Photoacoustic Imaging Can Democratize Dermatology Care

Mansak Shishak, Dr. Mansak Skin Clinic, and Somesh Gupta, All India Institute of Medical Sciences

Light-based technologies have long been used for therapeutics and diagnostics in dermatology. Their applications are wide-ranging and common, such as UV light-based treatments of the skin, vascular lasers to treat abnormal blood vessels, intense pulsed light to treat lesions and unwanted hair, and various imaging methods, such as confocal microscopy to monitor skin conditions. Imaging techniques have been modified to allow better resolution and accuracy in lesion classification and assessment for prognostication. System developers should be moving toward using “dermasmart” biomaterials and techniques, which offer high sensitivity, affordable methods of delivery, and are acceptable to patients.

Photoacoustic imaging, or optoacoustic imaging, combines the benefits of microscopy and ultrasonography. It uses a light-based laser system to provide high-resolution optical contrast, scanning lesions over a wide spatial topography, and to image depths beyond the papillary dermis. Combined with ultrasound, it measures tissue morphology, such as skin thickness, tumor characteristics, and vascular anomalies. Visualization of tumor margins in cutaneous melanomas can be completed at the same time as lymph node status evaluation. Early detection of diabetic vasculopathy with photoacoustic imaging will greatly enable prevention and management of common complications, such as diabetic foot and nonhealing ulcers.

Light-based technologies could aid in diagnostic compliance, since patients may be more receptive to methods that do not require biopsy, and are therefore painless and less invasive. Photoacoustic imaging also maps endogenous chromophores, such as melanin, lipids, collagen, and hemoglobin; many techniques currently employed for diagnostics target just one of these.

Deploying such tools for large segments of the population, in which early diagnosis and prompt intervention with a better prognosis are sorely needed, will determine its utility. We believe that preventable conditions require meaningful technology to solve nagging issues of timely specialist consultations — especially in rural care settings. Clinicians also will need to integrate imaging into artificial intelligence (AI)-based systems that inform treatment on-site. The introduction of deep learning and AI will assure more accurate data sets for photoacoustic image reconstruction, which will continue the growth of this technology into other communities.

Translating preclinical evidence to clinical utility that can be scalable and affordable and can enhance delivery of key capabilities to those with unmet needs will be the true test of its effectiveness. For widespread adoption in underserved areas, dermatologists will require an energy-efficient system, so engineers and manufacturers will need to focus on using cost-effective materials for illumination in a portable or hand-held system. Researchers must direct photoacoustic imaging systems’ adaptation into new settings and study its clinical efficacy in varied populations, optimizing its role in clinical dermatology care and delivery.

Meet the authors

Mansak Shishak, M.D., is a practicing dermatologist based in New Delhi, India, with a special interest in accessible therapeutics for special population groups; email: mansakshishak@gmail.com.

Somesh Gupta is a professor of dermatology and venereology at the All India Institute of Medical Sciences in New Delhi, India. He is one of the directors of the Dermatology, Aesthetics, and Surgery International League; email: someshgupta@aiims.edu.

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