Photographic scale for the characterization of actinic keratosis through reflectance confocal microscopy: a quantitative approach to cellular transformation.

Background: Actinic keratosis (AK) is a highly prevalent pre-cancerous skin lesion that often leads to cutaneous squamous cell carcinoma. There are different stages of evolution of the disease and several features that characterize keratosis. This study aimed to develop a qualitative and quantitative visual diagnostic tool to facilitate the identification of the characteristics and severity of the main cellular attributes of AK and to show its applicability in evaluating the evolution or treatment through image analysis. Methods: Literature research on the main scientific databases and in the institute's database was carried out to gather all the different levels of cellular transformation. To validate the scale, a preliminary characterization study was carried out with 21 subjects who had clinically diagnosed AK lesions to classify the attributes in each skin layer and test the accuracy of the diagnosis of the scale. Afterward, and to show the possibility of a follow-up with a topical treatment, the subjects were divided into two treatment groups, receiving either a cream formulation containing retinoic acid, or a placebo formula. The evaluation was carried out through confocal reflectance microscopy and a digital camera with dermoscopic quality before and after 90 days of treatment. Results: A table detailing the 18 attributes of AK, and a photographic scale containing RCM images graded by scores established for each characteristic and the frequency of spreading were developed. The results of the validation presented good repeatability, correlation with clinical evaluation, and capacity for differentiating treatments demonstrated by the significant improvement after topical treatment by the reduction of the score for 10 out of the 18 attributes. The preliminary study, evaluated by the detailed transformation scale highlights important differences in the subclinical approach that allows a deeper evaluation of the aspects of the lesion's re-incidence even after fully treated skin sites. Conclusion: This study brings an innovative method based on RCM, to assist in the quantification of cell transformation level, provide early diagnosis, and deliver a powerful treatment evaluation tool to provide smoother treatment, as well as prevent re-incidence in the cases.

In Vivo Evaluation of Laser-Induced Optical Breakdown (LIOBS) by 1064-nm Nd:YAG Fractional Picosecond Laser With Reflectance Confocal Microscopy and Precise Histopathologic Correlation.

OBJECTIVES: Picosecond lasers with a microlens array can cause laser-induced optical breakdown (LIOBS) and LIC (Intradermal laser-induced cavitation) within high-fluence areas. This study aimed to describe the clinical, reflectance confocal microscopy (RCM), histopathological findings, and the characteristics of vacuoles caused by LIOBS and LIC in individuals with skin types III and IV. MATERIALS AND METHODS: This study was performed on six Chilean healthy volunteers, males and females, aged 35-65 years old with Fitzpatrick skin phototypes III-IV. The laser was applied in the inner proximal area of the nondominant arm. RCM evaluation was performed 24 h later; 48 h later, skin biopsies were performed on the laser-treated areas. Clinical, histological, and RCM findings were recorded. RESULTS: Every individual developed a 10 mm2 area of clinical erythema in the treated area. Under RCM, all six volunteers had hyporeflective spherical structures at the level of the epidermis, consistent with intraepidermal vacuoles. Histopathological evaluation revealed different sizes of vacuoles in both the epidermis and dermis. CONCLUSION: The LIOBS and LIC processes and the secondary production of vacuoles could be highly valuable for effective dermal remodeling treatment and aid in promoting the production of new collagen, elastic fibers, and growth factors that could improve skin texture. These structures were visible under RCM and histopathological evaluation.

Film-Forming, Moisturizing, and Sensory Properties of a Cosmetic Formulation Containing Tara Gum and Brazilian Berry Extracts.

The development of cosmetic formulations with moisturizing and film-forming properties has been very important to help keep skin physiology and protection. In this context, this study aimed to develop a cosmetic formulation containing Tara gum and Brazilian berry extract and evaluate its physical-mechanical, film-forming, and sensory properties. A gel formulation was developed based on Tara gum added to Plinia cauliflora extract and was characterized by its spreadability profile and sensory properties. A clinical study was carried out with ten participants to evaluate the skin microrelief, stratum corneum water content, transepidermal water loss (TEWL), and skin morphological characteristics by reflectance confocal microscopy (RCM) before and after 2 h of application of the formulations. The formulation with Brazilian berry significantly decreased the work of shear parameter, which can be correlated with improved spreadability in the sensory analysis. The clinical study showed that both formulations improved skin hydration and reduced the TEWL. The RCM imaging analysis showed the visible film on the skin surface, a decrease in the size of furrows, an increase in the reflectance of the interkeratinocytes, and reflectance of the stratum corneum for both formulations. These results were more pronounced for the formulation containing Brazilian berry. The Tara gum in the gel formulation promoted the formation and visualization of a polymeric net on the stratum corneum surface, demonstrated by the images obtained from RCM. However, the formulation added with the Brazilian berry extract improved the skin microrelief, honeycomb pattern of the epidermis, and skin hydration in deeper layers of the epidermis.

Multiple Primary Melanoma: A Five-Year Prospective Single-Center Follow-Up Study of Two MC1R R/R Genotype Carriers.

BACKGROUND: Multiple primary melanoma (MPM) is a diagnostic challenge even with ancillary imaging technologies available to dermatologists. In selected patients' phenotypes, the use of imaging approaches can help better understand lesion characteristics, and aid in early diagnosis and management. METHODS: Under a 5-year prospective single-center follow-up, 58 s primary melanomas (SPMs) were diagnosed in two first-degree relatives, with fair skin color, red hair, green eyes, and personal history of one previous melanoma each. Patients' behavior and descriptive demographic data were collected from medical records. The information on the first two primary melanomas (PMs) were retrieved from pathology reports. The characteristics of 60 melanomas were collected from medical records, video dermoscopy software, and pathology reports. Reflectance confocal microscopy (RCM) was performed prior to excision of 22 randomly selected melanomas. RESULTS: From February 2018 to May 2023, two patients underwent a pooled total of 214 excisional biopsies of suspect lesions, resulting in a combined benign versus malignant treatment ratio (NNT) of 2.0:1.0. The number of moles excised for each melanoma diagnosed (NNE) was 1.7:1.0 and 6.9:1.0 for the female and male patient respectively. The in-situ melanoma/invasive melanoma ratio (IIR) demonstrated a higher proportion of in-situ melanomas for both patients. From June 2018 to May 2023, a total of 58 SPMs were detected by the combination of total body skin exam (TBSE), total body skin photography (TBSP), digital dermoscopy (DD), and sequential digital dermoscopy imaging (SDDI) via comparative approach. The younger patient had her PM one month prior to the second and third cutaneous melanomas (CMs), characterizing a case of synchronous primary CM. The male older relative had a total of 7 nonsynchronous melanomas. CONCLUSIONS: This CM cohort is composed of 83.3% in-situ melanoma and 16.7% invasive melanoma. Both patients had a higher percentage of SPM with clinical nevus-like morphology (84.5%), global dermoscopic pattern of asymmetric multiple component (60.3%) and located on the lower limbs (46.6%). When RCM was performed prior to excision, 81% of SPM had features suggestive of malignancy. As well, invasive melanomas were more frequent in the lower limbs (40%). In the multivariate model, for the two high-risk patients studied, the chance of a not associated with nevus ("de novo") invasive SPM diagnosis is 25 times greater than the chance of a diagnosis of a nevus-associated invasive SPM.

Evaluation of Morphological and Structural Skin Alterations on Diabetic Subjects by Biophysical and Imaging Techniques.

Diabetes causes increased production of advanced glycation end products (AGEs), which may lead to irreversible damage to collagen fibers, and early and more accentuated signs of skin aging. Thus, the objective of this study was to evaluate diabetic skin's mechanical and morphological characteristics and compare these to healthy skin. Twenty-eight female participants aged between 39 and 55 years were enrolled: half had type 2 diabetes, and the others were healthy. Wrinkles, transepidermal water loss (TEWL), stratum corneum water content, skin color, elasticity, morphological and structural characteristics of epidermis and dermis echogenicity were evaluated using biophysical and skin imaging techniques. Higher TEWL values were observed in participants with diabetes, who also showed lower skin elasticity and wrinkles with greater volume, area, and depth. In addition, the Reflectance Confocal Microscopy (RCM) imaging analysis showed that all participants with diabetes presented polycyclic papillae and deformed and amorphous collagen fibers. The obtained data showed significant differences between healthy and diabetic skin and could help develop more specific topical treatments to improve the treatment of skin conditions in people with diabetes. Finally, RCM is an advanced imaging technique that allows for a more profound analysis of diabetic skin, which could assist in the evaluation of dermocosmetic treatments to improve the skin alterations caused by this disease.

Development of multifunctional sunscreens: Evaluation of physico-mechanical and film-forming properties.

The exposome consists of several factors such as solar radiation and pollution, which can provoke skin damage and lead to premature skin aging. Thus, the use of multifunctional sunscreens is critical in order to prevent this damage. In addition, film formation is very important to reach the expected SPF. Within this context, the objective of the present study was to develop and evaluate the in vivo SPF, sensory, physico-mechanical, and film-forming properties of sunscreens containing a biopolymer from Tara and red algae. A clinical study of the film-forming effect and of skin hydration was performed by instrumental measurements and by biophysical and skin imaging techniques. The SPF of both formulations, with or without the biopolymer, was 45.6. This result was 10.09% higher than expected. higher than expected. However, the sunscreen added to the biopolymer showed better sensory and texture properties, significantly increased skin hydration and reduced transepidermal water loss. The film-forming property was observed by the analysis of Reflectance Confocal Microscopy images 2, 4, and 6 h after formulation application, and this result was more pronounced for the sunscreen added to the biopolymer. Thus, the film-forming property of the biopolymer was important for prolonging the skin barrier function due to film formation and to obtain more effective and multifunctional sunscreens that provide longer protection.

Film-Forming Properties of Topical Formulations for Skin and Hair: In Vivo and In Vitro Studies Using Biophysical and Imaging Techniques.

The film-forming effect is an important property of formulations for skin improvement and hair protection. Reflectance confocal microscopy, an advanced imaging technique, is an important tool for its evaluation. Thus, the aim of this study was to evaluate the film-forming properties of cosmetic formulations based on starches and containing a Spirulina maxima extract after their application to skin and hair, using sensorial analysis and instrumental measurements, with emphasis on reflectance confocal microscopy. Two formulations based on starches and PEG-75 lanolin containing or not (Vehicle) a Spirulina maxima dry extract were developed. The rheological behavior and sensorial properties of both formulations were evaluated. The film-forming property on the skin was evaluated in terms of skin hydration by RCM imaging analysis and transepidermal water loss (TEWL). The hair tresses were evaluated in terms of mechanical properties and RCM imaging analysis. The formulations showed pseudoplastic behavior and a low hysteresis area. In addition, the presence of Spirulina in the formulation did not interfere in the rheological parameters. Both formulations reduced TEWL and maintained the stratum corneum water content. The protective effect was also observed in the hair, since the application of the formulation with Spirulina showed a better performance in the tensile test when compared to vehicle. Thus, the proposed formulation showed film formation on the skin and hair surface that brought immediate benefits such as a reduction of TEWL. Finally, the formulations were shown to have film-forming effects and their use can be suggested for skin and hair protection against daily damage.

Pigmented lesion on the face: which is the chance of being melanoma using reflectance confocal microscopy features?

Facial melanoma presents itself as a brownish macula, being difficult to differentiate it from benign pigmented lesions of the face on clinical examination. Reflectance confocal microscopy (RCM) assists in diagnosing facial lesions in which dermoscopy has limitations, allowing to increase the diagnostic accuracy. The study aimed to analyze the RCM features of pigmented isolated lesions of the face for diagnosing melanoma. Also, we sought to establish the chance of a pigmented lesion on the face being a melanoma using RCM criteria. In this retrospective and prospective study, 105 clinical pigmented lesions on the face underwent RCM, and cytoarchitectural features in the epidermis, the dermo-epidermal junction (DEJ), and dermis were described. For statistical analysis, the exact chi-square test was applied to the RCM criteria. The odds ratio was estimated using univariate logistic regression. Finally, we used the multiple logistic regression method for creating a nomogram to predict the chance of a lesion being a melanoma. After univariate and multivariate logistic regression, atypical round nucleated cells within the epidermis, pagetoid spread, and follicular dendritic cells presented as statistically significant features. Then, a complex nomogram was created to give the chance of a pigmented lesion on the face being a melanoma. The presence of these three features resulted in a 98% probability for melanoma. This study allowed to estimate the diagnosis of melanoma on the face, using RCM, practicable and feasible in the daily routine, through the presence of some RCM nomogram criteria.

Skin photoaging in young men: A clinical study by skin imaging techniques.

OBJECTIVE: Differences in skin physiology and lifestyle among people can influence the skin damage caused by solar radiation. Photoprotection habits play an important role to prevent skin photoaging. Thus, the objective of the present study was to evaluate the skin changes resulting from solar exposure in young men by skin imaging techniques. METHODS: Twenty-three male, aged 18-28 years, with and without photoprotection habits participated in the study. Instrumental measurements in terms of dermis thickness and echogenicity (20 mHz ultrasound - DermaScanC® ), morphological and structural skin characterization (Reflectance Confocal Microscopy - VivaScope® 1500) and high-resolution imaging (Visioface® ) were performed in the malar region of the face. RESULTS: Pigmentation disorders, telangiectasia, wrinkles and lower dermis echogenicity were observed in the skin of subjects without photoprotection habits. Reflectance Confocal Microscopy images showed an irregular honeycomb pattern (35%), polycyclic papillae (40%) and coarse collagen fibres (35%), which are related to photoaging. CONCLUSION: Sun exposure without photoprotection results in a loss of dermal echogenicity and changes in the epidermis structure and collagen fibres regardless of chronological age. Thus, the study adds data for a discussion about correct photoprotection habits among young people and can help to increase the use of sunscreens for male public.

OBJECTIFS: Les différences de physiologie cutanée et de mode de vie peuvent influer sur les lésions cutanées causées par le rayonnement solaire. Les habitudes de photoprotection jouent un rôle important dans la prévention du photovieillissement cutané. Dans ce contexte, l'objectif de l'étude était d'évaluer les changements cutanés résultants de l'exposition au soleil chez les jeunes hommes à l'aide de techniques d'imagerie cutanée. MÉTHODES: L'étude a inclus 23 hommes, âgés de 18 à 28 ans, avec et sans habitudes de photoprotection. Des mesures instrumentales d'épaisseur et d'échogénicité du derme (échographie 20 mHz - DermaScanC®), de caractérisation morphologique et structurale de la peau (Reflectance Confocal Microscopy - VivaScope® 1500) et des images haute résolution (Visioface®) ont été réalisées dans la région malaire du visage. RÉSULTATS: Des troubles de la pigmentation, des télangiectasies, des rides et une moindre échogénicité du derme ont été observés sur la peau d'individus sans habitudes de photoprotection. Les images de microscopie confocale à réflectance ont montré un motif en nid d'abeille irrégulier (35%), des papilles polycycliques (40%) et des fibres de collagène épaisses (35%), qui sont liés au photovieillissement. CONCLUSION: L'exposition au soleil sans photoprotection entraîne une perte d'échogénicité cutanée et des modifications de la structure de l'épiderme et des fibres de collagène, quel que soit l'âge chronologique. Enfin, l'étude agrège les données pour une discussion sur les bonnes habitudes de photoprotection chez les jeunes et peut aider à augmenter l'utilisation des écrans solaires par le public masculin.

Management of complex head-and-neck basal cell carcinomas using a combined reflectance confocal microscopy/optical coherence tomography: a descriptive study.

INTRODUCTION: Recently, a combined reflectance confocal microscopy (RCM)-optical coherence tomography (OCT) has been tested for the diagnosis of basal cell carcinoma (BCC). Evaluating the role of RCM-OCT in management of complex BCCs has not been studied. The objective of the study was to investigate the utility of a new combined RCM-OCT device in the evaluation and management of complex BCCs in a descriptive study. METHODS: Prospective study of consecutive cases (July 2018-June 2019) of biopsy-proven 'complex' BCC defined as BCC in the head-and-neck area with multiple high-risk criteria such as large size in the mask area, multiple recurrences, and high-risk subtype. All cases were evaluated with a combined RCM-OCT device that provided simultaneous image viewing on a screen. Lesions were evaluated bedside with RCM-OCT according to previously described criteria. RESULTS: Ten patients with complex head-and-neck BCCs had mean age of 73.1 ± 13.0 years. Six (60%) patients were males. Mean BCC clinical size was 1.9 ± 1.2 cm (range 0.6-4.0 cm). RCM detected residual BCC in 8 out of 10 cases (80%) and OCT detected residual BCC in all 10 cases (100%). Six BCCs (60%) had a depth estimate of > 1000 µm under OCT. In five cases, (50%) RCM-OCT imaging results led to a change/modification in BCC management. CONCLUSION: The use of a combined RCM-OCT device may help in the evaluation of complex head-and-neck BCCs by guiding treatment selection and defining the extent of surgery.

Concordance among in vivo reflectance confocal microscopy, trichoscopy, and histopathology in the evaluation of scalp discoid lupus.

BACKGROUND: Reflectance confocal microscopy (RCM) has been used for the evaluation of several inflammatory skin conditions, including skin discoid lupus erythematosus (DLE), and has been correlated with conventional histopathology (HP). However, RCM is not being widely used in trichology. Few reports and just preliminary data suggest the use of RCM as a complementary tool in alopecias. OBJECTIVES: To correlate the major RCM features of scalp DLE with trichoscopy and HP findings of biopsy specimens obtained from the same lesions. METHODS: This is an observational, analytical, and cross-sectional study involving 12 patients with a clinically established diagnosis of scalp DLE. Patients underwent global clinical photograph, trichoscopy, and RCM examination in the same site followed by two 4-mm punch biopsy specimens for HP analysis. Inter-methods agreement among RCM imaging, trichoscopy, and horizontal histopathology sections (HHS) were calculated using Cohen Kappa (k) statistics. RESULTS: Statistical analysis of the agreement between RCM and HP features disclosed an overall agreement similar to skin DLE. Seven of the eleven features evaluated had agreement superior to 75%. We also evaluated RCM features associated with three of their corresponding trichoscopic findings for further investigation of their agreement with HP. Statistical analysis showed an enhancement with agreement of 86% when the non-invasive techniques are used together. CONCLUSION: Consistent correlation between RCM and HP observed in our study supports the reliability of RCM in the diagnosis of scalp DLE. RCM may be considered a promising tool for scalp DLE microscopic evaluation and presents similar RCM features to DLE in other body sites. By associating clinical, trichoscopic and RCM evaluation, dermatologists will have a non-invasive arsenal for the assessment of hair and scalp disorders, benefiting patients.

Application of biophysical and skin imaging techniques to evaluate the film-forming effect of cosmetic formulations.

OBJECTIVE: Products with film-forming effect, or 'second skin', which guarantees an immediate protective effect after application, is a highlight, especially when composed of natural ingredients. Thus, the objective of this study was to evaluate the immediate film-forming effect on skin of a gel and emulsion formulations added with Kappaphycus alvarezii and Caesalpinia spinosa extracts through biophysical and skin imaging techniques, especially with the Reflectance Confocal Microscopy (RCM). METHODS: The measurements were done in the forearm region before (baseline) and 1 h after of application of the developed formulation and its control. The parameters related to the stratum corneum water content, transepidermal water loss (TEWL), cutaneous microrelief and morphological and structural characteristics of the epidermis were analysed through the following biophysical and skin imaging techniques: Corneometer® CM 825, Tewameter® TM 300, Visioscan® VC98 and Vivascope® 1500, respectively. A sensorial analysis was also performed to study how the formulations were perceived on the skin. RESULTS: The obtained results showed that the active ingredient under study allows the film formation on the skin surface, leading to a reduction of TEWL and skin desquamation. The obtained images from RCM showed a reduction of furrows on the skin surface and a film formation after a single application of the formulations. However, these effects were more pronounced in the emulsion formulation, which suggests a synergistic effect of the active ingredient under study with the emollients of formulation composition. This result was also observed in the sensorial analysis, as both formulations added with the active substance were well evaluated. CONCLUSION: The presence of Kappaphycus alvarezii and Caesalpinia spinosa extracts in the studied cosmetic formulations, enabled a film formation on a skin surface, bringing benefits as a reduction of transepidermal water loss and skin desquamation, as well as a furrows reduction and an improvement of stratum corneum after 1 h of application. Finally, the skin imaging techniques can be suggested as an excellent tool to evaluate a film-forming effect of cosmetic formulations.

OBJECTIF: Les produits ayant un effet filmogène, ou « deuxième peau ¼ qui garantit un effet protecteur immédiat après l'application, sont un plus, notamment lorsqu'ils sont composés d'ingrédients naturels. L'objectif de cette étude visait ainsi à évaluer l'effet filmogène immédiat sur la peau de formulations avec gel et émulsion enrichies d'extraits de Kappaphycus alvarezii et de Caesalpinia spinosa grâce à des techniques d'imagerie cutanée et biophysique, en particulier par microscopie confocale par réflectance (MCR). MÉTHODES: Les mesures ont été effectuées dans la région de l'avant-bras avant (référence) et 1 h après l'application de la formulation développée et de son contrôle. Les paramètres liés à la teneur en eau de la couche cornée, perte d'eau transépidermique (Transepidermal Water Loss, TEWL), au microrelief cutané et aux caractéristiques structurelles et morphologiques de l'épiderme ont été analysés à l'aide des techniques d'imagerie cutanée et biophysique suivantes : Corneometer® CM 825, Tewameter® TM 300, Visioscan® VC98 et Vivascope® 1500, respectivement. Une analyse sensorielle a également été réalisée pour étudier comment les formulations étaient perçues sur la peau. RÉSULTATS: Les résultats obtenus ont montré que le principe actif étudié permet la formation d'un film à la surface de la peau, entraînant une réduction de la TEWL et de la desquamation de la peau. Les images obtenues par MCR ont montré une réduction des sillons à la surface de la peau et la formation d'un film après une seule application des formulations. Ces effets étaient toutefois davantage prononcés avec la formulation de type émulsion, ce qui suggère un effet synergique du principe actif étudié avec les émollients contenus dans la formulation. Ce résultat a également été observé dans l'analyse sensorielle, car les deux formulations enrichies en substance active ont été bien évaluées. CONCLUSION: La présence d'extraits de Kappaphycus alvarezii et de Caesalpinia spinosa dans les préparations cosmétiques étudiées a permis la formation d'un film à la surface de la peau, procurant des bénéfices sous forme d'une réduction de la perte d'eau transépidermique et de la desquamation de la peau, de même qu'une réduction des sillons et une amélioration de la couche cornée 1 h après l'application. Enfin, les techniques d'imagerie cutanée peuvent être proposées comme excellent outil d'évaluation de l'effet filmogène des préparations cosmétiques.

Reflectance confocal microscopy-guided carbon dioxide laser ablation of low-risk basal cell carcinomas: A prospective study.

BACKGROUND: Basal cell carcinoma (BCC) treatment modalities can be stratified by tumor subtype and recurrence risk. The main limitation of nonsurgical treatment modalities is the lack of histopathologic confirmation. Reflectance confocal microscopy (RCM) is a noninvasive imaging device that provides quasihistologic images. OBJECTIVE: To evaluate the feasibility and efficacy of RCM-guided carbon dioxide (CO2) laser ablation of low-risk BCCs. METHODS: Prospective study with biopsy specimen-proven low-risk BCCs imaged with RCM. RCM was performed on these sites before and after ablation. If residual tumor was found, a new series of laser passes were performed. The patients were then monitored for recurrence clinically and with RCM. RESULTS: Twenty-two tumor sites in 9 patients (5 men, 4 women) were imaged and treated. Median age was 59 ± 12.9 years (range, 30-74 years). Mean tumor size was 7.7 mm (range, 5-10 mm). Residual tumor was identified in 5 of 22 cases (22.7%) under RCM on immediate first-pass postablation sites, prompting additional laser passes. Median follow-up was 28.5 months (range, 22-32 months) with no recurrences found. CONCLUSIONS: Addition of RCM to laser ablation workflow can detect subclinical persistent tumor after initial ablation and may serve as an aid to increase the efficacy of laser ablation.

Photoageing-related skin changes in different age groups: a clinical evaluation by biophysical and imaging techniques.

OBJECTIVES: In view of the lack of studies about the morphological and structural changes caused by solar radiation in young people, the aim of the present study was to evaluate the photoageing-related changes in the skin of different age groups by biophysical and imaging techniques. METHODS: Forty-four healthy female subjects were divided into two age groups: Group 1 (G1): 18-35 years old and Group 2 (G2): 40-60 years old. The skin of malar region of the face was evaluated in terms of mechanical properties, disorder in the pigmentation pattern, morphological and structural changes using the Cutometer® , Colorimeter® , Visioface® and Dermascan C® devices and reflectance confocal microscopy (Vivascope® ). RESULTS: The results showed that the main changes in the skin of G1 were related to the pigmentation pattern, the papilla format and depletion of thin collagen fibres. These alterations were also observed in the skin of G2, but with more pronounced effects. CONCLUSION: The knowledge about the skin changes caused by photoageing obtained in this study is very important for the development of dermocosmetic products for more effective treatments particularly focused on this type of skin. Finally, objective characterization of photoageing showed the importance of photoprotective habits since the first years of life in order to retard the appearance of skin changes caused by solar radiation.

OBJECTIFS: Compte tenu du manque d'études sur les modifications structurelles et morphologiques causées par le rayonnement solaire chez les jeunes gens, le but de la présente étude était d'évaluer les changements liés au photovieillissement de la peau de différents groupes d'âges grâce des techniques de biophysique et d'imagerie. MÉTHODES: Quarante-quatre sujets féminins en bonne santé ont été divisés en deux groupes d'âges : Groupe 1 (G1) : 18-35 ans et Groupe 2 (G2) : 40-60 ans. La peau des régions malaires du visage a été évaluée en termes de propriétés mécaniques, troubles du schéma de pigmentation, et changements morphologiques et structurels à l'aide des dispositifs Cutometer®, Colorimeter®, Visioface® et Dermascan C® et de la microscopie confocale par réflectance (Vivascope®). RÉSULTATS: Les résultats ont montré que les principaux changements au niveau de la peau du G1 étaient liés au schéma de pigmentation, au format papillaire et à la déplétion de fines fibres de collagène. Ces altérations ont également été observées au niveau de la peau du G2, mais avec des effets plus prononcés. CONCLUSION: Les connaissances sur les modifications cutanées causées par le photovieillissement acquises grâce à cette étude sont très importantes pour le développement de produits dermo-cosmétiques pour des traitements plus efficaces axés plus particulièrement sur ce type de peau. Et enfin, la caractérisation objective du photovieillissement a montré l'importance des habitudes photoprotectrices depuis les premières années de vie afin de retarder l'apparition de modifications cutanées causées par le rayonnement solaire.

Influence of visible light on cutaneous hyperchromias: Clinical efficacy of broad-spectrum sunscreens.

INTRODUCTION: Cutaneous hyperchromias are disorders of skin pigmentation involving increased melanin production and its irregular accumulation in skin cells. The use of sunscreens is fundamental for the control of hyperchromias by reducing the stimulation of pigmentation, as melanin synthesis is mainly stimulated by solar radiation. Many studies have demonstrated that visible light can induce significant skin damage. Considering the effects of visible light, effective photoprotection should not be limited only to UV protection but should also involve visible and infrared protection. OBJECTIVE: The aim of this study was to evaluate the efficacy of UV-VIS sunscreens in protecting skin against damages caused by solar radiation and the influence of visible light on the appearance of cutaneous hyperchromias. METHODS: Forty volunteers aged 18 to 39 years with skin hyperpigmentation participated in the study. To evaluate the efficacy of the formulations developed, the percentage of hyperpigmented area was evaluated using high-resolution images-Visioface® Quick (Courage-Khazaka, Germany) and the analysis of epidermal pigmentation was performed by RCM-Vivascope® 1500 (Lucid, USA). Also, the melanin index was determined using the Mexameter® M X16 colorimeter (Courage-Khazaka, Germany). RESULTS: The developed formulations were effective in the reduction in melanin index, epidermal pigmentation, and percentage of hyperpigmented area. CONCLUSION: Finally, this study discusses how the combination of UV filters and pigments can protect the skin from solar radiation and reduces skin hyperpigmentations.

Mycosis fungoides: reflectance confocal microscopy and its role in the diagnosis

Background: Mycosis fungoides (MF), a T-cell lymphoma, is the most common variant of primary cutaneous lymphomas. The discrete clinical aspect of the early patch-stage and an overlapping clinical presentation with other erythematosquamous skin diseases make the diagnosis of MF challenging. Histopathology is the gold standard for the diagnosis of MF. However, in early stages, MF can simulate inflammatory diseases, presenting reactive lymphocytes and absence of lymphocytic cytologic atypia. Consecutive biopsies are often necessary from several clinically suspect sites. Previous studies evaluated Reflectance Confocal Microscopy (RCM) as a promising tool for MF diagnosis because it offers the opportunity to analyze skin structures non-invasively at a 'quasi-histopathologic' resolution and to guide the most representative site for biopsy. Case presentation: We present a 76 years-old woman with a 5-year history of erythematous plaques and patches. She had had 5 previous skin biopsies with a pattern suggestive of nummular eczema. The history and the clinical presentation led to the suspicion of MF. RCM examination was performed and two lesions were marked for biopsy. The histopathology exam confirmed the diagnosis of MF. The patient was submitted to topical treatment with total remission of the lesions. Conclusions: The mean time from onset of symptoms to diagnosis is 6 years and the delay in diagnosis results in delay for adequate therapy. Therefore, the selection of the biopsy site is crucial to avoid unrepresentative samples. Mancebo et al. recently published the largest cohort of cutaneous T.cell lymphoma examined with RCM. 83 lesions were evaluated, and the authors confirmed that this image technique was effective in to guide the most representative site for the biopsy. We believe that further and larger studies will clarify it and defining a diagnostic algorithm for the RCM diagnosis of MF.

Proposal for management and dermoscopy follow-up of nevi in patients affected by oculocutaneous albinism type Ia.

Albino patients are at great risk for developing cutaneous neoplasms, including melanomas. In this paper we describe the dermatoscopic findings of nevi in two patients with oculocutaneous albinism type Ia (OCA-Ia) highlighting that they manifest a vascular pattern similar to that described for amelanotic melanoma. We propose managing these patients with dermoscopy, using the comparative approach, digital follow up (DFU), and reflectance confocal microscopy as a complementary tool for difficult cases.