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Quantitative Multimodal Skin Imaging in Pediatric Health Care: Infantile Hemangiomas and Hypertrophic Burn Scars

Burkes, Shona A
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396532858

Abstract Details

2014, PhD, University of Cincinnati, Pharmacy: Pharmaceutical Sciences/Biopharmaceutics.
The traditional approach to evaluating infantile hemangiomas (IHs) and hypertrophic burn scars (HTS) in clinical pediatrics relies on subjective visual assessment by experienced clinicians. This method is often associated with high variability and lacks quantitation, thereby making it more challenging to determine the extent of treatment response over time and compare treatment modalities. IHs and HTS (benign cutaneous tumors) represent two skin conditions that develop from aberrant physiological processes, culminating in excessive growth and can be associated with mortality and morbidity. Reliable methods that can assess progression and detect early treatment effects are needed to optimize therapy individually. The development and application of multimodal skin imaging methods including, three-dimensional (3D) laser scanning for skin height, high-resolution color imaging, and biomechanical measurements of skin elasticity were used to assess treatment response in 17 burn scar patients with 27 HTS undergoing combination pulsed-dye laser and compression therapy (PDL+CT). This protocol was extended and the application of 3D surface scanning, high-resolution color imaging, and infrared (IR) thermography in static mode and active dynamic mode following 30 second cold stress were used to objectively characterize changes of height, color, temperature, area of involvement, and perfusion in 119 subjects with 134 IHs (35 superficial, 97 mixed) in the natural ontogeny (observation/untreated) and in response to treatment (oral propranolol, topical timolol). Additionally, a custom graphical user interface (GUI) was developed for co-registration of high-resolution color and IR thermal images and automated image analysis algorithms to objectively quantify and map relevant physiological information. Both multimodal protocols and methods for analysis of the data were designed to quantify the specific characteristics for each condition in comparison to the conventional subjective clinical evaluation. Overall, significant reductions in redness after 2 treatments and height and elasticity after 3 treatments were detected with the objective modalities in PDL+CT compared to CT alone (p < 0.05). Visual assessment of the scar by therapists, revealed significant changes in vascularity, pigmentation, pliability, and height in response to PDL+CT treatment than for CT alone after three treatments. IHs treated with propranolol had significant reductions over time in height, redness, temperature, a greater reduction in rewarming behavior and significant increases in yellowness and lightness (approaching normal tissue) compared to untreated and timolol treated hemangiomas. Significant decreases in tumor vascularity were detected using dynamic IR thermography between 10 - 18 and after 36 months of age compared to the first 6 months of age. Mixed IHs had significantly higher rewarming responses compared to superficial IHs. The data generated demonstrate that multimodal skin imaging is feasible for evaluating the ontogeny of IHs over time and differentiating various treatment techniques in HTS and IHs. Active dynamic infrared thermography shows great promise in discerning tumor vascularity. These methodologies may permit more standardized assessment of disease progression and treatment response, and have in comparing treatment modalities. Quantitative multimodal skin imaging can also be applied to other skin conditions, such as wounds, pressure ulcers, irritant dermatitis, and atopic dermatitis.
Marty Visscher, Ph.D. (Committee Chair)
Denise Adams, M.D. (Committee Member)
Donna Carlson Jones, Ph.D. (Committee Member)
Gerald Kasting, Ph.D. (Committee Member)
Kevin Li, Ph.D. (Committee Member)
R. Randall Wickett, Ph.D. (Committee Member)
171 p.
Pharmaceuticals
multimodal quantiative imaging; hypertrophic burn scars; infantile hemangioma; vascular tumors; objective skin imaging; noninvasive

Recommended Citations

Citations

  • Burkes, S. A. (2014). Quantitative Multimodal Skin Imaging in Pediatric Health Care: Infantile Hemangiomas and Hypertrophic Burn Scars [Doctoral dissertation, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396532858

    APA Style (7th edition)

  • Burkes, Shona. Quantitative Multimodal Skin Imaging in Pediatric Health Care: Infantile Hemangiomas and Hypertrophic Burn Scars. 2014. University of Cincinnati, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396532858.

    MLA Style (8th edition)

  • Burkes, Shona. "Quantitative Multimodal Skin Imaging in Pediatric Health Care: Infantile Hemangiomas and Hypertrophic Burn Scars." Doctoral dissertation, University of Cincinnati, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1396532858

    Chicago Manual of Style (17th edition)

ucin1396532858
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© 2014, all rights reserved.
This open access ETD is published by University of Cincinnati and OhioLINK.