An automatic procedure that grades some facial skin structural signs: agreements and validation with clinical assessments made by dermatologists.

OBJECTIVE: To confirm the robustness and validity of an automatic scoring system, algorithm-based, that grades the severity of nine facial signs through "selfies" smartphones pictures taken by European Caucasian women through dermatological assessments. METHODS: 157 Caucasian women from three countries (France, Germany, Spain), of different ages (20-75 years), took one "selfie" image by the frontal camera of their smartphones whereas local dermatologists photographed them with the back camera of the same smartphone. The same nine facial signs of these subjects were initially graded by these local dermatologists, using referential Skin Aging Atlases. All 314 "selfies" images were then further automatically analyzed by the algorithm. The severity of facial signs (wrinkles, pigmentation, ptosis, skin folds etc.) were statistically compared to the assessments made by the three dermatologists, taken as ground truth. RESULTS: Highly significant coefficients of correlation (P < 0.001) were found in the three cohorts between the grades provided by the system and those from dermatologists in live. The back camera - of a better resolution than the frontal one - seems affording slightly more significant correlations. However, although significantly correlated, the signs of vascular disorders and cheek skin pores present some disparities that are likely linked to the technical diversity of smartphones or self-shootings, leading to lower coefficients of correlations. CONCLUSION: This automatic scoring system offers a promising approach in the harmonization of Dermatological assessments of skin facial signs and their changes with age or the follow up of anti-aging treatments.

OBJECTIF: De confirmer la validité et la solidité d'un système de scorage automatique qui quantifie la sévérité de neuf signes du visage à partir de photographies de type "selfies" prises par des femmes Caucasiennes Européennes d'âge différents. MÉTHODES: 157 femmes Caucasiennes de trois pays différents (France, Allemagne, Espagne), d'âges différents (20-75 ans) ont pris un « selfie¼ avec la caméra frontale de leur téléphone tandis que le dermatologue local les a photographiées à l'aide de la caméra dorsale du même appareil. Les neuf signes faciaux ciblés par le système de scorage automatique ont été préalablement évalués par trois dermatologues locaux, utilisant des Atlas référentiels du vieillissement cutané. Les 314 images obtenues furent ensuite analysées automatiquement par l'algorithme. Les sévérités des neuf signes (rides, ptose, plis, pigmentation...) ont été ensuite comparées à celles établies par les dermatologues, considérées comme références absolues. RÉSULTATS: De très significatifs coefficients de corrélation (P < 0.001) ont été trouvés dans les trois cohortes entre les scores fournis par le système et ceux issus des évaluations des dermatologues des visages durant la visite des volontaires. La caméra du dos des smartphones - de meilleure résolution que la frontale - semble fournir de légèrement meilleures significativités. Cependant, bien que significativement corrélés, les signes des désordres vasculaires et des pores cutanés des joues montrent quelques disparités, dues possiblement à la diversité technique des smartphones ou celle des prises de vue, conduisant à de plus faibles coefficients de corrélation. CONCLUSION: Ce système de quantification automatique semble offrir une approche prometteuse dans l'harmonisation des évaluations dermatologiques des signes faciaux et leurs modifications liées à l'âge et/ou le suivi de traitements à vocation antivieillissement cutané.

[Post-inflammatory hyperpigmentation occuring after cosmetic procedures]. / Les hyperpigmentations post-inflammatoires succédant à des actes esthétiques.

A post-inflammatory hyperpigmentation (PIHP) can occur after cosmetic procedures such as chemical peels and lasers. Patients must be informed about this risk. Precautionary measures before, during and after the procedure can prevent or reduce the risk of PIHP. These procedures should not be done in summer on suntanned skin and patients have to be aware of the importance of an effective photoprotection. The PIHP occurs more frequently on dark-skinned patients, in Asians as well as in women with melasma history. In these cases, risk/benefit assessment of the cosmetic procedure is required: no risky procedure in patients at risk! PIHP can also be related to technical errors such as too high concentration or too long exposure time during peel procedure as well as excessive threshold fluences during laser procedure. If many therapies for PIHP damages can be proposed, patients feel frequently that they are not as quickly effective as they would like. Patients must be reassured as many PIHP resolve spontaneously. If photoprotection is always required, it is also possible to accelerate the pigmentation's clearing using the Kligman trio or the numerous topical lightening agents targeting several steps of the hyperpigmentation process. More invasive and expensive therapies such as peels, lasers, IPL or radiofrequency might be used for refractory cases. As a pigmentary relapse might occur after these procedures, the traditional Kligman trio should be always considered.