Introduction: Chronic ulcers significantly burden healthcare systems, requiring precise measurement and assessment for effective treatment. Traditional methods, such as manual segmentation, are time-consuming and error-prone. This review evaluates the potential of artificial intelligence AI-powered mobile apps for automated ulcer segmentation and their application in clinical settings. Methods: A comprehensive literature search was conducted across PubMed, CINAHL, Cochrane, and Google Scholar databases. The review focused on mobile apps that use fully automatic AI algorithms for wound segmentation. Apps requiring additional hardware or needing more technical documentation were excluded. Vital technological features, clinical validation, and usability were analysed. Results: Ten mobile apps were identified, showing varying levels of segmentation accuracy and clinical validation. However, many apps did not publish sufficient information on the segmentation methods or algorithms used, and most lacked details on the databases employed for training their AI models. Additionally, several apps were unavailable in public repositories, limiting their accessibility and independent evaluation. These factors challenge their integration into clinical practice despite promising preliminary results. Discussion: AI-powered mobile apps offer significant potential for improving wound care by enhancing diagnostic accuracy and reducing the burden on healthcare professionals. Nonetheless, the lack of transparency regarding segmentation techniques, unpublished databases, and the limited availability of many apps in public repositories remain substantial barriers to widespread clinical adoption. Conclusions: AI-driven mobile apps for ulcer segmentation could revolutionise chronic wound management. However, overcoming limitations related to transparency, data availability, and accessibility is essential for their successful integration into healthcare systems.
Over the last decades, the incidence of anal cancer has increased worldwide. The discovery of the HPV virus as its primary cause and the natural progression of the disease, involving precancerous lesions, have resulted in significant interest in screening for anal cancer. The use of cytology testing, high-risk HPV DNA research, high-resolution anoscopy, and their combination has been adopted with variable success in detecting anal HPV precancerous lesions. Various studies have been carried out to evaluate the sensitivity and specificity of these techniques in different populations. High-risk populations for developing anal cancer have been identified through study of incidence and prevalence. Therefore, different scientific societies and experts worldwide have provided different recommendations for screening, but a universal approach has not yet been established. The inhomogeneity of different risk groups, the variable accessibility to specifical techniques, and the lack of data regarding the cost–benefit ratio of screening are the main problems to address in order to define a consensus guideline acceptable worldwide. The purpose of this paper is to provide a comprehensive review of the literature on HPV precancerous lesions and its screening, particularly after the release of recent recommendations.
1 January 2024 in WOUNDS: A Compendium of Clinical Research and Practice
Background. Caustic substances can inflict severe damage on tissues upon contact. Knowledge about skin damage caused by sodium hypochlorite is quite limited, with only a few reports available in the literature. Case Report. A 79-year-old female with severe cognitive decline presented with multiple skin ulcerations that were covered by a blackish-greyish eschar and surrounded by a purple erythematous halo. During the medical examination, in a moment of clarity the patient confessed to self-inflicting the wounds through injections of bleach at night. Analysis of the liquid beneath the eschar from the ulcer swab and the histological examination confirmed the compatibility of lesions with the injection of sodium hypochlorite. Conclusion. Intradermal injection of sodium hypochlorite can cause severe damage to the skin tissue, with rapid formation of ulcerations covered by a blackish-greyish eschar. The surrounding skin may have an erythematous, swollen appearance and a purple-colored halo around it. Moreover, for a patient with a neuropsychiatric medical history, negative laboratory findings, or irregular skin lesions, self-induced ulcerations should always be considered in the differential diagnosis.
Background: Dermoscopy, a non-invasive diagnostic technique, is being increasingly used to evaluate cutaneous T-cell lymphomas such as mycosis fungoides (MF) and Sézary syndrome (SS). However, its diagnostic accuracy and role in staging remain underexplored. Objective: This study aimed to assess the dermoscopic patterns in MF and SS, correlating the findings with the disease stage and lesion type to evaluate dermoscopy’s diagnostic utility. Methods: A retrospective, monocentric analysis was conducted on patients with histologically confirmed MF or SS. Dermoscopic images were evaluated for vascular patterns, pigmentation, scaling, and keratin plugs. The statistical analysis assessed the correlations between these dermoscopic features and the TNMB staging and lesion type. A literature review was also performed to contextualize the findings, focusing on studies describing dermoscopic features in MF based on retrospective, prospective, and cross-sectional data. Results: The study included 30 patients with histologically confirmed MF or SS (19 males and 11 females; mean age: 64.5 years). The dermoscopic evaluation revealed that all the lesions were pigment-free, with vascular structures as the predominant feature. Linear vessels (40%) and serpentine vessels (13.3%) were the most frequently observed, along with dotted vessels (36.7%) and clods (10%). The vessel distribution was diffuse (40%) or perifollicular (36.7%), with a predominant red (56.7%) or orange (40%) background. Scaling was present in 76.7% of cases, either diffuse (40%) or perifollicular (36.7%), and keratin plugs were detected in 40% of the lesions. No statistically significant correlations were found between dermoscopic features and the TNMB stage or lesion type (p > 0.05). A cluster analysis identified two patient groups with differing vascular and scaling features but no clear association with disease stage. The literature review identified studies that commonly reported features in MF dermoscopy, including fine, short linear vessels and an orange-yellow background, particularly in early-stage MF. Spermatozoa-like structures have been marked as highly specific for diagnosing MF. Some studies also suggested a transition in vascular morphology from linear vessels in early disease to branched vessels and ulceration in advanced stages. Conclusions: Our results showed some vascular patterns have some potential but lack sensitivity for staging MF and SS. The terminology used and the reproducibility of our results compared to those reported in the literature showed little consistency, with none of our cases showing spermatozoa-like structures. Moreover, the same issues with the use of non-reproducible terminology were noted across the studies because it is not standardized and due to different incongruent dermoscopic patterns. More significant prospective studies with standardized descriptors and larger groups are needed to refine its diagnostic and staging utility.
Background: Dermoscopy, a non-invasive diagnostic tool, is increasingly used to evaluate cutaneous T-cell lymphomas such as Mycosis Fungoides (MF) and Sézary Syndrome (SS). However, its diagnostic accuracy and role in staging remain underexplored. Objective: This study aimed to assess dermoscopic patterns in MF and SS, correlating findings with disease stages and lesion types to evaluate diagnostic utility. Methods: A retrospective, monocentric analysis was conducted on patients with histologically confirmed MF or SS. Dermoscopic images were evaluated for vascular patterns, pigmentation, scaling, and keratin plugs. Statistical analysis assessed correlations with TNMB staging and lesion types. Results: All lesions were pigment-free, with vascular patterns being the predominant dermoscopic feature. Linear vessels (40%) and serpentine vessels (13.3%) were most common. Scaling, observed in 76.7% of lesions, showed diffuse or perifollicular distribution. No statistically significant correlations were found between dermoscopic features, TNMB stages, or lesion types. Cluster analysis suggested variability but no definitive patterns for disease staging. Conclusion: Dermoscopy reveals consistent vascular patterns but lacks sensitivity for staging MF and SS. More significant prospective studies with standardised descriptors are needed to refine its diagnostic and staging utility. Histopathological confirmation remains essential for accurate diagnosis.
30 October 2024 in Dermatology Practical & Conceptual
Introduction: Dermatological conditions affecting the nails can manifest differently in individuals with distinct skin tones. This often leads to difficulty in the recognition of nail diseases especially in people with skin of color (SoC), that result not well represented in the literature. Objectives: Our aim was to provide dermatologists with useful clues for prompt recognition and diagnosis of nail psoriasis (NPso) and nail lichen planus (NLP) in people with SoC. Methods: We described the ungual manifestations of NPso and NLP in a population of 30 patients with SoC. Diagnosis was primarily based on clinical examination; in cases of diagnostic uncertainty, a biopsy of the nail matrix was performed to obtain histological conclusive evidence. Results: Of the 30 people with SoC in the analysis, 24 patients had NPso with a median Fitzpatrick phototype of 4.77 and 6 patients had NLP with a median Fitzpatrick phototype of 5. Regarding the 24 patients with NPso, 10 presented with trachyonychia, 9 displayed nail pitting, 8 showed onycholysis, 12 had subungual hyperkeratosis, while splinter hemorrhages were visible in 2 patients and activation melanonychia was discernible on the nail plates of 8 patients. Over the 6 patients diagnosed with NLP, all of them had post-inflammatory pigmentation on the proximal nail, with 3 patients exhibiting trachyonychia and 3 others having longitudinal fissures; subungual hyperkeratosis was found in 5 patients, while 3 patients displayed activated melanonychia. Conclusion: People with SoC exhibit a peculiar clinical presentation of both NPso and NLP and a better understanding is essential for providing timely and effective care.