O fotoenvelhecimento tem sido um assunto de grande interesse na área cosmética e dermatológica. Portanto, é relevante a caracterização da pele fotoenvelhecida, bem como o desenvolvimento de formulações dermocosméticas adequadas e direcionadas à finalidade de uso proposta. As vitaminas A e E e seus derivados tem se destacado como substâncias ativas para tal finalidade, e, baseado nesse conceito, foi proposto um composto inovador, o Tocoretinate (éster de all-trans-ácido retinoico e D-?-tocoferol), uma potencial substância ativa alternativa ao ácido retinoico para atuar na melhoria das condições da pele fotoenvelhecida. Nesse contexto, o objetivo do presente projeto foi caracterizar as alterações cutâneas decorrentes do fotoenvelhecimento, desenvolver e avaliar a estabilidade e a eficácia clínica de formulações cosméticas antienvelhecimento contendo Tocoretinate (TR), palmitato de retinila ou acetato de tocoferila. Para tal, inicialmente foi feito o planejamento experimental Box-Behnken com metodologia de superfície de resposta (MSR) foi executado para avaliar os principais efeitos e interações das matérias-primas da formulação. Foram selecionadas três formulações contendo, ou não, 0,5% de palmitato de retinila, 5% do acetato de tocoferila e 0,1% de Tocoretinate, as quais foram avaliadas quanto a sua estabilidade. A caracterização da pele fotoenvelhecida brasileira na face, nos antebraços e no dorso das mãos foi realizada em 80 voluntárias em dois grupos de idade por meio de questionários de autoavaliação e por técnicas de biofísica e imagem da pele. A mesma avaliação foi realizada no antebraço volar e face de 41 voluntárias francesas de 40 a 65 anos. As formulações desenvolvidas foram avaliadas por técnicas de biofísica e análise de imagem antes e após 84 dias de uso pelas voluntárias brasileiras acima de 40 anos. A MSR permitiu a avaliação dos efeitos isolados bem como da interação de matérias primas em respostas como: parâmetros reológicos, sensorial e hidratação. As formulações desenvolvidas foram consideradas estáveis pelos testes de estabilidade realizados. Os principais efeitos relacionados ao fotoenvelhecimento foram: perda da qualidade elástica, maior número e largura de rugas, menor ecogenicidade, maior ângulo tipológico individual e maior tamanho de corneócitos. Na análise morfológica, foi observado um padrão de pigmentação irregular, queratinócitos distribuídos irregularmente, achatamento da junção dermoepidérmica e a presença de fibras de colágeno deterioradas. Diferentes características morfológicas, estruturais e biofísicas foram encontradas na pele brasileira e francesa, que são submetidas a diferentes fatores ambientais e apresentam hábitos distintos. A formulação contendo Tocoretinate atuou na hidratação, na elasticidade líquida, no aumento do componente viscoso da pele, na redução da espessura do estrato córneo, aumento da espessura da epiderme, melhoria da homogeneidade e redução da pigmentação da epiderme e aumento da profundidade das papilas dérmicas. As formulações contendo derivados de vitaminas A e E apresentaram efeito na hidratação cutânea e função barreira da pele, no aumento da porção viscoelástica da curva, aumento da reflectância entre os queratinócitos após 84 dias de estudo. A caracterização da pele por técnicas de biofísica e análise de imagem foi fundamental para a definição do protocolo de estudo clínico de eficácia aplicando as referidas técnicas. O estudo clínico mostrou a eficácia da formulação desenvolvida contendo Tocoretinate na melhoria das condições da pele fotoenvelhecida, e fornece embasamento científico relevante para o uso deste ingrediente ativo inovador tanto em produtos cosméticos como na clínica dermatológica. / Photoaging is a subject of great interest in cosmetics and dermatology. Thus, it is important to characterize photodamaged skin and the development of appropriate dermocosmetic formulations for this purpose. Vitamins A and E and their derivatives have emerged as active substances for this purpose, and, based on this concept, an innovative compound was proposed, the Tocoretinate (ester of all-trans retinoic acid and D-?-tocopherol), which is a potential active ingredient to replace retinoic acid, acting on the improvement of photodamaged skin conditions. The objective of this project is to characterize the skin changes due to photoaging and to develop, evaluate the stability and clinical efficacy of anti-aging cosmetic formulations containing Tocoretinate, retinyl palmitate and tocopheryl acetate. An experimental design of three factors in three levels of experience (Box-Behnken) with response surface methodology (RSM) was performed to evaluate the main effects and interactions of raw materials of the formulations. Three formulations were selected containing, or not, 0.5% retinyl palmitate, 5% tocopheryl acetate and 0.1% Tocoretinate, which were submitted to stability tests. The characterization of the brazilian photodamaged skin on the face, forearms and back of the hands was carried out on 80 volunteers in two age groups through self-assessment questionnaires and biophysical and skin imaging techniques. The same evaluation was performed on the volar forearm and face of 41 French volunteers aged between 40-65 years old. The developed formulations were evaluated by biophysical and skin imaging techniques before, and after 84 days of application of the formulations. RSM allowed the evaluation of the effects of the raw materials on the responses: rheological behavior, sensory properties and hydration. The formulations were considered stable in stability tests. The clinical and morphological features related to photoaging were: loss of the elastic quality, more wrinkles, less echogenicity, higher individual typological angle and larger size of corneocytes and a thicker stratum corneum. For the morphological analysis, an irregular pigmentation pattern was observed, keratinocytes irregularly distributed, flattening of the dermal-epidermal junction and the presence of damaged collagen fibers. Different morphological, structural and biophysical characteristics were found in Brazilian and French skin, that are exposed to different environmental factors and has distinct habits. The formulation containing Tocoretinate acted on skin hydration, elasticity, reduced stratum corneum thickness, increased epidermal thickness, improved uniformity, reduced skin pigmentation, and also increased depth of dermal papillae. Formulations containing derivatives of vitamins A and E acted on skin barrier function and hydration, increasing the portion of the viscoelastic curve and improved the interkeratinocyte reflectance after 84 days of the study. The characterization of the skin by biophysical techniques and skin imaging analysis was fundamental in effectively defining the clinical study protocol applying these techniques. The clinical study showed the efficacy of the formulations developed containing Tocoretinate in improving photodamaged skin conditions, and provides relevant scientific basis for the use of this innovative active ingredient both in dermocosmetics and in dermatology.

O fotoenvelhecimento tem sido um assunto de grande interesse na área cosmética e dermatológica. Portanto, é relevante a caracterização da pele fotoenvelhecida, bem como o desenvolvimento de formulações dermocosméticas adequadas e direcionadas à finalidade de uso proposta. As vitaminas A e E e seus derivados tem se destacado como substâncias ativas para tal finalidade, e, baseado nesse conceito, foi proposto um composto inovador, o Tocoretinate (éster de all-trans-ácido retinoico e D-?-tocoferol), uma potencial substância ativa alternativa ao ácido retinoico para atuar na melhoria das condições da pele fotoenvelhecida. Nesse contexto, o objetivo do presente projeto foi caracterizar as alterações cutâneas decorrentes do fotoenvelhecimento, desenvolver e avaliar a estabilidade e a eficácia clínica de formulações cosméticas antienvelhecimento contendo Tocoretinate (TR), palmitato de retinila ou acetato de tocoferila. Para tal, inicialmente foi feito o planejamento experimental Box-Behnken com metodologia de superfície de resposta (MSR) foi executado para avaliar os principais efeitos e interações das matérias-primas da formulação. Foram selecionadas três formulações contendo, ou não, 0,5% de palmitato de retinila, 5% do acetato de tocoferila e 0,1% de Tocoretinate, as quais foram avaliadas quanto a sua estabilidade. A caracterização da pele fotoenvelhecida brasileira na face, nos antebraços e no dorso das mãos foi realizada em 80 voluntárias em dois grupos de idade por meio de questionários de autoavaliação e por técnicas de biofísica e imagem da pele. A mesma avaliação foi realizada no antebraço volar e face de 41 voluntárias francesas de 40 a 65 anos. As formulações desenvolvidas foram avaliadas por técnicas de biofísica e análise de imagem antes e após 84 dias de uso pelas voluntárias brasileiras acima de 40 anos. A MSR permitiu a avaliação dos efeitos isolados bem como da interação de matérias primas em respostas como: parâmetros reológicos, sensorial e hidratação. As formulações desenvolvidas foram consideradas estáveis pelos testes de estabilidade realizados. Os principais efeitos relacionados ao fotoenvelhecimento foram: perda da qualidade elástica, maior número e largura de rugas, menor ecogenicidade, maior ângulo tipológico individual e maior tamanho de corneócitos. Na análise morfológica, foi observado um padrão de pigmentação irregular, queratinócitos distribuídos irregularmente, achatamento da junção dermoepidérmica e a presença de fibras de colágeno deterioradas. Diferentes características morfológicas, estruturais e biofísicas foram encontradas na pele brasileira e francesa, que são submetidas a diferentes fatores ambientais e apresentam hábitos distintos. A formulação contendo Tocoretinate atuou na hidratação, na elasticidade líquida, no aumento do componente viscoso da pele, na redução da espessura do estrato córneo, aumento da espessura da epiderme, melhoria da homogeneidade e redução da pigmentação da epiderme e aumento da profundidade das papilas dérmicas. As formulações contendo derivados de vitaminas A e E apresentaram efeito na hidratação cutânea e função barreira da pele, no aumento da porção viscoelástica da curva, aumento da reflectância entre os queratinócitos após 84 dias de estudo. A caracterização da pele por técnicas de biofísica e análise de imagem foi fundamental para a definição do protocolo de estudo clínico de eficácia aplicando as referidas técnicas. O estudo clínico mostrou a eficácia da formulação desenvolvida contendo Tocoretinate na melhoria das condições da pele fotoenvelhecida, e fornece embasamento científico relevante para o uso deste ingrediente ativo inovador tanto em produtos cosméticos como na clínica dermatológica. / Photoaging is a subject of great interest in cosmetics and dermatology. Thus, it is important to characterize photodamaged skin and the development of appropriate dermocosmetic formulations for this purpose. Vitamins A and E and their derivatives have emerged as active substances for this purpose, and, based on this concept, an innovative compound was proposed, the Tocoretinate (ester of all-trans retinoic acid and D-?-tocopherol), which is a potential active ingredient to replace retinoic acid, acting on the improvement of photodamaged skin conditions. The objective of this project is to characterize the skin changes due to photoaging and to develop, evaluate the stability and clinical efficacy of anti-aging cosmetic formulations containing Tocoretinate, retinyl palmitate and tocopheryl acetate. An experimental design of three factors in three levels of experience (Box-Behnken) with response surface methodology (RSM) was performed to evaluate the main effects and interactions of raw materials of the formulations. Three formulations were selected containing, or not, 0.5% retinyl palmitate, 5% tocopheryl acetate and 0.1% Tocoretinate, which were submitted to stability tests. The characterization of the brazilian photodamaged skin on the face, forearms and back of the hands was carried out on 80 volunteers in two age groups through self-assessment questionnaires and biophysical and skin imaging techniques. The same evaluation was performed on the volar forearm and face of 41 French volunteers aged between 40-65 years old. The developed formulations were evaluated by biophysical and skin imaging techniques before, and after 84 days of application of the formulations. RSM allowed the evaluation of the effects of the raw materials on the responses: rheological behavior, sensory properties and hydration. The formulations were considered stable in stability tests. The clinical and morphological features related to photoaging were: loss of the elastic quality, more wrinkles, less echogenicity, higher individual typological angle and larger size of corneocytes and a thicker stratum corneum. For the morphological analysis, an irregular pigmentation pattern was observed, keratinocytes irregularly distributed, flattening of the dermal-epidermal junction and the presence of damaged collagen fibers. Different morphological, structural and biophysical characteristics were found in Brazilian and French skin, that are exposed to different environmental factors and has distinct habits. The formulation containing Tocoretinate acted on skin hydration, elasticity, reduced stratum corneum thickness, increased epidermal thickness, improved uniformity, reduced skin pigmentation, and also increased depth of dermal papillae. Formulations containing derivatives of vitamins A and E acted on skin barrier function and hydration, increasing the portion of the viscoelastic curve and improved the interkeratinocyte reflectance after 84 days of the study. The characterization of the skin by biophysical techniques and skin imaging analysis was fundamental in effectively defining the clinical study protocol applying these techniques. The clinical study showed the efficacy of the formulations developed containing Tocoretinate in improving photodamaged skin conditions, and provides relevant scientific basis for the use of this innovative active ingredient both in dermocosmetics and in dermatology.

No description available.

O câncer de mucosa oral é um problema de saúde pública, com maior incidência em homens acima de 50 anos. Uma das manifestações clínicas mais precoces do câncer da mucosa oral são as lesões leucoqueratósica. O aspecto clínico não homogêneo e o tamanho maior de 200mm2, em mucosa não queratinizada como a do assoalho da boca e ventre da língua, são aspectos que implicam na possibilidade de evolução da lesão. A dificuldade do diagnóstico das lesões precoces está na seleção do local a ser biopsiado principalmente frente a lesões extensas e heterogêneas. O objetivo desta pesquisa é avaliar se a utilização do exame clínico juntamente com os métodos auxiliares de diagnóstico das lesões leucoqueratósica da mucosa oral (VELscope®, Azul de toluidina e Solução de lugol) contribui para uma maior precisão do diagnóstico de displasias nestas lesões quando comparado ao histopatológico. E, identificar os padrões morfológicos destas lesões quando avaliadas por meio da microscopia confocal reflectante. Foram selecionados 30 pacientes, maiores de 18 anos, portadores de lesão clínica compatível com leucoplasia oral triados no ambulatório da disciplina de Estomatologia Clínica da Faculdade de Odontologia da Universidade de São Paulo e que precisavam ser submetidos à biópsia para o estabelecimento do diagnóstico final. Foram realizados os testes de Azul de Toluidina, Solução de Lugol, VELscope®, microscopia confocal reflectante e posteriormente, a biópsia incisional para obtenção do diagnóstico final. Os pacientes incluídos possuíam média de idade 60,66 anos, sendo 70% (21/30) do gênero feminino e 30% (9/30) do gênero masculino. O tabagismo foi relatado por 16,7% (5/30) dos pacientes, sendo 60% (3/5) homens. A associação do tabagismo e etilismo foi relatada em 10% (3/30) dos pacientes, o tabagismo isoladamente por 6,6% (2/30) e o de etilismo por 3,3%(1/30). A associação dos hábitos e o etilismo isolado foram relatados somente por homens. Enquanto que o hábito de tabagismo isolado foi relatado somente por mulheres. Com o uso do VELscope® todas as lesões apresentaram perda da fluorescência tecidual sendo, portanto todas positivas para este método. Com a Solução de Lugol, 100% das lesões não coraram, sendo portanto positivas para este método. O exame histopatológico permitiu o diagnóstico de 30% (9/30) casos de carcinoma epidermoide, 10% (3/30) de neoplasia intraepitelial, 20% (6/30) de líquen plano oral e 40% (12/30) de líquen simple crônico oral. Para o uso do VELscope® e do Lugol foi observada uma sensibilidade de 100% e uma especificidade de 50%.Para o Azul de Toluidina foi observada uma sensibilidade de 63,15%- 66,66% e especificidade de 75,67%-82,35%.Na Microscopia Confocal Reflectante foram definidos padrões para os quatro diferentes diagnósticos observados. Os métodos auxiliares de diagnóstico por cromoscopia e fluorescência de mucosa se mostraram eficientes no auxílio da delimitação da extensão da lesão e a Microscopia Confocal Reflectante permitiu a visualização de padrões morfológicos das lesões brancas de forma não invasiva. A utilização da Microscopia Confocal Reflectante permitiu também a determinação de padrões morfológicos para o carcinoma epidermoide, a neoplasia intraepitelial, o líquen plano oral e o líquen simples crônico oral e se mostrou eficiente quando comparada ao exame histopatológico. / Cancer of the oral mucosa is a public health problem, with higher incidence in men above 50 years. One of the earliest manifestations of cancer of the oral mucosa lesions are leukokeratosis. The inhomogeneous clinical aspect and the larger size of 200mm2 in non-keratinized mucosa as the floor of the mouth and constipation of the tongue, are aspects that imply the possibility of evolution of the lesion. The difficulty of diagnosis of early lesions is in the selection of the site to be biopsied primarily against large and heterogeneous lesions. The objective of this research is to evaluate the use of clinical examination along with diagnostic aids leucoqueratósica of oral lesions (VELscope ®, Toluidine blue and Lugol solution) methods contributes to greater accuracy of diagnosis of dysplasia in these lesions when compared the histopathological. And identify the morphological patterns of these lesions when evaluated by reflectance confocal microscopy. 30 patients older than 18 years, with clinical lesion compatible with oral leukoplakia screened in the outpatient discipline of Clinical Dentistry, Faculty of Dentistry, University of São Paulo and that needed to be biopsied to establish the final diagnosis were selected. Tests toluidine blue, Lugol\'s solution, VELscope ®, reflectance confocal microscopy (RCM) and subsequently, incisional biopsy to obtain the final diagnosis were performed. Patients enrolled had a mean age 60.66 years, 70% (21/30) were female and 30% (9/30) were male. Smoking was reported by 16.7% (5/30) of patients, 60% (3/5) homens.A association of smoking and alcohol use was reported in 10% (3/30) of patients, smoking alone by 6.6% (2/30) and of alcoholism by 3.3% (1/30). The association of habits and alcoholism alone were reported by men only. While the habit of smoking alone was reported by women only. Using the VELscope ® all lesions showed loss of tissue fluorescence, so being all positive for this method. With Lugol\'s solution, 100% of the lesions did not stain, thus being positive for this method. Histopathological examination allowed the diagnosis of 30% (9/30) cases of squamous cell carcinoma, 10% (3/30) of intraepithelial neoplasia, 20% (6/30) of oral lichen planus and 40% (12/30) chronic oral lichen simple. For the use of Lugol VELscope ® and a sensitivity of 100% and a specificity of 50% was observed for the toluidine blue a sensitivity of 63.15%- 66.66% was observed and a specificity of 75.67% - 82.35%. Confocal Microscopy In reflective patterns observed for the four different diagnoses were defined. Auxiliary diagnostic methods chromoscopy and fluorescence mucosa were effective in aiding the delimitation of the extent of injury and Reflectance Confocal Microscopy allowed the visualization of morphological patterns of white lesions noninvasively. Use the Reflectance Confocal Microscopy also allowed the determination of morphological patterns to epidermoid carcinoma, intraepithelial neoplasia, oral lichen planus and lichen simplex chronic oral and proved efficient when compared to histopathology.

O câncer de mucosa oral é um problema de saúde pública, com maior incidência em homens acima de 50 anos. Uma das manifestações clínicas mais precoces do câncer da mucosa oral são as lesões leucoqueratósica. O aspecto clínico não homogêneo e o tamanho maior de 200mm2, em mucosa não queratinizada como a do assoalho da boca e ventre da língua, são aspectos que implicam na possibilidade de evolução da lesão. A dificuldade do diagnóstico das lesões precoces está na seleção do local a ser biopsiado principalmente frente a lesões extensas e heterogêneas. O objetivo desta pesquisa é avaliar se a utilização do exame clínico juntamente com os métodos auxiliares de diagnóstico das lesões leucoqueratósica da mucosa oral (VELscope®, Azul de toluidina e Solução de lugol) contribui para uma maior precisão do diagnóstico de displasias nestas lesões quando comparado ao histopatológico. E, identificar os padrões morfológicos destas lesões quando avaliadas por meio da microscopia confocal reflectante. Foram selecionados 30 pacientes, maiores de 18 anos, portadores de lesão clínica compatível com leucoplasia oral triados no ambulatório da disciplina de Estomatologia Clínica da Faculdade de Odontologia da Universidade de São Paulo e que precisavam ser submetidos à biópsia para o estabelecimento do diagnóstico final. Foram realizados os testes de Azul de Toluidina, Solução de Lugol, VELscope®, microscopia confocal reflectante e posteriormente, a biópsia incisional para obtenção do diagnóstico final. Os pacientes incluídos possuíam média de idade 60,66 anos, sendo 70% (21/30) do gênero feminino e 30% (9/30) do gênero masculino. O tabagismo foi relatado por 16,7% (5/30) dos pacientes, sendo 60% (3/5) homens. A associação do tabagismo e etilismo foi relatada em 10% (3/30) dos pacientes, o tabagismo isoladamente por 6,6% (2/30) e o de etilismo por 3,3%(1/30). A associação dos hábitos e o etilismo isolado foram relatados somente por homens. Enquanto que o hábito de tabagismo isolado foi relatado somente por mulheres. Com o uso do VELscope® todas as lesões apresentaram perda da fluorescência tecidual sendo, portanto todas positivas para este método. Com a Solução de Lugol, 100% das lesões não coraram, sendo portanto positivas para este método. O exame histopatológico permitiu o diagnóstico de 30% (9/30) casos de carcinoma epidermoide, 10% (3/30) de neoplasia intraepitelial, 20% (6/30) de líquen plano oral e 40% (12/30) de líquen simple crônico oral. Para o uso do VELscope® e do Lugol foi observada uma sensibilidade de 100% e uma especificidade de 50%.Para o Azul de Toluidina foi observada uma sensibilidade de 63,15%- 66,66% e especificidade de 75,67%-82,35%.Na Microscopia Confocal Reflectante foram definidos padrões para os quatro diferentes diagnósticos observados. Os métodos auxiliares de diagnóstico por cromoscopia e fluorescência de mucosa se mostraram eficientes no auxílio da delimitação da extensão da lesão e a Microscopia Confocal Reflectante permitiu a visualização de padrões morfológicos das lesões brancas de forma não invasiva. A utilização da Microscopia Confocal Reflectante permitiu também a determinação de padrões morfológicos para o carcinoma epidermoide, a neoplasia intraepitelial, o líquen plano oral e o líquen simples crônico oral e se mostrou eficiente quando comparada ao exame histopatológico. / Cancer of the oral mucosa is a public health problem, with higher incidence in men above 50 years. One of the earliest manifestations of cancer of the oral mucosa lesions are leukokeratosis. The inhomogeneous clinical aspect and the larger size of 200mm2 in non-keratinized mucosa as the floor of the mouth and constipation of the tongue, are aspects that imply the possibility of evolution of the lesion. The difficulty of diagnosis of early lesions is in the selection of the site to be biopsied primarily against large and heterogeneous lesions. The objective of this research is to evaluate the use of clinical examination along with diagnostic aids leucoqueratósica of oral lesions (VELscope ®, Toluidine blue and Lugol solution) methods contributes to greater accuracy of diagnosis of dysplasia in these lesions when compared the histopathological. And identify the morphological patterns of these lesions when evaluated by reflectance confocal microscopy. 30 patients older than 18 years, with clinical lesion compatible with oral leukoplakia screened in the outpatient discipline of Clinical Dentistry, Faculty of Dentistry, University of São Paulo and that needed to be biopsied to establish the final diagnosis were selected. Tests toluidine blue, Lugol\'s solution, VELscope ®, reflectance confocal microscopy (RCM) and subsequently, incisional biopsy to obtain the final diagnosis were performed. Patients enrolled had a mean age 60.66 years, 70% (21/30) were female and 30% (9/30) were male. Smoking was reported by 16.7% (5/30) of patients, 60% (3/5) homens.A association of smoking and alcohol use was reported in 10% (3/30) of patients, smoking alone by 6.6% (2/30) and of alcoholism by 3.3% (1/30). The association of habits and alcoholism alone were reported by men only. While the habit of smoking alone was reported by women only. Using the VELscope ® all lesions showed loss of tissue fluorescence, so being all positive for this method. With Lugol\'s solution, 100% of the lesions did not stain, thus being positive for this method. Histopathological examination allowed the diagnosis of 30% (9/30) cases of squamous cell carcinoma, 10% (3/30) of intraepithelial neoplasia, 20% (6/30) of oral lichen planus and 40% (12/30) chronic oral lichen simple. For the use of Lugol VELscope ® and a sensitivity of 100% and a specificity of 50% was observed for the toluidine blue a sensitivity of 63.15%- 66.66% was observed and a specificity of 75.67% - 82.35%. Confocal Microscopy In reflective patterns observed for the four different diagnoses were defined. Auxiliary diagnostic methods chromoscopy and fluorescence mucosa were effective in aiding the delimitation of the extent of injury and Reflectance Confocal Microscopy allowed the visualization of morphological patterns of white lesions noninvasively. Use the Reflectance Confocal Microscopy also allowed the determination of morphological patterns to epidermoid carcinoma, intraepithelial neoplasia, oral lichen planus and lichen simplex chronic oral and proved efficient when compared to histopathology.

Background. The development of non-invasive imaging techniques has been stimulated by the shortcomings of histopathology. Currently the only valid diagnostic technique in dermatology is skin biopsy which remains a painful, invasive intervention for the patient. Moreover, this approach is not always convenient for monitoring and follow-up of a skin disease. Optical imaging technologies could solve these shortcomings as they are fast, precise, repeatable and painless. There are four established non-invasive skin imaging techniques used in daily practice: dermoscopy, high-frequency ultrasound, reflectance confocal microscopy (RCM) and conventional optical coherence tomography (C-OCT). In imaging there is a trade-off between resolution and penetration depth. The former permits the visualization of cells, if the resolution is at least 3 µm. The latter enables the recognition of patterns and structures in deeper layers of the skin if the penetration depth is deeper than 150 µm. New non-invasive techniques using infrared light sources have been developed recently. The technique used in this work is a high-definition optical coherence tomography (HD-OCT).Objectives. The overall aims of this thesis were the feasibility of HD-OCT to visualize in/ex vivo, in real time and in 3-D the cellular and structural morphology of the skin, secondly the assessment of the capability of this technology to measure in vivo and real time the cutaneous optical properties, and finally the determination of the contribution of this technique to the non-invasive near-infrared imaging technologies. Five specific objectives have been established: i) could cells be observed in their 3-D microenvironment in normal and diseased skin, ii) could we describe morphologic features of cells and structures in normal and diseased skin (m_HD-OCT), iii) could these morphologic features be quantified by optical property analysis (o_HD-OCT), iv) was it possible to perform accurate thickness measurements in normal and diseased skin, and finally v) what was the diagnostic potential of this technique?Methodology. HD-OCT uses a combination of parallel time-domain interferometry, high power tungsten lamp (with Gaussian filter, very low lateral coherence and ultra-high bandwidth (1300 nm +/- 100 nm)), and last but not least, full field illumination with real time focus tracking. A constant homogeneous resolution of 3 µm resolution in all three dimensions is obtained up to a depth of 570 µm. Hence, the system is capable of capturing real time full 3-D images. Moreover, the in vivo assessment of optical properties of the skin is only applicable to OCT when operating in focus-tracking mode, which is the case for HD-OCT. The means to obtain answers to the five specific questions were the comparison of en face HD-OCT images with RCM and HD-OCT cross-sectional images with histopathology and C-OCT. Results. At least 160 line pares were observed by imaging a high resolution phantom with HD-OCT. This suggested a 3 µm lateral resolution. The presence of cells such as keratinocytes, melanocytes, inflammatory cells, fibroblasts and melanophages in their 3-D cutaneous microenvironment in vivo as well as ex vivo has been demonstrated .A qualitative description of structures and patterns in normal and diseased skin could be performed by HD-OCT. Clear structural changes of the epidermis, dermo-epidermal junction, papillary dermis and reticular dermis related to intrinsic skin ageing could be observed. Lobulated structures, surrounded by stretched stromal fibers and arborizing vessels, could be demonstrated in nodular basal cell carcinoma (BCC). The o_HD-OCT of normal and diseased skin could be assessed in vivo. This approach permitted the quantitative assessment of the OCT signal attenuation profiles of normal healthy skin, actinic keratosis (AK) and squamous cell carcinoma (SCC). Differences in signal attenuation profiles could be demonstrated between these three groups. These differences were also observed between BCC subtypes. The slope of the exponential attenuation of the signal in the upper part of the epidermis was very high in benign nevi. The more malignant the lesion the lower the slope. Thickness measurements of epidermis and papillary dermis could be performed by m_HD-OCT, based on a cross-sectional images and their corresponding en face image. More accurate measurements of epidermal and papillary dermal thickness could be performed based on the optical analysis of a skin volume by o_HD-OCT. The diagnostic potential of HD-OCT in comparison with dermoscopy, RCM and C-OCT could be assessed regarding i) melanoma, ii) BCC differentiation from BCC imitators and BCC sub-differentiation and iii) SCC differentiation from AK. A much higher diagnostic potential could be demonstrated for o_HD-OCT in comparison with m_HD-OCT concerning melanoma detection. The diagnostic potential of HD-OCT to discriminate BCC from clinical BCC imitators was moderate. However, HD-OCT seemed to have high potential in sub-differentiation of BCC subtypes: i) it seemed to be the best technique to include and exclude a superficial BCC, ii) the technique appeared to be the best approach to exclude nodular BCC, and iii) HD-OCT looked to be the best technique to include an infiltrative BCC. Finally, HD-OCT has proven to be a powerful method to discriminate AK from SCC.Conclusions. HD-OCT is able to capture real time 3-D imaging with a sufficiently high optical resolution and penetration depth to allow the visualization of cells in and ex vivo in their micro-architectural context. At the same time, HD-OCT permits the recognition of patterns and structures in a sufficiently large volume of skin (1.5 mm³). HD-OCT closes therefore the gap between RCM with a high resolution but low penetration depth and C-OCT with a low resolution but high penetration depth. Moreover, HD-OCT permits, in contrast to RCM and C-OCT, the real time in vivo analysis of optical properties of the skin. HD-OCT seems to be a promising tool for early diagnosis of melanoma, BCC sub-differentiation and differentiation between SCC and AK.Future perspectives. Multicenter validation studies are needed to determine the diagnostic performance of this promising new technology, especially in other clinical settings combining both morphological and optical property analysis. This combined analysis could be a valuable method not only for diagnosis, monitoring and therapeutic guidance of dermatologic diseases but it could also be helpful in the management of non-dermatologic conditions such as diabetic micro-angiopathy, infantile cystinosis or even osteoporosis. / Doctorat en Sciences médicales (Santé Publique) / info:eu-repo/semantics/nonPublished

Dans cette thèse, nous développons des modèles et des méthodes statistiques pour le traitement d’images de microscopie confocale de la peau dans le but de détecter une maladie de la peau appelée lentigo. Une première contribution consiste à proposer un modèle statistique paramétrique pour représenter la texture dans le domaine des ondelettes. Plus précisément, il s’agit d’une distribution gaussienne généralisée dont on montre que le paramètre d’échelle est caractéristique des tissus sousjacents. La modélisation des données dans le domaine de l’image est un autre sujet traité dans cette thèse. A cette fin, une distribution gamma généralisée est proposée. Notre deuxième contribution consiste alors à développer un estimateur efficace des paramètres de cette loi à l’aide d’une descente de gradient naturel. Finalement, un modèle d’observation de bruit multiplicatif est établi pour expliquer la distribution gamma généralisée des données. Des méthodes d’inférence bayésienne paramétrique sont ensuite développées avec ce modèle pour permettre la classification d’images saines et présentant un lentigo. Les algorithmes développés sont appliqués à des images réelles obtenues d’une étude clinique dermatologique. / In this work, we develop statistical models and processing methods for confocal microscopy images. The first contribution consists of a parametric statistical model to represent textures in the wavelet domain. Precisely, a generalized Gaussian distribution is proposed, whose scale parameter is shown to be discriminant of the underlying tissues. The thesis deals also with modeling data in the image domain using the generalized gamma distribution. The second contribution develops an efficient parameter estimator for this distribution based on a natural gradient approach. The third contribution establishes a multiplicative noise observation model to explain the distribution of the data. Parametric Bayesian inference methods are subsequently developed based on this model to classify healthy and lentigo images. All algorithms developed in this thesis have been applied to real images from a dermatologic clinical study.