Madrid F. Metabolic pathways that control skin homeostasis and inflammation. Trends Mol. Med. 2020;26:975–986. doi: 10.1016/j.molmed.2020.04.004.
- Rosenberger C, et al. Upregulation of hypoxia-inducible factors in normal and psoriatic skin. J. Invest. Dermatol. 2007;127:2445–2452. doi: 10.1038/sj.jid.5700874.
- Coimbra S, et al. Erythroid disturbances before and after treatment of Portuguese psoriasis vulgaris patients: A cross-sectional and longitudinal study. Am. J. Clin. Dermatol. 2012;13:37–47. doi: 10.2165/11592110-000000000-00000.
- Luo X, et al. Broadband high frequency ultrasonic transducer based functional photoacoustic mesoscopy for psoriasis progression. IEEE Trans. Ultrason. Ferroelectr. Freq. Control. 2021 doi: 10.1109/TUFFC.2021.3136870.
- Lee SH, Kim M, Han KD, Lee JH. Low hemoglobin levels and an increased risk of psoriasis in patients with chronic kidney disease. Sci. Rep. 2021;11:14741. doi: 10.1038/s41598-021-94165-w.
- Chen YW, Tseng SH. Efficient construction of robust artificial neural networks for accurate determination of superficial sample optical properties. Biomed. Opt. Express. 2015;6:747–760. doi: 10.1364/BOE.6.000747.
- Hsu CK, et al. Non-invasive evaluation of therapeutic response in keloid scar using diffuse reflectance spectroscopy. Biomed. Opt. Express. 2015;6:390–404. doi: 10.1364/BOE.6.000390.
- Jacques S, Glickman R, Schwartz J. Internal absorption coefficient and threshold for pulsed laser disruption of melanosomes isolated from retinal pigment epithelium. Proc. SPIE. 1996;2681:468–477. doi: 10.1117/12.239608.
- Taroni P, et al. Seven-wavelength time-resolved optical mammography extending beyond 1000 nm for breast collagen quantification. Opt. Express. 2009;17:15932–15946. doi: 10.1364/OE.17.015932.
Source: PubMed