Evaluation of Treatment Efficacy through Skin Texture Analysis

Evaluation of Treatment Efficacy through Skin Texture Analysis


The traditional assessment of skin texture based on multiple health professionals can lead to inconsistent results making standardized digital dermatological monitoring, as provided by SCARLETRED, an essential tool.

Currently, both in terms of health or skin cosmetic effects, there has been a particular need for the analysis and quantitative evaluation of skin texture. As there are numerous factors which can affect the quality and thus the texture of the skin, including dermatological disorders such as acne and rosacea, assessment by multiple doctors using traditional methods is prone to variations given its subjective nature.

With that in mind, there is a need by dermatologists for a tool which allows for a more accurate and automated evaluation of skin texture alterations aiming to improve patient diagnosis and individualized treatment plans. By extension, providing medical professionals with a scalable digital technology that enables a standardized assessment approach is essential for the monitoring of treatment effectiveness.  

In this context, SCARLETRED, an Austrian digital health company, has developed a innovative solution, Scarletred®Vision, for the standardized imaging, documentation, quantification, and assessment of conditions ranging from dermatological disorders to drug reactions on the skin to nail fungal infections.

Scarletred®Vision is a CE certified Class I Medical Device: the system is ICH-GCP, GDPR- and HIPAA-compliant and is a certified ISO-13485 Quality Management System. It is used in a wide variety of settings, including clinical trials (preclinical to phase IV), routine clinical work, hospital care as well as remote monitoring of patients. Scarletred®Vision’s scalability allows doctors to easily empower their subjects to participate and provide valuable data remotely, from the comfort of their home. 

How does Scarletred®Vision work?

Scarletred®Vision consists of the following components:

Mobile App: generation of high-quality images in conformity with data protection regulations and patient anonymity

QR-Code: each subject receives a QR-Code from their medical doctor/expert. Participant-specific information that could be used to identify them is not stored (e.g. name, date of birth, etc.) on Scarletred®Vision

Skin Patches: are placed next to the skin/nail area to be imaged and documented. The software recognizes the color patch and calibrates of the image for lighting conditions and size

Online Platform: web-based platform accessible from any browser allowing the documentation, data management, quantification, and analysis of patient/subject data


Scarletred®Vision Mobile App

Imaging & ePRO

Step 1: Place the Skin Patch on the healthy skin next to the area of interest

Step 2: Take an image using the Mobile App, which is then automatically uploaded to the secure online platform

Step 3: The analysis can be performed on the Online Platform, which offers multiple tools to assist the medical professionals.

Step 4 (Optional): Electronic Patient Reported Outcomes (ePROs) and questionnaires can be customized and configured to appear after the image has been taken (Figure 1). The answers and the resulting scores are documented centrally on the platform together with the corresponding image. 

Scarletred Vision mobile app ePRO
Figure 1. Scarletred®Vision in-App DLQI. The ePROs can be customized and configured to appear automatically at specific timepoints, as per clinician/study requirements. In this example, the Dermatology Life Quality Index (DLQI) has been configured to automatically appear after an image of the area of interest has been captured.

Scarletred®Vision Online Platform

Documentation and Measurement

Images generated by the Scarletred®Vision mobile app are uploaded to the online platform, which can be used for automated documentation and image analysis. The standardized images are presented in such a way that allows the medical professional to have a clear overview of the disease progression over time.

The quantification of erythema on the on the online platform is made possible by Scarletred®Vision's most iconic signal map, the Standard Erythema Value (SEV*) which  augments the visualization of erythema through the pseudo-colors. The customizable analytical tools allow for the objective assessment and measurement of specific additional parameters: redness (+a*), yellowness (+b*), and lightness (L*) as well as lesion surface area.

Skin Texture 

Information on skin texture offers valuable insight for doctors as an addition to the lesion scores and the measurement of other important metrics, such as surface area and erythema. Skin texture refers to visual patterns or spatial arrangement of pixels which cannot be efficiently described and measured by regional color and intensity. SCARLETRED tackled this issue and developed a tool which, with the help of clinically validated methods, analyzes skin texture and quantitatively assesses the condition (smoothness/roughness) of the skin (Figure 2 and 3).

The tool takes over a dozen metrics into consideration- energy, contrast, entropy to name a few. The algorithm scans the image(s) and the resulting values indicate the skin's homogeneity and smoothness.

Skin texture analysis combined with the quantification of erythema, the surface area measurement, and other centralized assessments on the online platform combine into a powerful tool giving experts and medical professionals a complete picture of the skin's condition over time.

Before treatment

Figure 2a. Analysis on the Scarletred®Vision Online Platform: Original calibrated image of the Rosacea-affected area before treatment. After the global reference area (black) and the area of interest (AOI, blue) have been selected, the measurement result with all the corresponding information such as a date & time stamp, notes by the doctor (e.g. concomitant medication, psychological state, etc.), a body tag of the imaged area (useful for data management), score for severity assessment, and in-app questionnaire results (e.g. DLQI, QoL, and many more customizable ePROs) are summarized. In this example, the mean values of the Standard Erythema value (SEV*) are shown. Not depicted in this figure, yet available as additional visualization tools, are the following pseudo-signal maps: redness (a*), lightness (L*), and yellowness (b*), each highlighting a specific parameter.

Figure 2b. Texture analysis on the Scarletred®Vision Online Platform: Skin texture of a rosacea patient before treatment. The platform presents the results of the skin texture analysis for the global reference area (black) as well as the Rosacea affected area (AOI, blue), in the form of values assigned for energy, contrast, entropy, homogeneity, and overall smoothness. In this example showing a rosacea patient's cheek before treatment, the algorithm classified the skin's smoothness at 21.30%.

After treatment

Figure 3a. Analysis on the Scarletred®Vision Online Platform: Original calibrated image of a rosacea patient after treatment. In this example, the values for the Standard Erythema Value (SEV*) are shown for both the global reference area (black) and the area of interest (AOI, blue). The results of the analysis shows a decrease in the mean SEV* score at the AOI compared to the SEV* value measured before the start of the treatment (Figure 2a). Not depicted in this figure, yet available as additional visualization tools are the following pseudo-signal maps: lightness (L*), redness (a*) and yellowness (b*), each highlighting a specific parameter.

Figure 3b. Analysis on the Scarletred®Vision Online Platform: Skin texture of a rosacea patient after treatment. The platform displays the results of the skin texture analysis for the global reference area (black) as well as the area of interest, namely the patient's right cheek (blue circle). After treatment, the texture analysis resulted in classifying the skin as "semi-smooth", with a smoothness of 28.40%, indicating that the treatment has indeed improved the texture of the skin.

Scarletred®Vision’s innovative approach to creating digital solutions is the first of its kind. Its modular framework makes it applicable to all skin conditions (dermatological diseases, injection sites, drug reactions, allergic reactions, cosmeceuticals and many more). The certified Medical Device offers digital documentation and analytical tools that have been proven, both in the clinical and home-based settings, to increase data quality, enable doctors to quantify visual parameters, to improve patient treatment regimen and patient compliance, save doctors time, and generate analyses that are not obtainable with other technologies in the field.

Don’t be a stranger!  Get in touch with our Team so that we can discuss how to best tailor our solution to fit your needs: support@scarletred.com

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