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Phototesting based on a divergent beam: a study on normal subjects
Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.
Linköping University, Department of Biomedical Engineering. Linköping University, The Institute of Technology.ORCID iD: 0000-0002-0012-7867
Linköping University, Department of Biomedicine and Surgery, Dermatology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Biomedicine and Surgery, Dermatology. Linköping University, Faculty of Health Sciences.
2001 (English)In: Photodermatology, Photoimmunology & Photomedicine, ISSN 0905-4383, E-ISSN 1600-0781, Vol. 17, no 4, 189-196 p.Article in journal (Refereed) Published
Abstract [en]

In a previous publication from our group, phototesting based on a single exposure to a divergent UVB beam with radially decreasing irradiance values was suggested. The aim of the present study was to evaluate technical, practical and biological aspects of the suggested method in normal subjects. Twenty healthy volunteers were provoked on the back with both a collimated beam (four fixed doses, in circular areas with a diameter of 1.5 cm) and the divergent beam (a continuous, radially attenuating dose spectrum covering an area with a diameter of 4.5 cm). Eleven of the subjects were subjected to double provocation with the divergent beam. Assessment was carried out at 6 and 24 h after exposure by measuring the diameter of the reactions both visually and by mapping the skin blood flow change with laser Doppler perfusion imaging (LDPI). Minimal erythemal dose (MED) was determined for both the collimated and the divergent provocation. The reaction diameters were used to decide MED by combination to a mm for mm mapped dose spectrum of the divergent beam profile. Dose-response curves were plotted using the quantitative response data of the LDPI-images against the corresponding dosimetry data. No systematic difference could be proven between LDPI and visual diameters and a 95% confidence interval for the mean difference was calculated to (-0.8, 2.0). Slightly greater diameters were found at the visual assessment performed at 6 h compared to 24 h (95% confidence interval (-0.1, 2.8)). Double provocation showed a good reproducibility both for the visual and the LDPI assessment (P<0.05). The divergent beam provocation allowed a more detailed discrimination of MED compared to the collimated beam provocation. The MED values determined with the divergent beam were, however, generally higher, especially in the lower range of MED values. Technical factors related to the beam divergence and the correct measurement of erythemal effective irradiance are believed to be the explanation for this phenomenon, which is thus correctable. In conclusion, the results from this study support our belief that the phototesting protocol based on a divergent beam constitutes a good opportunity for improved phototesting, since MED and dose-response characteristics may be extracted in more detail from a single UV exposure.

Place, publisher, year, edition, pages
2001. Vol. 17, no 4, 189-196 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-12817DOI: 10.1034/j.1600-0781.2001.170409.xOAI: oai:DiVA.org:liu-12817DiVA: diva2:17118
Available from: 2007-12-05 Created: 2007-12-05 Last updated: 2017-12-14
In thesis
1. Towards a broader use of phototesting: in research, clinical practice and skin cancer prevention
Open this publication in new window or tab >>Towards a broader use of phototesting: in research, clinical practice and skin cancer prevention
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In western societies, skin cancer incidence has increased dramatically over recent decades, due predominantly to increased sun exposure habits. Ultraviolet (UV) light exposure and individual light sensitivity of the skin constitute two important factors affecting the risk for skin cancer development. Individuals with a heightened propensity to get sunburnt have a higher risk for skin malignancies, and need to protect themselves more systematically from the sun. Individual UVlight sensitivity can be determined either by self-estimation of tendency to burn and tan, as in the Fitzpatrick’s classification, or by use of a phototest. Although phototesting constitutes a considerably more objective method, it is only sparsely used, chiefly due to financial and resource related factors, and is mainly limited to investigation of photodermatoses or dose-management in photo therapy.

The general aim of this thesis was to develop and improve aspects of the phototest procedure in rder to broaden the utilisation of phototesting within the fields of research, clinical practice and skin cancer prevention. As a first step, a new phototesting technique, using a divergent UVB beam was evaluated. The principle of the method is to provoke a circular UVB-erythema in the skin, the diameter of which is related to the administered dose and thus the Minimal Erythema Dose (MED). In a test group of healthy subjects, naked eye reading by a trained observer resulted in a more exact, estimation of UVB-sensitivity, compared to traditional phototesting. Since the diffuse border of the provoked erythema was challenging for the untrained observer to read, the need for an objective, bio-engineering technique for test reading was clear. In this thesis, Laser Doppler perfusion imaging (LDPI) has been used. This data also enabled an objective description of doseresponse for the reaction, an outcome not possible in traditional testing. The divergent beam method was also shown to be useful as a model for evaluation of the effect of topically applied substances.

In order to broaden the utilisation of phototests in general, a test procedure built on patient performed self-reading of skin tests (a traditional phototest and an irritant patch test) was evaluated. The reliability of these self-readings was shown to be substantial when compared to the control readings of a trained observer.

Using the self-reporting procedure, phototesting was evaluated as a tool in primary prevention of skin cancer. The study focussed on sun habits and sun protection behaviour, and also on investigating the impact of different forms of presentation of the preventive information. Results showed significantly higher impact for a personally mediated preventive message than by letterform. For individuals with heightened UV-sensitivity the performance of a phototest led to a greater tendency to adopt sun protection behaviour than for subjects with a lower UV-sensitivity, suggesting that phototesting is a useful way to improve the outcome in terms of preventive behaviours for this group of susceptible, at-risk individuals.

Divergent beam phototesting, patient-performed self-reading, and the application of phototesting in skin cancer prevention emerge as three novel, previously little investigated, aspects of phototesting, for which promising results could be demonstrated.

Abstract [sv]

Under de senaste årtiondena har insjuknandet i hudcancer ökat dramatiskt i västvärlden, detta till stor del beroende på förändrade solvanor. Exponering för solens ultravioletta strålning (UVstrålning) samt den individuella ljuskänsligheten i huden utgör två viktiga faktorer av betydelse för uppkomsten av hudcancer. Individer med ökad benägenhet att bli rödbrända i solen löper också ökad risk för hudcancer av solexponering, och behöver således vara extra noga med att skydda sig mot solen. Hur känslig man är mot solljuset kan bedömas antingen genom självskattning (klassificering enligt Fitzpatrick), eller genom att använda ett ljustest. Det sistnämnda är en betydligt mer objektiv metod, men används ändå relativt sparsamt, sannolikt ofta beroende på brist på resurser, tid eller klinisk rutin.

Det övergripande syftet med avhandlingen var att utveckla och förbättra aspekter på ljustestningsförfarandet med inriktning på att kunna bredda användningen av ljustest inom forskning, klinisk verksamhet och hudcancerprevention. Som ett första steg undersöktes och utvärderades en ny ljustestteknik, baserad på en divergent (spridd) UV-stråle. Genom att belysa huden med ett cirkulärt UV-ljusfält framkallas en cirkulär rodnad (erytem), där diametern på rodnaden står i relation till den individuella ljuskänsligheten i huden. I jämförelse med traditionell ljustestningsmetodik visade sig metoden resultera i en noggrannare uppskattning av ljuskänslighet, samt möjligheten att beskriva ett dos-responsförhållande inom det rodnade hudområdet. Eftersom kanten på den framkallade rodnaden tenderade att bli ganska diffust avgränsad framkom dock, med undantag för speciellt tränade avläsare, svårigheter att läsa av testet med enbart ögats hjälp. Av den anledningen krävdes mer objektiv, hudfysiologisk mätmetodik. I de genomförda studierna användes så kallad Laser Doppler perfusion imaging (LDPI) för detta. Förutom uppskattning av ljuskänsligheten testades den divergenta UV-strålen också som modell för skattning av anti-inflammatorisk effekt av ämnen som appliceras på huden, exempelvis cortison, och visade sig användbar för detta.

I syfte att öka förutsättningarna för bredare användning av ljustest, genomfördes en studie där försökspersonerna själva fick avläsa ett traditionellt ljustest och rapportera in testresultatet. Resultaten jämfördes med avläsningar utförda av en kunnig avläsare, och visade på god tillförlitlighet.

Slutligen, med hjälp av den beskrivna självavläsningsproceduren, undersöktes i en primärvårdspopulation, om ljustestning kan vara användbart för att förebygga hudcancer, med inriktning på att påverka individers solvanor, solskyddsbeteende och attityder gentemot solning. I studien jämfördes även olika modeller för att presentera ett preventionsbudskap, och där ett muntligt sådant, förmedlat vid ett läkarbesök, hade ett betydligt bättre genomslag än motsvarande, enbart skriftlig, information. För individer med hög ljuskänslighet bidrog ljustestet till ökat solskyddsbeteende, vilket indikerar att ljustest skulle kunna vara ett användbart verktyg i eftersträvan att förebygga hudcancer speciellt i denna grupp av individer med förhöjd hudcancerrisk.

Sammanfattningsvis utgör ljustestning med divergent UV-stråle, självavläsning av ljustest samt användning av ljustest vid hudcancerprevention tre nya, tidigare sparsamt undersökta aspekter på ljustestning, för vilka den här avhandlingen visar lovande resultat.

Place, publisher, year, edition, pages
Institutionen för klinisk och experimentell medicin, 2007
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1024
Keyword
Phototesting, divergent beam, skin cancer prevention, self-reading, minimal erythema dose, sun protection behaviour
National Category
Dermatology and Venereal Diseases
Identifiers
urn:nbn:se:liu:diva-10378 (URN)978-91-85895-62-5 (ISBN)
Public defence
2007-11-30, Aulan, Hälsans hus, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2007-12-05 Created: 2007-12-05 Last updated: 2009-08-22
2. Single exposure phototesting and assessment of pigmented skin lesions: quantitative methods in terms of blood perfusion estimates
Open this publication in new window or tab >>Single exposure phototesting and assessment of pigmented skin lesions: quantitative methods in terms of blood perfusion estimates
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis concerns the development of quantitative phototesting for the investigation of individual skin sensitivity to ultraviolet (UV) radiation, and the assessment of pigmented skin lesions (PSL) in terms of blood perfusion estimates. In both cases, laser Doppler perfusion imaging (LDPI) was used to quantify the perfusion.

The proposed phototesting method is based on a single exposure to a divergent UVB beam, which produces a continuous, radially attenuating dose field covering an area with a diameter of 4.5 cm. In order to meet the demands posed by this approach, two-dimensional dosimetry was developed, the entire dose field was adapted to the standard erythemal action spectrum for humans, and a spatially resolving technique (LDPI) was used for objective quantification of the skin response. Data analysis methods were developed, enabling the determination of minimal erythemal dose (MED) and the extraction of dose-response information. The method was evaluated on a normal material (20 subjects), proving a good reproducibility of the MED and enhanced possibilities to extract individual dose-response information. In the study of anti-inflammatory effects (16 subjects) of topically applied substances, linear curve-fitting (0.89 ≤ R2 ≤ 0.98) was shown to adequately describe the relationship between dose and response in the dose range immediately above the MED. The gradient of the derived post MED-lines was used as a measure of the response aggressiveness. The results are promising and warrant further evaluation, e.g. in the investigation of patients with suspected photodermatoses.

This thesis also presents a method for the extraction and presentation of blood perfusion data of pigmented skin lesions in conjunction with optical information on the lesions' spatial extent. The boundaries of pigmented lesions could successfully be delineated, using standard image processing steps, in the total light intensity images given by LDPI. Classical blood perfusion measures such as mean perfusion and perfusion quotients was confined to the ROI, making relevant comparison to corresponding values of neighbouring healthy tissue possible. This data analysis approach was used on a pooled group of PSL showing promising results. The method may prove to be a useful adjunct in the discriminative assessment of pigmented skin lesions.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2003. 68 p.
Series
Linköping Studies in Science and Technology. Dissertations, ISSN 0345-7524 ; 839
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24502 (URN)6626 (Local ID)91-7373-722-4 (ISBN)6626 (Archive number)6626 (OAI)
Public defence
2003-09-19, Viktoriasalen, Universitetssjukhuset, Linköping, 09:15 (Swedish)
Opponent
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2013-01-02

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Ilias, MichailWårdell, KarinFalk, MagnusAnderson, Chris

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