Archives of Dermatological Research

, Volume 303, Issue 2, pp 79–87

Tissue viability imaging (TiVi) in the assessment of divergent beam UV-B provocation

  • Jim O’Doherty
  • Joakim Henricson
  • Joey Enfield
  • Gert E. Nilsson
  • Martin J. Leahy
  • Chris D. Anderson
Original Paper

Abstract

In routine clinical phototesting and in basic research, naked eye dermatological assessment is the “gold standard” for determining the patient’s minimal erythemal dose (MED). In UV-B testing with a divergent, radially attenuating beam of characterised dosimetry, laser Doppler perfusion imaging has been previously used to give quantitative description of reactivity to doses above the MED in addition to a “single-dose” objective determination of the MED itself. In the present paper, the recently developed tissue viability imaging (TiVi) technology is presented for the first time as a reliable, easily applicable, high-resolution alternative to LDPI in the divergent beam testing concept. Data obtained after provocation with a range of doses was analysed in order to determine the reaction diameter, which can be related to the MED using field dosimetry. The dose–response features of exposure above the MED and the relationship between naked eye readings and the diameter were determined from the image data. TiVi data were obtained faster than LDPI data and at a higher spatial resolution of 100 μm instead of 1 mm. A tool was developed to centre over the erythema area of the acquired image. Response data could be plotted continuously against dose. Thresholding of processed images compared to naked eye “gold standard” readings showed that the normal skin value +4 standard deviations produced a good fit between both methods. A linear fitting method for the dose–response data provided a further method of determination of the reaction diameter (MED). Erythemal “volume under the surface (VUS)” for the reaction provided a new concept for visualising information. TiVi offers advantages over LDPI in the acquisition and analysis of data collected during divergent beam testing. An increased amount of data compared to traditional phototesting is easily and more objectively obtained which increases applicability in the clinical and research environment.

Keywords

Photo-testing Tissue viability imaging UV-B Microcirculation Polarization spectroscopy Minimal erythemal dose 

References

  1. 1.
    Ananthaswamy HN, Loughlin S, Cox P, Evans RL, Ullrich SE, Kripke ML (1997) Sunlight and skin cancer: inhibition of p53 mutations in UV-irradiated mouse skin by sunscreens. Nat Med 3:510–514CrossRefPubMedGoogle Scholar
  2. 2.
    Dawe RS, Cameron H, Yule S, Man I, Ibbotson SH, Ferguson J (2002) UV-B phototherapy clears psoriasis through local effects. Arch Dermatol 138:1071–1076CrossRefPubMedGoogle Scholar
  3. 3.
    Falk M (2007) Towards a broader use of phototesting. PhD thesis, Linköping University, SwedenGoogle Scholar
  4. 4.
    Falk M, Ilias MA, Wårdell K, Anderson C (2003) Phototesting with a divergent UV-B beam in the investigation of anti-inflammatory effects of topically applied substances. Photodermatol Photo 19:195–202CrossRefGoogle Scholar
  5. 5.
    Falk M, Ilias M, Anderson C (2008) Inter-observer variability in reading of phototest reactions with sharply or diffusely delineated borders. Skin Res Technol 14:397–402CrossRefPubMedGoogle Scholar
  6. 6.
    Falk M, Anderson C (2010) Reliability of self-assessed reading of skin tests—a possible approach in research and clinical practice? Dermatol Online J 16(2):4PubMedGoogle Scholar
  7. 7.
    Falk M, Anderson C (2008) Prevention of skin cancer in primary healthcare: an evaluation of three different prevention effort levels and the applicability of a phototest. Eur J Gen Pract 14:68–75CrossRefPubMedGoogle Scholar
  8. 8.
    Farage M (2008) Enhancement of visual scoring of skin irritant reactions using cross-polarized light and parallel-polarized light. Contact Dermatitis 58:147–155CrossRefPubMedGoogle Scholar
  9. 9.
    Fitzpatrick TB (1988) The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol 124(6):869–871CrossRefPubMedGoogle Scholar
  10. 10.
    Gordon PM, Saunders PJ, Diffey BL, Farr PM (1998) Phototesting prior to narrowband (TL-01) ultraviolet B phototherapy. Br J Dermatol 139(5):811–814CrossRefPubMedGoogle Scholar
  11. 11.
    Hamzavi I (2006) Photoadaptation: a path toward rational phototherapy protocols. J Invest Dermatol 126:2156–2158CrossRefPubMedGoogle Scholar
  12. 12.
    Henricson J, Nilsson A, Tesselaar E, Nilsson G, Sjöberg F (2009) Tissue viability imaging: microvascular response to vasoactive drugs induced by iontophoresis. Microvasc Res 78(2):199–205CrossRefPubMedGoogle Scholar
  13. 13.
    Ilias MA, Anderson C, Wårdell K (1999) Single exposure phototesting utilizing a divergent ultraviolet beam. Skin Res Tech 5:255–259CrossRefGoogle Scholar
  14. 14.
    Ilias MA, Wårdell K, Falk M, Anderson C (2001) Phototesting based on a divergent beam—a study on normal subjects. Photodermatol Photo 17:189–196CrossRefGoogle Scholar
  15. 15.
    Ilias MA (2004) Single exposure phototesting and assessment of pigmented skin lesions—quantitative methods in terms of blood perfusion estimates, PhD thesis, Linköping University, SwedenGoogle Scholar
  16. 16.
    Leahy MJ, Enfield JG, Clancy NT, O’Doherty J, McNamara P, Nilsson GE (2007) Biophotonic methods in microcirculation imaging. Med Laser Appl 22:105–126CrossRefGoogle Scholar
  17. 17.
    Leahy MJ, de Mul FFM, Nilsson GE, Maniewski R (1999) Principles and practices of the laser Doppler perfusion technique. Technol Health Care 7:143–162PubMedGoogle Scholar
  18. 18.
    Mallbris L, Edstrom DW, Sunblad L, Granath F, Ståhle M (2005) UVB up-regulates the antimicrobial protein hCAP18 mRNA in human skin. J Invest Dermatol 125:1072–1074PubMedGoogle Scholar
  19. 19.
    McNamara P, O’Doherty J, O’Connell ML, Fitzgerald BW, Anderson C, Nilsson GE, Toll RJ, Leahy MJ (2009) Tissue viability (TiVi) imaging: temporal effects of local occlusion studies in the volar forearm. J Biophotonics 3:66–74CrossRefGoogle Scholar
  20. 20.
    Millard TP, Hawk JL (2002) Photosensitivity disorders: cause, effect and management. Am J Clin Dermatol 3:239–246CrossRefPubMedGoogle Scholar
  21. 21.
    Moseley H, Naasan H, Dawe RS, Woods J, Ferguson J (2008) Population reference intervals for minimal erythemal doses in monochromator phototesting. Photoderm Photoimmunol Photomed 25:8–11CrossRefGoogle Scholar
  22. 22.
    Nilsson GE, Zhai H, Chan HP, Farahmand S, Maibach HI (2009) Cutaneous bioengineering instrumentation standardization: the tissue viability imager. Skin Res Tech 15:6–13CrossRefGoogle Scholar
  23. 23.
    O’Doherty J, Henricson J, Anderson C, Leahy MJ, Nilsson GE, Sjöberg F (2007) Sub-epidermal imaging using polarized light spectroscopy for assessment of skin microcirculation. Skin Res Tech 13:472–484CrossRefGoogle Scholar
  24. 24.
    O’Doherty J (2008) Assessment of tissue viability by polarised light spectroscopy, PhD thesis, University of Limerick, IrelandGoogle Scholar
  25. 25.
    O’Doherty J, McNamara P, Clancy NT, Enfield JG, Leahy MJ (2009) Comparison of instruments of microcirculatory blood flow and red blood cell concentration. J Biomed Opt 14(3):034025CrossRefPubMedGoogle Scholar
  26. 26.
    Palmer RA, Aquilina S, Milligan PJ, Walker SL, Hawk JL, Young AR (2006) Photoadaptation during narrowband ultraviolet-B therapy is independent of skin type: a study of 352 patients. J Invest Dermatol 126:1256–1263CrossRefPubMedGoogle Scholar
  27. 27.
    Roelandts R, Ryckaert S (1999) Solar urticaria: the annoying photodermatosis. Int J Dermatol 38:411–418CrossRefPubMedGoogle Scholar
  28. 28.
    Schornagel IJ, Sigurdsson V, Nijhuis EHJ, Bruijnzeel-Koomen CAFM, Knol EF (2004) Decreased neutrophil skin infiltration after UV-B exposure in patients with polymorphous light eruption. J Invest Dermatol 123:202–206CrossRefPubMedGoogle Scholar
  29. 29.
    Urbach F (1969) Solar simulation for phototesting of human skin In: Urbach F (ed) The biologic effects of ultraviolet radiation with emphasis on the skin. Pergamon Press, NY, pp 107–114Google Scholar
  30. 30.
    Wirén K, Frithiof H, Sjöqvist C, Lodén M (2009) Enhancement of bioavailability by lowering of fat content in topical formulations. Br J Dermatol 160(3):552–556CrossRefPubMedGoogle Scholar
  31. 31.
    Yaar M, Gilchrest BA (2007) Photoageing: mechanism, prevention, therapy. Br J Dermatol 157:874–887CrossRefPubMedGoogle Scholar
  32. 32.
    Youn JI, Park JY, Jo SJ, Rim JH, Choe YB (2003) Assessment of the usefulness of skin phototype and skin color as the parameter of cutaneous narrow band UV-B sensitivity in psoriasis patients. Photodermatol Photo 19:261–264CrossRefGoogle Scholar
  33. 33.
    Zasloff M (2005) Sunlight, Vitamin D, and the innate immune defenses of the human skin. J Invest Dermatol 125:xvi–xviiCrossRefPubMedGoogle Scholar
  34. 34.
    Zhai H, Chan HP, Farahmand S, Nilsson GE, Maibach HI (2009) Comparison of tissue viability imaging and colorimetry: skin blanching. Skin Res Tech 15:20–23CrossRefGoogle Scholar
  35. 35.
    Zhai H, Chan HP, Farahmand S, Nilsson GE, Maibach HI (2009) Tissue viability imaging: mapping skin erythema. Skin Res Tech 15:14–19CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Jim O’Doherty
    • 1
    • 2
  • Joakim Henricson
    • 3
  • Joey Enfield
    • 2
  • Gert E. Nilsson
    • 3
    • 4
  • Martin J. Leahy
    • 2
  • Chris D. Anderson
    • 5
  1. 1.Department of Medical PhysicsRoyal Surrey County HospitalGuildfordUnited Kingdom
  2. 2.Department of PhysicsUniversity of LimerickLimerickIreland
  3. 3.Allergy Centre, University HospitalLinköping UniversityLinköpingSweden
  4. 4.Wheelsbridge ABLinköpingSweden
  5. 5.Division of Dermatology, Department of Clinical and Experimental MedicineLinköping UniversityLinköpingSweden

Personalised recommendations