The present invention relates generally to biosensors, and more particularly to reliable, low-cost, fully-integrated hydration sensors for monitoring and diagnosis of skin diseases in any environment, fabricating methods and applications of the same.
The background description provided herein is for the purpose of generally presenting the context of the invention. The subject matter discussed in the background of the invention section should not be assumed to be prior art merely as a result of its mention in the background of the invention section. Similarly, a problem mentioned in the background of the invention section or associated with the subject matter of the background of the invention section should not be assumed to have been previously recognized in the prior art. The subject matter in the background of the invention section merely represents different approaches, which in and of themselves may also be inventions. Work of the presently named inventors, to the extent it is described in the background of the invention section, as well as aspects of the description that may not otherwise qualify as prior art at the time of filing, are neither expressly nor impliedly admitted as prior art against the invention.
Skin disease affects 1 in 4 individuals at a total cost of US $75 billion in yearly spending in the U.S. However, misdiagnosis rates range between less than 10% for dermatologists to 50-80% amongst general practitioners, the latter of whom receive the most patient visits related to skin conditions. Visual identification of skin diseases is non-ideal due to the indistinct nature of disease appearance. Common symptoms for various skin diseases such as inflammation, erythema, and edema are unspecific and visual tracking of symptom severity is difficult. The inverse scenario is also true: a particular disease, such as atopic dermatitis or eczema, may have several sub-categories that present different visual cues. Therefore, solely relying on lesion morphology is insufficient to determine the state of sub-surface layers of skin, particularly in individuals with skin of color, such as the type and extent of damage to the tissue, progression of the disease, and chronicity of the lesion. Clinical tools and procedures used for diagnosis such as biopsies, dermoscopy, magnetic resonance imaging (MRI), and corneometry are expensive, often not widely accessible, and typically uncomfortable for sensitive regions of the skin. The measurements can be time-consuming and/or error prone. These circumstances motivate the need for efficient and intuitive tools to monitor skin health compatible with use both inside and outside the clinic, in any environment and on nearly any location on the body surface.
Thermal sensing is a novel and non-invasive approach to monitoring skin health. Unlike traditional electrical impedance-based techniques (corneometry), these sensors can measure the thermal properties of skin as a function of depth up to several millimeters. Skin thermal sensors demonstrated in past literature involve some combination of limiting drawbacks, including (i) shallow measurement depth (<a few 100 μm), (ii) requirement of expensive cleanroom micro-fabrication, (iii) external power source/battery-reliant operation, (iv) absence of theoretical frameworks to provide direct connections between the measured data and clinically relevant information like skin water content, (v) large measurement errors (±12%) and poor repeatability, (vi) lack of smartphone integration/convenient sensor readout capabilities and/or most importantly (vii) lack of clinical validation across a range of important skin disorders and conditions, inside and outside of hospital facilities.
Therefore, a heretofore unaddressed need exists in the art to address the aforementioned deficiencies and inadequacies.
This invention in one aspect discloses a hydration sensor for monitoring and/or diagnosing a skin condition, and characterizing the hydration status in healthy individuals, for cosmetic and health/wellness applications. The hydration sensor includes a top layer for thermal, chemical and mechanical isolation of the hydration sensor from the environment; a bottom layer operably placed on a target area of interest on the skin; and a flexible printed circuit board (f-PCB) disposed between the top layer and the bottom layer. The f-PCB contains electronics for sensing and wireless communication. The bottom layer operably serves as a direct interface between the f-PCB and the skin. The top layer serves to thermally, chemically and mechanically isolate the underlying layers and electronics from the environment.
In one embodiment, the electronics comprises a heating circuit comprising a heating element for operably heating the target area of interest of the skin; and a sensing circuit comprising a temperature sensor for simultaneously recording a transient temperature change (ΔT) thereof.
In one embodiment, the heating element comprises a heater comprising at least one resistor.
In one embodiment, the heater comprises two or more surface-mount (SMT) thin film resistors, thick film resistors, through-hole resistors, and/or ultrathin-film (about 50-200 nm thick) metal resistors connected in series to form a heater.
In one embodiment, the temperature sensor comprises at least one SMT negative temperature coefficient thermistor, positive temperature coefficient thermistor, resistance temperature detector (RTD), thermocouple or any other conductive temperature sensor.
In one embodiment, the heating element and the temperature sensor are arranged from each other by a distance.
In one embodiment, the distance is determined by the design requirement of depth sensitivity into the skin, and ranges from about 10 μm to about 10 mm.
In one embodiment, the heater and temperature sensor are the same component, where the distance between them is zero.
In one embodiment, the sensing circuit further comprises a microcontroller (μC).
In one embodiment, the heater is operably switchable between ON and OFF controlled by the microcontroller.
In one embodiment, the microcontroller is programmable with custom-designed embedded codes using at least one of near field communication (NFC), Wi-Fi/Internet, Bluetooth, Bluetooth low energy (BLE), and GSM/Cellular communication protocols for wireless communication of the hydration sensor to a custom smartphone application.
In one embodiment, the electronics further comprises a primary antenna tuned to primary frequency, and a secondary antenna.
In one embodiment, the primary antenna is a transmission coil of an external device that is capable of wireless communications using the NFC protocol.
In one embodiment, the data transfer/powering strategy can be translated easily to various wireless techniques, e.g., Wi-fi, Bluetooth/BLE, cellular network, and so on.
In one embodiment, the external device is a smartphone, a tablet, a computer, or any electronic device with data reading capability.
In one embodiment, the secondary antenna comprises a first antenna electronically connected for powering the sensing circuit and for communicating data to the external device using the NFC protocol, and a second antenna electronically connected to the heating circuit for powering the heating element.
In one embodiment, the first antenna and the second antenna are arranged in a concentric geometry.
In one embodiment, the first antenna has a quality-factor (Q) that is relatively high to enable good communication distance and coupling across external devices with different primary antennae, and the second antenna has the quality-factor that is relatively low to support adequate power harvesting despite the difference between its resonance frequency and that of the primary coil.
In one embodiment, the quality-factor of the first antenna is about 11, and the quality-factor of the second antenna is about 8.
In one embodiment, the first antenna is tuned to the primary frequency, and the second antenna is tuned to a secondary frequency that is different from the primary frequency so as to prevent interference with the first antenna.
In one embodiment, the primary frequency is a standard NFC frequency of about 13.56 MHz, and the secondary frequency is about 19.04 MHz.
In one embodiment, the hydration sensor can be operated with a single antenna.
In one embodiment, the hydration sensor has a dynamic temperature range of about 18-45° C., adjustable through an amplifier gain, with a minimum resolution of about 15 mK, limited by the ADC.
In one embodiment, the electronics comprises a generic design including blocks of (a) a powering system comprising voltage/power regulators driven by an external battery or magnetic induction to supply power to the heater, sensing and communication circuits; (b) an ADC chip or data modulator to prepare the output of the sensing circuit for transmission to an external readout device; and (c) a transceiver chip having at least one of Wi-Fi, Bluetooth, BLE, NFC, and GSM/Cellular communication protocols to transmit the output signal to the external readout device.
In one embodiment, the f-PCB is formed of a flexible material.
In one embodiment, the flexible material comprises polyimide (PI) polyethylene terephthalate (PET), or any one of them in combination with a stiff PCB material including FR-4 and thin layers of copper/metal interconnects forming the circuitry.
In one embodiment, the f-PCB comprises open spaces and/or mechanical relief cuts for enhancing the overall flexibility, and limiting lateral thermal transport through the PI, away from the sensing components.
In one embodiment, the metal interconnect trace width is minimized to limit heat sinking away from the sensing area of the hydration sensor, thereby improving the sensitivity.
In one embodiment, the bottom layer comprises a flexible adhesive layer bonding to a thin layer of SiO2 sputter-coated on a backside of the f-PCB.
In one embodiment, the bottom layer adheres to the f-PCB through use of silicone bonding material, epoxy, glue, or commercial adhesive.
In one embodiment, the bottom layer further comprises an ultrathin fabric of fiberglass or a reinforcement material embedded in the flexible adhesive layer for enhancing the mechanical robustness of the hydration sensor.
In one embodiment, the reinforcement material is flexible and has varying mesh density and thickness to lend tear resistance to the bottom layer.
In one embodiment, the flexible adhesive layer is formed of silicone or silicone gel, or commercially available double-sided skin-safe adhesives (preferably hypoallergenic), with the ratio of silicone and silicone gel being adjusted to co-optimize mechanical integrity and tackiness of the adhesive.
In one embodiment, the relative ratio of silicone and silicone gel in the mixture to form the flexible adhesive is co-optimized for mechanical integrity of the adhesive and level of tackiness of the adhesive.
In one embodiment, the top layer is a shell-like top encapsulation layer including small air gaps for thermally insulating the critical sensing components.
In one embodiment, the top layer is formed of a flexible material including silicone or silicone gel.
In one embodiment, the top layer comprises an air pocket/gap/shell which thermally isolates the sensing area of the hydration sensor from the environment, thereby improving hydration sensor sensitivity; a shell made of silicone or similar materials, preferably hypoallergenic, to chemically and mechanically isolate and protect the underlying layers of the hydration sensor from external elements including water, dust, and/or from user touch; or a hollow shell-like structure to provide a soft touch or feel to the user.
In one embodiment, the top layer is fabricated using molds to cure the silicone or similar materials, preferably hypoallergenic.
In one embodiment, the top layer is formed of a flexible material including silicone or silicone gel, low/high density polyethylene (LDPE/HDPE), polystyrene, Teflon®, and various other flexible polymers.
In one embodiment, the hydration sensor has low flexural rigidity and effective modulus, to facilitate application even on highly curved features of the skin.
In one embodiment, the hydration sensor is compatible for use in conjunction with other adhesives/tapes/bandages for example Tegaderm™, Scotch Tape™, surgical tape, for applications on highly curved features on the human body/skin.
In one embodiment, the hydration sensor is a soft, thin, wireless, and battery-free skin hydration sensor.
In one embodiment, the hydration sensor can be used for applications to measure thermal conductivity, thermal diffusivity, heat capacity and other thermal properties of any material as a function of depth.
In one embodiment, the hydration sensor can be used for applications to measure water content of any material surface as a function of depth, including hydrogels, plants (irrigation and agriculture applications), food preservation (dried food products, grains, fruits, meats), and/or concrete (industrial applications).
In one embodiment, the hydration sensor can be used to monitor composition of food/beverages, medicines/industrial chemicals.
In one embodiment, the hydration sensor is compatible with alcohol-based cleaning wipes allowing for re-use across different users, without any damage to the hydration sensor or loss in efficacy of the hydration sensor adhesive.
In one embodiment, the hydration sensor can be sterilized using alcohol, autoclave steam sterilization, and gas phase sterilization.
In one embodiment, the hydration sensor is re-usable and removal without irritation to the skin or damage to the hydration sensor.
In one embodiment, the thermal properties of the skin comprise thermal conductivity (k) and thermal diffusivity (α) of the skin that are related to water content (φ) of the skin, wherein the water content is a function of a skin depth.
In one embodiment, the water content φE (epidermis) and φD (dermis) are determined from the measured temperature change ΔT vs. time t (full waveform analysis).
In one embodiment, the temperature change (ΔT) in the temperature sensor is operably captured by an ADC and transmitted to the external device.
In one embodiment, the water content φE (epidermis) and φD (dermis), and skin surface temperature T0 are used to determine a normal state or a disease state of the skin.
In one embodiment, the water content φE (epidermis) and φD (dermis), and skin surface temperature T0 are used to diagnose various skin diseases.
In one embodiment, the water content φE (epidermis) and φD (dermis), and skin surface temperature T0 are serve as quantitative metrics of an efficacy of a treatment of a skin disease.
In one embodiment, the hydration sensor is usable for monitoring the skin condition, or other health and wellness products including skin moisturizers, lotions, and/or creams.
In one embodiment, an aggregate water content φ comprising the full measurement volume serves as a quantitative metric for diagnosis of skin diseases or of an efficacy of a treatment of a skin disease.
In one embodiment, the hydration sensor is usable for delivering treatment, monitoring the effects, modulating the treatment protocol as necessary, and/or potentially predicting for flares based on quantitative, individualized measurements on specific lesion sites.
In one embodiment, the hydration sensor is usable for monitoring water content of internal organs for various diseases where traditional monitoring techniques fail to offer continuous assessment of organ health. In one embodiment, the hydration sensor is usable for monitoring organs during organ transport for applications in organ transplant.
In one embodiment, the hydration sensor is usable in both clinical and at-home settings.
In one embodiment, the hydration sensor can be used to monitor hydration status of healthy skin for applications in cosmetics, sports, and health/wellness.
In one embodiment, the skin health data (hydration of dermis, epidermis and skin temperature) for both lesions/healthy sites can be shared with physicians for remote medical care applications.
In another aspect, the invention relates to a method of fabricating a hydration sensor. The method includes forming a bottom layer comprising a layered structure of a first flexible layer, a second flexible layer, and a fabric of fiberglass/a reinforcement material embedded between the first flexible layer and the second flexible layer; treating a surface of the bottom layer with ultraviolet (UV) light to create reactive —OH groups on the surface of the bottom layer; sputter coating a layer of SiO2 onto a backside of an f-PCB, wherein the f-PCB contains electronics for sensing and wireless communication; adhering the f-PCB to the bottom layer via a covalent dehydration reaction between the —OH groups on the layer of SiO2 sputter coated onto the backside of the f-PCB and the treated surface of the bottom layer; forming a top shell layer including small air gaps; placing the top shell layer and the bottom layer such that the f-PCB is positioned between the top shell layer and the bottom layer and subsequently curing them on a hotplate so as to seal them; and cutting the sealed structure out in a desired shape to form the hydration sensor.
In one embodiment, each of the first flexible layer and the second flexible layer is formed of silicone or silicone gel, or commercially available double-sided skin-safe adhesives (preferably hypoallergenic), with the ratio of the silicone and silicone gel being adjusted to co-optimize mechanical integrity and tackiness of the adhesive.
In one embodiment, the reinforcement material is flexible and has varying mesh density and thickness to lend tear resistance to the bottom layer.
In one embodiment, the bottom layer adheres to the f-PCB through use of silicone bonding material, epoxy, glue, or commercial adhesive.
In one embodiment, the top shell layer is formed of silicone or silicone gel, low/high density polyethylene (LDPE/HDPE), polystyrene, Teflon®, and various other flexible polymers.
In one embodiment, the top layer comprises an air pocket/gap/shell which thermally isolates the sensing area of the hydration sensor from the environment, thereby improving hydration sensor sensitivity; a shell made of silicone or similar materials, preferably hypoallergenic, to chemically and mechanically isolate and protect the underlying layers of the hydration sensor from external elements including water, dust, and/or from user touch; or a hollow shell-like structure to provide a soft touch/feel to the user.
In one embodiment, the top layer is fabricated using molds to cure the silicone or similar materials, preferably hypoallergenic.
In one embodiment, the f-PCB is formed of a flexible material comprising polyimide (PI), polyethylene terephthalate (PET), or any one of them in combination with stiff PCB material such as FR-4.
In one embodiment, the f-PCB comprises open spaces and/or mechanical relief cuts for enhancing the overall flexibility, and limiting lateral thermal transport through the PI, away from the sensing components.
In one embodiment, the electronics comprises a heating circuit comprising a heating element for operably heating the target area of interest of the skin; and a sensing circuit comprising a temperature sensor for simultaneously recording a transient temperature change (ΔT) thereof.
In one embodiment, the heating element and the temperature sensor are arranged laterally away from each other by a distance.
In one embodiment, the distance is determined by the design requirement of depth sensitivity into the skin, and ranges from about 10 μm to about 10 mm.
In one embodiment, the heater and temperature sensor are the same component, wherein the distance between them is zero.
In one embodiment, the sensing circuit further comprises a microcontroller (μC).
In one embodiment, the microcontroller is programmable with a custom-designed embedded code using an NFC read/write interface allowed for wireless communication of the hydration sensor to a custom smartphone application.
In one embodiment, the electronics further comprises a primary antenna tuned to a primary frequency, and a secondary antenna.
In one embodiment, the primary antenna is a transmission coil of an external device that is capable of wireless communications using an NFC protocol.
In one embodiment, the external device is a smartphone, a tablet, a computer, or any electronic device with data reading capability.
In one embodiment, the secondary antenna comprises a first antenna electronically connected to the microcontroller for powering the sensing circuit and for communicating data to the external device using the NFC protocol, and a second antenna electronically connected to the heating circuit for powering the heating element.
In one embodiment, the first antenna and the second antenna are arranged in a concentric geometry.
In one embodiment, the first antenna is tuned to the primary frequency, and the second antenna is tuned to a secondary frequency that is different from the primary frequency so as to prevent interference with the first antenna.
In one embodiment, the hydration sensor can be operated using a single antenna.
In one embodiment, the electronics comprises a generic design including blocks of (a) a powering system comprising voltage/power regulators driven by an external battery or magnetic induction to supply power to the heater, sensing and communication circuits; (b) an ADC (analog to digital convertor) chip or data modulator to prepare the output of the sensing circuit for transmission to an external readout device; and (c) a transceiver chip having at least one of NFC, Wi-Fi/Internet, Bluetooth, BLE, and GSM/Cellular communication protocols to transmit the output signal to the external readout device.
In yet another aspect, the invention relates to a method of monitoring and/or diagnosing a condition of a skin. The method includes attaching a hydration sensor onto a target area of interest of the skin, wherein the hydration sensor comprising an f-PCB containing electronics for sensing and wireless communication, wherein the electronics comprising a heating circuit comprising a heating element; a sensing circuit comprising a temperature sensor; a microcontroller coupled to the heating element and the sensing circuit, and a transceiver coupled to the heating element, the sensing circuit and the microcontroller; heating the target area of interest of the skin by the heating element and simultaneously recording a transient temperature change (ΔT) thereof by the temperature sensor; obtaining water content of the target area of interest of the skin from the temperature change (ΔT); and determining a condition of the skin at the target area of interest based on the obtained water content.
In one embodiment, the water content comprises water content φE of the epidermis and water content φD of the dermis.
In one embodiment, the step of obtaining the water content comprises separately determination of φE and φD from the temperature change ΔT vs. t curves, thereby enabling real-time display of φE and φD on the phone application shortly after completing the measurement.
In one embodiment, the transceiver transmits data through a wireless communication protocol including NFC, Wi-Fi/Internet, Bluetooth, BLE, or Cellular communication.
In one embodiment, the transceiver relays data to an external device through various wireless communication methods including NFC, Wi-Fi/Internet, Bluetooth, BLE, or Cellular communication.
In one embodiment, the transceiver is powered wirelessly or through use of a battery/capacitive discharge mechanism.
In one embodiment, the transceiver comprises a primary antenna tuned to primary frequency, and a secondary antenna.
In one embodiment, the primary antenna is a transmission coil of an external device that is capable of wireless communications using the NFC protocol.
In one embodiment, the secondary antenna comprises a first antenna electronically connected to the microcontroller for powering the sensing circuit and for communicating data to the external device using the NFC protocol, and a second antenna electronically connected to the heating circuit for powering the heating element.
In one embodiment, the first antenna and the second antenna are arranged in a concentric geometry.
In one embodiment, the first antenna is tuned to the primary frequency, and the second antenna is tuned to a secondary frequency that is different from the primary frequency so as to prevent interference with the first antenna.
In one embodiment, the external device is a smartphone, a tablet, a computer, or any electronic device with data reading capability.
In one embodiment, the method further comprises programming the microcontroller with a custom-designed embedded code using an NFC read/write interface allowed for wireless communication of the hydration sensor to a custom smartphone application.
In one embodiment, the step of heating the target area of interest of the skin comprises powering the heating element through a regulated DC supply at a voltage of about 3.3 V derived from the secondary AC voltage at the second antenna, resulting in a constant thermal power of q=10 mW/mm2.
In one embodiment, the temperature sensor connects as one of the arms of a Wheatstone bridge powered by a rectified 2.1 V from the RF μ microcontroller, wherein the voltage across the arms of the Wheatstone bridge is amplified, subsequently read by the RF microcontroller ADC, then transmitted through the first antenna to the phone NFC reader, and recorded in the phone's memory, and displayed on the screen.
In one embodiment, the step of determining the condition of the skin at the target area of interest comprises comparing the obtained water content to a standard water content at the target area of interest so as to determine a normal state or a disease state of the skin.
In one embodiment, the step of determining the condition of the skin at the target area of interest comprises diagnosing a skin disease at the target area of interest based on wherein the obtained water content thereof.
In one embodiment, the step of determining the condition of the skin at the target area of interest comprises diagnosing a skin disease at the target area of interest by comparing measurements of skin barrier function to a clinician-derived overall dry skin (ODS) score.
In one embodiment, the step of determining the condition of the skin at the target area of interest comprises evaluating an efficacy of a treatment of the skin disease.
In one embodiment, the method further comprises one or more steps of delivering treatment, monitoring the effects, modulating the treatment protocol as necessary, and/or potentially predicting for flares based on quantitative, individualized measurements on specific lesion sites.
These and other aspects of the present invention will become apparent from the following description of the preferred embodiment taken in conjunction with the following drawings, although variations and modifications therein may be affected without departing from the spirit and scope of the novel concepts of the disclosure.
The accompanying drawings illustrate one or more embodiments of the invention and together with the written description, serve to explain the principles of the invention. Wherever possible, the same reference numbers are used throughout the drawings to refer to the same or like elements of an embodiment.
The invention will now be described more fully hereinafter with reference to the accompanying drawings, in which exemplary embodiments of the invention are shown. This invention may, however, be embodied in many different forms and should not be construed as limited to the embodiments set forth herein. Rather, these embodiments are provided so that this invention will be thorough and complete, and will fully convey the scope of the invention to those skilled in the art. Like reference numerals refer to like elements throughout.
The terms used in this specification generally have their ordinary meanings in the art, within the context of the invention, and in the specific context where each term is used. Certain terms that are used to describe the invention are discussed below, or elsewhere in the specification, to provide additional guidance to the practitioner regarding the description of the invention. For convenience, certain terms may be highlighted, for example using italics and/or quotation marks. The use of highlighting has no influence on the scope and meaning of a term; the scope and meaning of a term is the same, in the same context, whether or not it is highlighted. It will be appreciated that same thing can be said in more than one way. Consequently, alternative language and synonyms may be used for any one or more of the terms discussed herein, nor is any special significance to be placed upon whether or not a term is elaborated or discussed herein. Synonyms for certain terms are provided. A recital of one or more synonyms does not exclude the use of other synonyms. The use of examples anywhere in this specification including examples of any terms discussed herein is illustrative only, and in no way limits the scope and meaning of the invention or of any exemplified term. Likewise, the invention is not limited to various embodiments given in this specification.
One of ordinary skill in the art will appreciate that starting materials, biological materials, reagents, synthetic methods, purification methods, analytical methods, assay methods, and biological methods other than those specifically exemplified can be employed in the practice of the invention without resort to undue experimentation. All art-known functional equivalents, of any such materials and methods are intended to be included in this invention. The terms and expressions which have been employed are used as terms of description and not of limitation, and there is no intention that in the use of such terms and expressions of excluding any equivalents of the features shown and described or portions thereof, but it is recognized that various modifications are possible within the scope of the invention claimed. Thus, it should be understood that although the invention has been specifically disclosed by preferred embodiments and optional features, modification and variation of the concepts herein disclosed may be resorted to by those skilled in the art, and that such modifications and variations are considered to be within the scope of this invention as defined by the appended claims.
Whenever a range is given in the specification, for example, a temperature range, a time range, or a composition or concentration range, all intermediate ranges and subranges, as well as all individual values included in the ranges given are intended to be included in the invention. It will be understood that any subranges or individual values in a range or subrange that are included in the description herein can be excluded from the claims herein.
It will be understood that, as used in the description herein and throughout the claims that follow, the meaning of “a”, “an”, and “the” includes plural reference unless the context clearly dictates otherwise. Thus, for example, reference to “a cell” includes a plurality of such cells and equivalents thereof known to those skilled in the art. As well, the terms “a” (or “an”), “one or more” and “at least one” can be used interchangeably herein. It is also to be noted that the terms “comprising”, “including”, and “having” can be used interchangeably.
It will be understood that when an element is referred to as being “on”, “attached” to, “connected” to, “coupled” with, “contacting”, etc., another element, it can be directly on, attached to, connected to, coupled with or contacting the other element or intervening elements may also be present. In contrast, when an element is referred to as being, for example, “directly on”, “directly attached” to, “directly connected” to, “directly coupled” with or “directly contacting” another element, there are no intervening elements present. It will also be appreciated by those of skill in the art that references to a structure or feature that is disposed “adjacent” another feature may have portions that overlap or underlie the adjacent feature.
It will be understood that, although the terms first, second, third etc. may be used herein to describe various elements, components, regions, layers and/or sections, these elements, components, regions, layers and/or sections should not be limited by these terms. These terms are only used to distinguish one element, component, region, layer or section from another element, component, region, layer or section. Thus, a first element, component, region, layer or section discussed below could be termed a second element, component, region, layer or section without departing from the teachings of the invention.
Furthermore, relative terms, such as “lower” or “bottom” and “upper” or “top,” may be used herein to describe one element's relationship to another element as illustrated in the figures. It will be understood that relative terms are intended to encompass different orientations of the device in addition to the orientation depicted in the figures. For example, if the device in one of the figures is turned over, elements described as being on the “lower” side of other elements would then be oriented on “upper” sides of the other elements. The exemplary term “lower”, can therefore, encompasses both an orientation of “lower” and “upper,” depending of the particular orientation of the figure. Similarly, if the device in one of the figures is turned over, elements described as “below” or “beneath” other elements would then be oriented “above” the other elements. The exemplary terms “below” or “beneath” can, therefore, encompass both an orientation of above and below.
It will be further understood that the terms “comprises” and/or “comprising”, or “includes” and/or “including”, or “has” and/or “having”, or “carry” and/or “carrying”, or “contain” and/or “containing”, or “involve” and/or “involving”, “characterized by”, and the like are to be open-ended, i.e., to mean including but not limited to. When used in this disclosure, they specify the presence of stated features, regions, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, regions, integers, steps, operations, elements, components, and/or groups thereof.
Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. It will be further understood that terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning that is consistent with their meaning in the context of the relevant art and the invention, and will not be interpreted in an idealized or overly formal sense unless expressly so defined herein.
As used in the disclosure, “around”, “about”, “approximately” or “substantially” shall generally mean within 20 percent, preferably within 10 percent, and more preferably within 5 percent of a given value or range. Numerical quantities given herein are approximate, meaning that the term “around”, “about”, “approximately” or “substantially” can be inferred if not expressly stated.
As used in the disclosure, the phrase “at least one of A, B, and C” should be construed to mean a logical (A or B or C), using a non-exclusive logical OR. As used herein, the term “and/or” includes any and all combinations of one or more of the associated listed items.
Embodiments of the invention are illustrated in detail hereinafter with reference to accompanying drawings. The description below is merely illustrative in nature and is in no way intended to limit the invention, its application, or uses. The broad teachings of the invention can be implemented in a variety of forms. Therefore, while this invention includes particular examples, the true scope of the invention should not be so limited since other modifications will become apparent upon a study of the drawings, the specification, and the following claims. For purposes of clarity, the same reference numbers will be used in the drawings to identify similar elements. It should be understood that one or more steps within a method may be executed in different order (or concurrently) without altering the principles of the invention.
Visual diagnosis and tracking of skin diseases requires significant expertise and training. Existing diagnostic tools range from invasive procedures (e.g., skin biopsy) to imaging techniques (e.g., dermoscopy, confocal microscopy) which are expensive, infrequent, time-consuming, and require expertise to deploy. Noninvasive, point of care tools like corneometers have limited diagnostic value, interrogate only the top surface of the skin (about 15 μm), and are prone to measurement error due to high inter-rater variability, limiting use to research applications.
One of the objectives of this invention is to provide a soft, battery-free, flexible, non-invasive, reusable, low-cost, fully-integrated hydration sensor that is capable of monitoring and diagnosis of skin diseases in any environment.
Referring to
In one embodiment, the top layer is a shell-like top encapsulation layer including small air gaps/pockets (panel A of
In one embodiment, the top layer is formed of a flexible material including silicone or silicone gel, low/high density polyethylene (LDPE/HDPE), polystyrene, Teflon®, and various other flexible polymers. In one embodiment, the top layer is fabricated using molds to cure the silicone or similar materials, preferably hypoallergenic.
The bottom layer operably serves as a direct interface between the f-PCB and the skin. In one embodiment, the bottom layer comprises a flexible adhesive layer bonding to a thin layer of SiO2 that is sputter-coated on a backside of the f-PCB. In one embodiment, the bottom layer adheres to the f-PCB through use of silicone bonding material, epoxy, glue, or commercial adhesive. The bottom layer may further comprise an ultrathin fabric of fiberglass or a reinforcement material embedded in the flexible adhesive layer for enhancing the mechanical robustness of the hydration sensor. In one embodiment, the reinforcement material is flexible and has varying mesh density and thickness to lend tear resistance to the bottom layer. In one embodiment, the flexible adhesive layer is formed of silicone or silicone gel, or commercially available double-sided skin-safe adhesives (preferably hypoallergenic), with the ratio of silicone and silicone gel being adjusted to co-optimize mechanical integrity and tackiness of the adhesive.
The f-PCB contains electronics for sensing and wireless communication. In one embodiment, the f-PCB is formed of a flexible material. In one embodiment, the flexible material comprises polyimide (PI) polyethylene terephthalate (PET), or any one of them in combination with a stiff PCB material including FR-4. In one embodiment, the f-PCB comprises open spaces and/or mechanical relief cuts for enhancing the overall flexibility, and limiting lateral thermal transport through the PI, away from the sensing components.
In one embodiment, the electronics, as shown in panels A-B of
In one embodiment, the heating element comprises a heater comprising at least one resistor. The at least one resistor comprises two or more of surface-mount (SMT) thin film resistors, thick film resistors, through-hole resistors, and/or ultrathin-film (about 50-200 nm thick) metal resistors connected in series to form a heater. In one embodiment, the temperature sensor comprises an SMT negative temperature coefficient thermistor, positive temperature coefficient thermistor, resistance temperature detector (RTD), thermocouple or any other conductive temperature sensor.
In one embodiment, the temperature change (ΔT) in the temperature sensor is operably captured by an ADC of the microcontroller and transmitted to the external device.
In one embodiment, the sensing circuit further comprises a microcontroller (C), and the heater is operably switchable between ON and OFF controlled by the microcontroller. In one embodiment, the microcontroller is programmable with custom-designed embedded codes using at least one of NFC, Wi-Fi/Internet, Bluetooth, BLE, and Cellular communication protocols for wireless communication of the hydration sensor to a custom smartphone application.
In one embodiment, the electronics further comprises a primary antenna tuned to primary frequency, and a secondary antenna.
In one embodiment, the primary antenna is a transmission coil of an external device that is capable of wireless communications using the NFC protocol. In one embodiment, the external device is a smartphone, a tablet, a computer, or any electronic device with data reading capability.
In one embodiment, the secondary antenna comprises a first antenna electronically connected to the microcontroller for powering the sensing circuit and for communicating data to the external device using the NFC protocol, and a second antenna electronically connected to the heating circuit for powering the heating element. In one embodiment, the first antenna and the second antenna are arranged in a concentric geometry.
In one embodiment, the first antenna has a quality-factor (Q) that is relatively high to enable good communication distance and coupling across external devices with different primary antennae, and the second antenna has the quality-factor that is relatively low to support adequate power harvesting despite the difference between its resonance frequency and that of the primary coil. In one embodiment, the quality-factor of the first antenna is about 11, and the quality-factor of the second antenna is about 8.
In one embodiment, the first antenna is tuned to the primary frequency, and the second antenna is tuned to a secondary frequency that is different from the primary frequency so as to prevent interference with the first antenna. In one embodiment, the primary frequency is a standard NFC frequency of about 13.56 MHz, and the secondary frequency is about 19.04 MHz.
In one embodiment, the electronics comprises a generic design including blocks of (a) a powering system comprising voltage/power regulators driven by an external battery or magnetic induction to supply power to the heater, sensing and communication circuits; (b) an ADC (analog to digital convertor) chip or data modulator to prepare the output of the sensing circuit for transmission to an external readout device; and (c) a transceiver chip having at least one of at least one of NFC, Wi-Fi/Internet, Bluetooth, BLE, and Cellular communication protocols to transmit the output signal to the external readout device.
In one embodiment, the hydration sensor has a dynamic temperature range of about 18-45° C., adjustable through an amplifier gain, with a minimum resolution of about 15 mK, limited by the ADC.
In one embodiment, the hydration sensor has low flexural rigidity and effective modulus, to facilitate application even on highly curved features of the skin.
The hydration sensor is a soft, thin, wireless, and battery-free skin hydration sensor, and compatible for use in conjunction with other adhesives/tapes/bandages for example Tegaderm™, Scotch Tape® surgical tape, for applications on highly curved features on the human body/skin.
The thermal properties of the skin comprise thermal conductivity (k) and thermal diffusivity (α) of the skin that are related to water content (φ) of the skin. The water content is a function of a skin depth.
In one embodiment, an aggregate water content φ comprising the full measurement volume serves as a quantitative metric for diagnosis of skin diseases or of an efficacy of a treatment of a skin disease.
In one embodiment, the water content φE (epidermis) and φD (dermis), and skin surface temperature T0 are determined from the measured temperature change ΔT vs. time t.
In one embodiment, the water content φE (epidermis) and φD (dermis), and skin surface temperature T0 are used to determine a normal state or a disease state of the skin.
In one embodiment, the water content φE (epidermis) and φD (dermis), and skin surface temperature T0 are used to diagnose various skin diseases.
In one embodiment, the water content φE (epidermis) and φD (dermis), and skin surface temperature T0 are serve as quantitative metrics of an efficacy of a treatment of a skin disease.
The hydration sensor is usable for monitoring the skin condition, or other health and wellness products including skin moisturizers, lotions, and/or creams.
The hydration sensor is also usable for delivering treatment, monitoring the effects, modulating the treatment protocol as necessary, and/or potentially predicting for flares based on quantitative, individualized measurements on specific lesion sites.
The hydration sensor is further usable for monitoring water content of internal organs for various diseases where traditional monitoring techniques fail to offer continuous assessment of organ health. In one embodiment, the hydration sensor is usable for monitoring organs during organ transport for applications in organ transplant.
The hydration sensor can be used to monitor hydration status of healthy skin for applications in cosmetics, sports, and health/wellness. The skin health data (hydration of dermis, epidermis and skin temperature) for both lesions/healthy sites can be shared with physicians for remote medical care applications.
The hydration sensor is re-usable and removal without irritation to the skin or damage to the hydration sensor.
The hydration sensor is usable in both clinical and at-home settings.
In another aspect, the invention relates to s method of fabricating a hydration sensor. Referring to
In one embodiment, each of the first flexible layer and the second flexible layer is formed of silicone or silicone gel, or commercially available double-sided skin-safe adhesives (preferably hypoallergenic), with the ratio of the silicone and silicone gel being adjusted to co-optimize mechanical integrity and tackiness of the adhesive. In one embodiment, the reinforcement material is flexible and has varying mesh density and thickness to lend tear resistance to the bottom layer.
In one embodiment, the bottom layer adheres to the f-PCB through use of silicone bonding material, epoxy, glue, or commercial adhesive.
In one embodiment, the top shell layer is formed of silicone or silicone gel, low/high density polyethylene (LDPE/HDPE), polystyrene, Teflon®, and various other flexible polymers.
In one embodiment, the top layer comprises an air pocket/gap/shell which thermally isolates the sensing area of the hydration sensor from the environment, thereby improving hydration sensor sensitivity; a shell made of silicone or similar materials, preferably hypoallergenic, to chemically and mechanically isolate and protect the underlying layers of the hydration sensor from external elements including water, dust, and/or from user touch; or a hollow shell-like structure to provide a soft touch/feel to the user.
In one embodiment, the top layer is fabricated using molds to cure the silicone or similar materials, preferably hypoallergenic.
In one embodiment, the f-PCB is formed of a flexible material comprising polyimide (PI), polyethylene terephthalate (PET), or any one of them in combination with stiff PCB material such as FR-4. In one embodiment, the f-PCB comprises open spaces and/or mechanical relief cuts for enhancing the overall flexibility, and limiting lateral thermal transport through the PI, away from the sensing components.
In one embodiment, the electronics comprises a heating circuit comprising a heating element for operably heating the target area of interest of the skin; and a sensing circuit comprising a temperature sensor for simultaneously recording a transient temperature change (ΔT) thereof. In one embodiment, the heating element and the temperature sensor are arranged laterally away from each other by a distance. In one embodiment, the distance is determined by the design requirement of depth sensitivity into the skin, and ranges from 10s of μm to a few mm. In one embodiment, the heater and temperature sensor are the same component, wherein the distance between them is zero.
In one embodiment, the sensing circuit further comprises a microcontroller (C). In one embodiment, the microcontroller is programmable with custom-designed embedded codes using at least one of NFC, Wi-Fi/Internet, Bluetooth, BLE, and Cellular communication protocols for wireless communication of the hydration sensor to a custom smartphone application.
In one embodiment, the electronics further comprises a primary antenna tuned to a primary frequency, and a secondary antenna.
In one embodiment, the primary antenna is a transmission coil of an external device that is capable of wireless communications using the NFC protocol. In one embodiment, the external device is a smartphone, a tablet, a computer, or any electronic device with data reading capability.
In one embodiment, the secondary antenna comprises a first antenna electronically connected to the microcontroller for powering the sensing circuit and for communicating data to the external device using the NFC protocol, and a second antenna electronically connected to the heating circuit for powering the heating element. In one embodiment, the first antenna and the second antenna are arranged in a concentric geometry.
In one embodiment, the first antenna is tuned to the primary frequency, and the second antenna is tuned to a secondary frequency that is different from the primary frequency so as to prevent interference with the first antenna.
In one embodiment, the hydration sensor can be operated using a single antenna.
In one embodiment, the electronics comprises a generic design including blocks of (a) a powering system comprising voltage/power regulators driven by an external battery or magnetic induction to supply power to the heater, sensing and communication circuits; (b) an ADC (analog to digital convertor) chip or data modulator to prepare the output of the sensing circuit for transmission to an external readout device; and (c) a transceiver chip having at least one of NFC, Wi-Fi/Internet, Bluetooth, BLE, and Cellular communication protocols to transmit the output signal to the external readout device.
In yet another aspect, the invention relates to a method d of monitoring and/or diagnosing a condition of a skin. The method includes attaching a hydration sensor onto a target area of interest of the skin, wherein the hydration sensor comprising an f-PCB containing electronics for sensing and wireless communication, wherein the electronics comprising a heating circuit comprising a heating element; a sensing circuit comprising a temperature sensor; a microcontroller (μC) coupled to the heating element and the sensing circuit, and a transceiver coupled to the heating element, the sensing circuit and the microcontroller; heating the target area of interest of the skin by the heating element and simultaneously recording a transient temperature change (ΔT) thereof by the temperature sensor; obtaining water content of the target area of interest of the skin from the temperature change (ΔT); and determining a condition of the skin at the target area of interest based on the obtained water content. In one embodiment, the water content comprises water content φE of the epidermis and water content φD of the dermis.
In one embodiment, the step of obtaining the water content comprises separately determination of φE and φD from the temperature change ΔT vs. t curves, thereby enabling real-time display of φE and φD on the phone application shortly after completing the measurement.
In one embodiment, the transceiver transmits data through a wireless communication protocol including at least one of NFC, Wi-Fi/Internet, Bluetooth, BLE, and Cellular communication. In one embodiment, the transceiver relays data to an external device through various wireless communication methods including at least one of NFC, Wi-Fi/Internet, Bluetooth, BLE, and Cellular communication protocols.
In one embodiment, the transceiver is powered wirelessly or through use of a battery/capacitive discharge mechanism.
In one embodiment, the transceiver comprises a primary antenna tuned to primary frequency, and a secondary antenna. In one embodiment, the primary antenna is a transmission coil of an external device that is capable of wireless communications using the NFC protocol. In one embodiment, the secondary antenna comprises a first antenna electronically connected to the microcontroller for powering the sensing circuit and for communicating data to the external device using the NFC protocol, and a second antenna electronically connected to the heating circuit for powering the heating element. In one embodiment, the first antenna and the second antenna are arranged in a concentric geometry. In one embodiment, the first antenna is tuned to the primary frequency, and the second antenna is tuned to a secondary frequency that is different from the primary frequency so as to prevent interference with the first antenna.
In one embodiment, the method further comprises programming the microcontroller with a custom-designed embedded code using an NFC read/write interface allowed for wireless communication of the hydration sensor to a custom smartphone application.
In one embodiment, the step of heating the target area of interest of the skin comprises powering the heating element through a regulated DC supply at a voltage of about 3.3 V derived from the secondary AC voltage at the second antenna, resulting in a constant thermal power of q=10 mW/mm2.
In one embodiment, the temperature sensor connects as one of the arms of a Wheatstone bridge powered by a rectified 2.1 V from the RF μC, wherein the voltage across the arms of the Wheatstone bridge is amplified, subsequently read by the RF μC ADC, then transmitted through the first antenna to the phone NFC reader, and recorded in the phone's memory, and displayed on the screen.
In one embodiment, the step of determining the condition of the skin at the target area of interest comprises comparing the obtained water content to a standard water content at the target area of interest so as to determine a normal state or a disease state of the skin.
In one embodiment, the step of determining the condition of the skin at the target area of interest comprises diagnosing a skin disease at the target area of interest based on wherein the obtained water content thereof.
In one embodiment, the step of determining the condition of the skin at the target area of interest comprises diagnosing a skin disease at the target area of interest by comparing measurements of skin barrier function to a clinician-derived overall dry skin (ODS) score.
In one embodiment, the step of determining the condition of the skin at the target area of interest comprises evaluating an efficacy of a treatment of the skin disease.
In one embodiment, the method further comprises one or more steps of delivering treatment, monitoring the effects, modulating the treatment protocol as necessary, and/or potentially predicting for flares based on quantitative, individualized measurements on specific lesion sites.
In one exemplary embodiment, a soft, battery-free, flexible, non-invasive, reusable skin hydration sensor (SHS) adherable to even small-areas and curvilinear surfaces of the body is disclosed. The sensor platform/system operably measures the volumetric water content in skin as a function of depth (up to about 1 mm), and wirelessly transmits data to any near field communication (NFC) compatible smartphone. In certain embodiments, the hydration sensor system comprises off-the-shelf electronic components in a manufacturable layout, along with unique powering strategies, and encapsulation procedures, leading to robust device operation with high precision (±5%) measurements of water content and high-resolution (±0.015° C.) assessments of skin surface temperature. Validation on n=16 healthy/normal human subjects reveals an average water content of about 63% in the skin across multiple body locations. Pilot studies on patients with skin diseases, including atopic dermatitis (AD), psoriasis, urticaria, xerosis cutis, and rosacea, illustrate the capability of the hydration sensor to categorize skin diseases and aid in future diagnosis (φAD=0.0034). A demonstration includes monitoring changes in hydration level for a diseased subject with the application of topical treatments.
The hydration sensor has potential to be made very low cost and can be made ubiquitous because it pairs easily with smart devices. Measurements made by the hydration sensor can be recorded in an application that will keep track of skin hydration measurements and to help relay data with a physician if required. The device is prime for FDA approval for several dermatological diseases as it is noninvasive, very low-risk, and made of bio-compatible materials which interface with the skin.
Among other things, the hydration sensor can be used for hydration measurements of skin for cosmetics applications, including, but are not limited to, hydration measurements of skin to assess topical creams/ointments/moisturizers; hydration measurements of skin to determine severity of dermatological diseases; hydration measurements of skin to aid in dermatological disease diagnosis; hydration measurements on plants to determine water uptake and help determine optimal irrigation strategies for applications in agriculture; hydration measurements of internal organs to monitor organ health.
In addition, the hydration sensor can be used for applications to measure thermal conductivity, thermal diffusivity, heat capacity and other thermal properties of any material as a function of depth.
The hydration sensor can also be used for applications to measure water content of any material surface as a function of depth, including hydrogels, plants (irrigation and agriculture applications), food preservation (dried food products, grains, fruits, meats), and/or concrete (industrial applications).
The hydration sensor can be used to monitor composition of food/beverages, medicines/industrial chemicals.
The hydration sensor is compatible with alcohol-based cleaning wipes allowing for re-use across different users, without any damage to the hydration sensor or loss in efficacy of the hydration sensor adhesive.
The hydration sensor can be sterilized using alcohol, autoclave steam sterilization, and gas phase sterilization.
The hydration sensor can easily be translated to other wireless powering/data transfer technologies, and allows non-invasive measurements of skin hydration beyond the most superficial layers of the skin.
The hydration sensor platform has at least the following advantages:
These and other aspects of the present invention are further described below. Without intent to limit the scope of the invention, exemplary instruments, apparatus, methods and their related results according to the embodiments of the present invention are given below. Note that titles or subtitles may be used in the examples for convenience of a reader, which in no way should limit the scope of the invention. Moreover, certain theories are proposed and disclosed herein; however, in no way they, whether they are right or wrong, should limit the scope of the invention so long as the invention is practiced according to the invention without regard for any particular theory or scheme of action.
Visual diagnosis and tracking of skin diseases requires significant expertise and training. Existing diagnostic tools range from invasive procedures (e.g., skin biopsy) to imaging techniques (e.g., dermoscopy, confocal microscopy) which are expensive, infrequent, time-consuming, and require expertise to deploy. Noninvasive, point of care tools like corneometers have limited diagnostic value, interrogate only the top surface of the skin (˜15 μm), and are prone to measurement error due to high inter-rater variability, limiting use to research applications.
This exemplary study reports a set of results in materials, device designs and analysis approaches that address all these aforementioned challenges, in the form of a soft, thin, wireless, and battery-free skin hydration sensor (SHS) and corresponding models that can be used to accurately assess water content of skin regardless of body location or environment. Careful systems-level engineering enables highly robust, reliable measurements and with platforms that are compatible with established manufacturing techniques for consumer electronics gadgetry, with readily available off-the-shelf components. Theoretical modeling establishes a means to directly determine the volumetric water content in skin as a function of depth, from the raw data obtained using the sensors. Benchtop characterization tests and studies using healthy/normal subjects establish the accuracy and reliability of the SHS devices, as well as the key engineering parameters that affect these quantities. Key results include clinical use of the SHS on n=13 patients with a wide range of inflammatory skin conditions (e.g., atopic dermatitis, psoriasis, urticaria, xerosis cutis, and rosacea), with benchmarks against standard tools, to quantitatively characterize the diseased locations. Additional clinical demonstrations include tracking improvements in skin water content after application of a topical moisturizer.
The objective of this exemplary study is to design and demonstrate a robust, wireless, battery-free and soft sensor for widespread, non-invasive monitoring of skin hydration independent of clinical settings, and to validate their performance against clinical standard tools. Patients recruited received full informed consent (Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; IRB Study #STU00209010). Inclusion criteria specified healthy/normal subjects or patients undergoing evaluation or routine-checkups for clinical skin-related pathologies. A hypoallergenic silicone-based surgical tape (Kind Removal Silicone Tape, 3M, Inc., USA) assisted in adhering the device to the skin. Sterilization of the moisture meters and SHS required individual wiping down of all surfaces with single-use alcohol wipes (Sterile Alcohol Prep Pads, Dynarex Corp., USA).
Patients with Disease: The sensor recorded measurements in triplicate on identified lesions, perilesional locations, or unaffected contralateral locations if no perilesional area with a normal appearance was available. A waiting period of 30 s after application of the device to skin and between measurements ensured the sensing components achieved thermal equilibrium with the temperature of the skin. Corneometer readings (gpskin Barrier, GPower, Inc., KR) taken in triplicate on the same corresponding sites served as a metric for comparison to the measurements taken by the SHS.
Patients with healthy normal skin: Measurements using the SHS device were only performed once on each body location to imitate a real-life use-case. Body locations selected for studies on healthy/normal subjects included the forehead, cheek, volar forearm, shin, calf, and heel. Measurements were not performed in cases with presence of excessive hair at the measurement site or for those who had applied moisturizer to that region of skin. A hypoallergenic silicone-based surgical tape (Kind Removal Silicone Tape, 3M, Inc., USA) assisted in adhering the device to the skin. Sterilization of the moisture meters and SHS required individual wiping down all surfaces with single-use alcohol wipes (Sterile Alcohol Prep Pads, Dynarex Corp., USA).
Initial prototypes and proof-of-concept devices involved use of a laser cutter (LPKF U4, LPKF Inc., DE) to pattern a double-sided copper-clad laminate (Pyralux AP8535R, DuPont, Inc., USA) and standard micro-soldering techniques. To avoid damage to the critical sensing components, soldering the thermistor (NTCG063JF103FT, TDK Corporation, Japan) and heater resistors (RR0306P-681-D, Susumu Co., Ltd., Japan) using a low-temperature solder paste (TS391AX10, Chip Quik Inc., USA) and heat gun temperature of 200° C. for less than 5 seconds was the final step in component assembly. Initial devices were prototyped in a lab setting, and the final designs were then sent to an external ISO-9001 compliant vendor for full manufacturing and assembly of multiple f-PCBs to illustrate the compatibility with readily available outsource manufacturing techniques. Programming the microcontroller (RF430FRL152H, Texas Instruments, Inc., USA) with a custom-designed embedded code using an NFC read/write interface (TRF7970AEVM, Texas Instruments, Inc., USA) allowed for wireless communication of the sensor to a custom smartphone application. This software application features tunable measurement time and custom file naming.
Briefly, preparing a layered structure of about 45 μm thickness of silicone (Ecoflex 00-30, Smooth-On, Inc., USA)/silicone gel (Ecoflex gel, Smooth-On, Inc., USA), about 30 μm thin fiberglass fabric, followed by an additional about 45 μm thin silicone/silicone gel on a glass slide yielded the bottom layer of the SHS device, as the direct interface between the f-PCB and the skin. The f-PCB adhered to the silicone layer via bonding between a thin coating of SiO2 sputter deposited onto the backside of the f-PCB and dangling —OH bonds on the surface of the silicone (formed through UV-light functionalization). A custom-made aluminum mold and a hot press (Carver Press, Carver Inc., USA) allowed formation of a structured film of silicone (about 2.7 mm thickness) as the top shell of the device. Screen printing uncured silicone beyond the outermost border of the f-PCB, placing the top shell and bottom layer together and subsequently curing of the entire device on a hotplate at about 70° C. for about 10 min sealed the system.
Cutting the completed structure out in a teardrop shape using a die cutter and peeling the structure off the glass slide completed the fabrication process.
The detailed fabrication procedures in certain embodiments are shown in
Powering the heater occurs through a regulated DC supply at a voltage of about 3.3 V derived from the secondary AC voltage at Ant. 2, resulting in a constant thermal power of q=10 mW/mm2. The resistance of the heating element remains nearly constant due to its low temperature coefficient of resistance=25 ppm/° C. The thermistor connects as one of the arms of a Wheatstone bridge powered by a rectified 2.1 V from the RF μC. The voltage across the arms of the Wheatstone bridge is amplified, subsequently read by the RF μC ADC (sampling rate=1 Hz, resolution=10 bits), then transmitted to the phone (data rate=0.125 Hz) NFC ISO15693 reader, and finally recorded in the phone's memory, and also displayed on the screen. The application supports to the use of any smart devices such as Android phones with NFC capability.
The relationship between the thermistor resistance R and temperature T derived from the vendor datasheet is:
Referring to the circuit schematic shown in panel A of
where R1=R2=10 kΩ, R3=10.7 kΩ, and VDD=2.1 V. and g is the amplifier gain given by
Rg=45.3 kΩ (gain resistor). Vout is converted to a 10-bit digital output by the μC ADC which has an input range of 0-0.9V. Thus,
FEA was performed using the commercial software ABAQUS. As shown in
All P-values correspond to a two-sided Wilcoxon signed rank test with the null hypothesis H0=N−L=0. Error bars in various data plots indicate the standard deviations over three consecutive trials on the substrate/skin. Subjects with dense coverage of hair and those who applied moisturizer were omitted from the data on healthy/normal subjects in panel F of
The SHS measures the thermal properties (conductivity k and diffusivity α) of the skin using the transient plane source (TPS) technique. TPS exploits Joule heating via a resistive element placed on the top of a sample of interest while simultaneously recording the transient temperature change (ΔT) of the heating element itself or of a separate temperature sensor. An exploded-view diagram of the SHS appears in panel A of
The resulting hydration sensors are flexible, thin (about 2.1 mm), lightweight (about 2.5 g), and have small lateral dimensions (about 4.5 cm×3.1 cm) (panels B-C of
A detailed circuit diagram for the f-PCB electronics appears in panel A of
The sensing component comprises two commercial surface-mount (SMT) thin film resistors (R=680±3.4Ω each) connected in series to form a heater (about 0.9×0.9 mm2) and an SMT negative temperature coefficient thermistor, placed 60 μm laterally away from the heater (panel B of
Measurements of ΔT for a single device are highly repeatable, with an error of only 2% (possible sources of variability are in
The sensitivity of the SHS (i.e., the range ΔT for materials across the span of physiological values of k) depends partly upon the fraction of the generated thermal power that passes through the sample of interest. Ideally, the thermal properties of the sample will dominate the response, ΔT. Alternate paths of thermal transport/thermal sinking, namely those that can occur within the device itself, reduce the sensitivity to the sample. Associated techniques to improve sensitivity include reducing the widths and thicknesses of interconnect metal (Cu) traces in the vicinity of the heater/thermistor, reducing the thickness of the adhesive, and increasing the thermal power density (
Sensor geometry can also alter measurement sensitivity, however due to the small (about 60 μm) spacing between the heater and thermistor, there is negligible difference in sensitivity between the case of a single component serving as both the heater and the thermistor and the separated heater/thermistor structure (
To predict the effect of some key design parameters, a simplified model is established herein. As shown in panel A of
where J0(x) and J1(x) are the Bessel functions of the first kind with zero- and first-orders, respectively, and erfc(x) is the complementary error function. Combined with the micromechanics model Eqs. (1) and (2) below, ΔTsensor can be related to the skin water content φskin. In some previous works, the heater itself serves as the sensor such as that the average temperature in heater is the sensor temperature, which is
Referring the design with the sensor separate from the heater as design 1 and the one with sensor/heater being the same as design 2, the simplified model shows that the sensitivity of temperature change to skin water content of design 1 is about 30% smaller than that of design 2 (panel A of
In previous reports, fitting procedures based on finite element analysis (FEA) and measurements of ΔT vs. t define local, volumetric-averaged values of k for the sample under test, appropriate for homogeneous, isotropic materials (panels F-G of
where
as plotted in
At the macroscale, FEA establishes a relationship between ΔT (at time t=0-13 s) and the thermal properties kE, αE, kD and αD, and therefore the water content φE and φD. For the typical epidermal thickness (h=100 μm), at short times following initiation of heating (e.g., t=2 s), thermal transport occurs substantially into the epidermis but only slightly into the dermis (panel C of
To determine the water content φE (epidermis) and φD (dermis) from an experimental curve of temperature change ΔT vs. time t, φE and ED are extracted through minimization of the quantity below
where ttotal is the total heating time, ΔT (t) is the temperature predicted by the FEA and micromechanics model, and ΔT(t) is the experimental measurement.
For a few cases, depending on the individual and the body location, large epidermal thicknesses (e.g., heel, h≈600 μm) limit the transport of heat to the dermis even at t=13 s. This behavior leads to a relative insensitivity of ΔT to φD (
Error in the determined φE and φD from error in the temperature measurement: Given a curve of ΔT vs. t, φE and φD can be determined by the fitting method shown above. Adding an error to the temperature change such that ΔT becomes ΔT(1+δ) and performing the fitting again, the differences between the fitted water contents are the errors arising from the relative error in temperature measurement δ.
Error in the determined φE and φD from error in epidermis thickness. Epidermis thickness has a small effect on the relationship of ΔT vs. φE and D. For a typical epidermis thickness h=100 μm, fitting is performed to obtain φE and φD from the experimental curve of ΔT vs. t. Changing the epidermis thickness by ±20% and performing the fitting again for the same experimental curve, the differences between the fitted water contents are the errors arising from the error in epidermis thickness. The average errors for φE and ED ranging from 5% to 95% are 2.9% for epidermis and 1.9% for dermis (for 20% error in epidermis thickness).
In practice, for the cases reported here, errors in the values of φE and φD determined in this manner are less than about 500 (
Surgical and Radiologic Anatomy 24, 183-189, 2002). For locations
Measurements on several healthy/normal subjects (npatients=16, demographics in Table 3) on six different body locations each illustrate the accuracy of the fitting process and utility of the model (panel G of
Use of the SHS system, for the first time, on patients diagnosed with various skin diseases are the key set of results which illustrate the clinical utility and the versatility of the technology. For assessments of disease lesions, φE and φD, along with skin surface temperature T0, are important indicators of different conditions, such as edema and erythema. It is noted that calculations of φE and φD involve measurements of ΔT and are thus independent of T0. The same types of information can also serve as quantitative metrics of the efficacy of treatment strategies, for example, moisturizers/ointments. These combined features aid in diagnosis, treatment response tracking, and potential detection of flares. The following also compares measurements of the SHS with those of a commercially available, portable corneometer (gpskin barrier pro, GPower, KR) that determines both transepidermal water loss (TEWL, a contact-less measurement using humidity and temperature sensors) and stratum corneum hydration (ScH, an electrical impedance/capacitive measurement), and shows good correlation to clinical gold-standard tewameters and corneometers. TEWL is a complementary measurement to skin permeability/hydration and assesses skin barrier function. It is noted that the corneometer, along with the aforementioned gold-standard devices, involves only superficial measurements depths, typically confined to the stratum corneum (about 15 μm). Few devices have mm-scale measurement depths but have large (1-5 cm) probe diameters which prevent small-area measurements.
The first demonstration focuses on patients with atopic dermatitis (AD), an inflammatory disease of the skin that causes red, itchy rashes on various locations of the body. In the United States, 18 million adults suffer from AD, with worldwide prevalence rates of 1-20%. This pilot study involves nlesion=13 lesions across npatient=7 patients clinically diagnosed with AD by a dermatologist using both the SHS and the corneometer. Patient demographics is listed in Table 4. SHS outputs include measurements of T0, φE, L(N) and φD, L(N) on the diseased site (the lesion L), and on healthy-looking skin on a similar body location or perilesional area (non-lesional area N) as a standard of comparison. T0 and corneometer data for lesions in
Measurements on Patients with Psoriasis and Urticaria
Additional clinical studies use the SHS to measure φE, φD, and T0 (see FEA curve fits in
The SHS can also provide insights into dermal diseases owing to its capability to measure properties deep into the skin, through measurements performed on patients with urticaria. This condition occurs in the epidermis and the upper portions of the dermis, where localized vasodilation occurs, and biofluid exudes into the surrounding tissue. Measurements on npatient=2 patients for a total of nlesion=4 urticaria lesions indicate enhanced water content in the lesion than the non-lesional area for both the epidermis and dermis (panels H-M of
Topical Treatment on a Patient with Xerosis Cutis and Atopic Dermatitis
Diagnosing a disease state represents the first step in patient care. The next involves delivering treatment, monitoring the effects, modulating the treatment protocol as necessary, and potentially predicting for flares based on quantitative, individualized measurements on specific lesion sites. The results in the following demonstrate this approach in the context of a topical cream (CeraVe Moisturizing Cream, DFB Technology, Ltd., USA) applied to a patient diagnosed with both xerosis cutis (XC) and AD.
Measurements with the SHS indicate that for both XC lesions on the anterior leg, application of moisturizer for 30 minutes improves φE from its low initial value (+10 to 30%) but does not affect φD, as expected because moisturizers only improve superficial skin hydration (panels A-B of
The acute AD lesions on the elbow, wrist, and antecubital fossa exhibit no increase in φE,L with moisturizer and negligible change in φD,L (panels F-K of
Thin, soft, wireless skin hydration sensors disclosed in this invention exhibit high repeatability in measurements, robust operation in various conditions, and, through careful systems engineering, overcome the severe shortcomings of poor repeatability in previous work. The robust design has enabled the first true application of well-known thermal physics and the TPS technique in actual clinical/non-clinical settings under varied conditions for several patients over multiple body locations. The feature of wireless data transmission and use with a wide range of mobile devices facilitates use in assisting patients with quantitative tracking of their skin health and sharing these data with their physicians. The designs specifically align with commercial manufacturing capacity that supports the consumer electronics industry, thus allowing for low-cost production and broad distribution to both clinicians and patients. This work thus has the potential to create opportunities for measurements not formerly achievable on patients in clinical environments and in the home.
Measurement areas have millimeter scale dimensions, allowing detection and mapping of small lesions on the skin, even on challenging and/or sensitive regions of the body. The measurement depths can reach about 1 mm, and the temporal information allows discrimination between surface and deep skin properties from a single set of time series data. The contact to the skin occurs naturally or can be paired with external medical-grade adhesives, without need for control over application pressure. These three features are absent from conventional corneometers. Furthermore, the device offers superior measurement capabilities, with average repeatability error of about 5% for φE and about 4% for φD. As comparison, the average error for TEWL and ScH from the commercial corneometer are about 14.4% and about 30.1%, respectively.
A limitation of the measurement is that the thickness of the epidermis is typically not known, and it cannot be easily inferred directly from the thermal data. For healthy/normal subjects, the literature values represent fair assumptions, as small variations in thickness do not alter fitting results significantly. On the other hand, for diseased locations, the thickness can change dramatically. While in these cases the top about 100 μm may not necessarily represent the ‘epidermis,’ the hydration values of the top 100 μm of skin and remaining about 900 μm below are accurate and serve the need for skin diagnostics. Paired with visual inspection, and as seen in measurements on patients with visible skin thickening, the device may yield signatures for lesions with different skin thickness. Determining signatures for each disease and sub-type warrants, however, careful investigation on many patients. Procedures include characterizing the difference between lesions and non-lesional areas, acute and chronic conditions, different subject populations, and response to treatments. The scope of the SHS platform can also be extended to monitor water content of internal organs for various diseases where traditional monitoring techniques (blood tests, MRI, etc.) fail to offer continuous assessment of organ health.
Ultimately, the technology presented here allows monitoring of skin health anywhere, anytime, and by anyone. The SHS has the potential for use in both clinical and at-home settings, from its ability to discern atopic dermatitis lesions (P=0.0034) and psoriasis lesions (P=0.0156) with high significance, detect trends for dermal diseases like urticaria and rosacea, and assess treatment efficacy. Capabilities for determining changes in skin water content presents an important benefit across the entire continuum of care for inflammatory skin diseases. This soft, conformal, battery-free system device may provide significant perspectives on skin diseases and continuous monitoring of skin health.
The skin serves a variety of roles as an immune, sensory, and thermoregulatory organ, but one could argue its function as a protective barrier is the most fundamental. Atopic dermatitis (AD) and xerosis cutis (XC) are two common skin conditions that demonstrate skin barrier dysfunction through itch and dry skin. While both AD and XC are characterized by impaired skin barrier function, the pathogenesis is distinct.
Atopic dermatitis is recognized as a chronic inflammatory disease of the skin. Affecting up to 20% of children and 3% of adults, the most common and significant symptoms are dry skin and itch, but lesions, severity, and course are all highly variable among patients with management aimed at symptomatic relief and prevention of flares. Although it has been known that damage to the epidermis was a component of AD, recognition that abnormalities of the skin barrier as contributory in pathogenesis is more recent. Intrinsic barrier factors that contribute to dysfunction in AD are believed to be diverse, including inherited filaggrin abnormalities, decreased ceramides, and disordered tight junctions; the effect of these factors is compounded by autoimmune pathways, including action of T-helper type 2 cells and their related cytokines, as well as external factors such as exposure to environments with low humidity. Ultimately, patients with AD have decreased stratum corneum hydration, increased trans-epidermal water loss (TEWL), and higher pH when compared to non-atopic individuals.
While the epidemiology of xerosis cutis is difficult to assess due to its broad definition and wide range of severity, it is recognized as particularly common in older patients with some estimates up to 86% of patients over the age of 65. Given the high occurrence of itch in patients with xerosis cutis, there is also a higher risk of complications resulting from scratching, including pain, infection, and overall diminished quality of life due to impaired ability to participate in daily activities. Regarding the pathophysiology of XC, it is most commonly the result of age-related changes in the physiology of the skin barrier, namely the ability of the skin to generate and retain natural moisture, proteins, and lipids. Furthermore, UV radiation leading to natural breakdown of filaggrin and reduced levels of natural moisturizing factor is also contributory with cumulative effect over multiple exposures.
While there are existing physician-grading scales, there are currently no widely used objective digital biomarkers that accurately reflect the severity of the disease or the clinical manifestations of AD and XC. Thus, there is need for objective and repeatable methods to assess skin barrier function in normal and affected skins. Subjective grading and patient reported outcomes are indirect methods of assessing the health of the skin barrier that are commonly used to guide management. Examples of scoring systems include the overall dry skin (ODS) score, six area six sign (SASSAD) score, and the AD area severity index (ADASI). However, these grading systems are imprecise due to user variability and can be unreliable for assessing small but clinically meaningful changes over time. These measures also become difficult to apply in populations such as pediatrics where patients may be unable to adequately report the severity of their symptoms. These limitations were the reason for developing objective measurements such as skin hydration and TEWL to quantify the health of the skin barrier.
Traditionally, corneometry has been used as an objective measure, relating skin impedance to the water content of the stratum corneum. There has also been work demonstrating the use of spectroscopy as a means of evaluating skin hydration. TEWL, or the measure of water passively evaporating through the skin to the external environment, is also generally considered to be an indicator of skin barrier health, but the accuracy is often influenced by environmental factors like humidity and temperature. However, well-researched tools that are currently available for measuring skin hydration and TEWL are generally bulky, expensive, and have limitations in terms of repeatability and generalizability.
In this exemplary study, we present the findings from a clinical validation study of a novel skin hydration sensor (SHS) to address existing technology limitations, and demonstrate the ability for the SHS to capture measurements of skin barrier function in a diverse population including healthy normal subjects, and patients with atopic dermatitis and xerosis cutis in comparison to a clinician-derived ODS score. The SHS is a wireless, flexible sensor that evaluates the thermal conductivity of the skin to determine water content. The use of thermal conductivity is a novel approach to evaluating skin hydration that has been established as a direct means of measuring skin hydration as a function of skin barrier health. This modality also offers the advantage of overcoming depth limitations seen with impedance-based devices. Prior validation studies have also established that measurements with the SHS device are more repeatable and less susceptible to ambient changes in temperature than earlier attempts to leverage thermal conductivity in evaluating hydration. In addition, the form factor of the devices allows for flexible conformation to the skin that improves skin contact, patient comfort, and even continuous wear. The device is also supported by wireless communication capabilities with a wide range of mobile devices allowing for assessments in a patient's natural home environment.
Overall, the SHS device provides objective measurements of skin hydration barrier function with clear discrimination between different ODS scores across three body locations and the application of a moisturizer. Furthermore, the SHS device provides the ability to distinguish skin barrier function across healthy volunteers, XD, and AD patients. This device may be useful as an endpoint for clinical trials for experimental therapeutics, assess treatment response in clinical practice, and warn of impending deterioration of skin barrier function prior to worsening clinical symptoms.
The SHS device developed at Northwestern University is described above. The device in one embodiment includes a 1 by 1.5 cm flexible sensor coated in silicone. The device applies a small amount of heat to the skin and uses temperature sensors to calculate the thermal conductivity of the skin, which corresponds with water content. Measurements are displayed through an app connected via Bluetooth®.
This study was approved by the institutional review boards of Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University.
Participants were recruited in the outpatient dermatology clinic of Northwestern Medicine. Written, informed consent was obtained prior to study participation. Exclusion criteria were: <18 years of age, pregnancy, and active, open lesions or other dermatologic history that precluded sensor placement. Dermatologic history was obtained via electronic chart review. A total of 136 subjects (86 women and 50 men) with a mean age of 44 years (range of 19-95 years, standard deviation of 19 years) were enrolled in this study including 18 patients with AD. 40% of subjects self-identified as White/Caucasian, 31% of subjects self-identified as Asian, 14% of subjects self-identified as Black/African American, and 8% of subjects self-identified as Hispanic/Latino. A summary of the demographics in this study is included in Table 5. 139 measurement sites with XC, and 215 healthy normal measurement sites. We correlate the objective measurements captured by the SHS sensor with a dermoscopic and clinical image derived ODS scores between two graders across all subjects in three body locations (forearm, lower leg, and forehead). A subgroup of participants were assessed with the SHS sensor before and after moisturizer application (n=49 subjects). A Kruskal-Wallis test with multi-comparison correction was conducted in a post-hoc analysis comparing the SHS measurements organized by clinician-derived ODS scores.
Anatomic sites selected for this study included the flexor surface of the forearm, the flexor surface of the lower leg, and the midline of the forehead. These areas were chosen primarily for accessibility. The forehead was selected as an internal control known to have consistently higher hydration compared to other sites. Specific placement of the devices was chosen to avoid subject-specific factors (e.g., body hair, cuts, tattoos). A 5×5 cm area at each anatomic site was identified, sanitized with a single-use alcohol wipe, and marked with a surgical marker to ensure that the same location was used for all measurements.
Study visits began with a set of photographs of the measurement sites. One set of photographs was taken with an iPhone X camera, and one set was taken with an iPhone X camera and a Dermlite dermatoscope attachment. These photographs were used to issue an overall dry skin score to the site. Images were scored by two reviewers with an aim of 90% concordance. A third reviewer was brought in to decide between differing scores. Of note, ODS 4 was not used in this study because the definition for this score is “dominated by large scales, advanced roughness, redness present, eczematous changes and cracks” and active, open lesions or cracking of the skin was an exclusion criteria.
Triplicate measurements were recorded with the SHS at each measurement site. Single-use alcohol wipes were used to sterilize the devices.
An optional extension of the study was also offered to participants. In this extension, 50 mg of moisturizer was gently applied to the sites of interest and rubbed into the skin for 15 seconds. These application parameters were selected for consistency with existing sunscreen studies as well as the FDA recommendation for sunscreen application (2 mg/cm2). Another set of measurements (triplicate at each location with each device) were then taken 15 minutes after application of the moisturizer. The standard commercial moisturizer used was an aqueous cream manufactured by CeraVe.
Results were analyzed and visualized in MATLAB®. The differences in measurements across ODS scores, anatomic locations, and skin condition (i.e. healthy control, XC, AD) were analyzed using a nonparametric Kruskal-Wallis with Tukey post-hoc analysis. A Wilcoxon rank sum test was used to compare the measurements taken before and after the application of moisturizer. While not a primary goal of the program, concurrent corneometry measurements (Delfin Moisture Meter) were also obtained. Prior work has demonstrated greater repeatability of the SHS sensor versus corneometry.
Skin hydration readings (a scale of 0 to 1) decreased with increasing ODS at each site (p<0.001, p=0.003, and p<0.001 for the arm, leg, and forehead, respectively). Median measurement at ODS 0 vs. ODS 3 at the arm were 0.614 (CI: 0.601-0.627) vs. 0.3858 (CI: 0.356-0.415) and 0.6525 (CI: 0.631-0.675) vs. 0.3642 (CI: 0.341-0.388) for ODS 0 vs. ODS 3 at the leg. In the moisturizer subgroup, a baseline ODS score of 3 yielded a greater increase (66% and 41% at the arm and leg, respectively) in skin hydration after moisturizer application compared to baseline ODS scores of 2 (33% and 22% at the arm and leg, respectively), 1 (18% and 13% at the arm and leg, respectively), or 0 (5% and 2% at the arm and leg, respectively). Median measurement at the arm and leg were higher for HNL measurement sites 0.6070 and 0.6501 for the arm and leg, respectively) vs. sites designated XC (0.5238 and 0.4871 at the arm and leg, p<0.001 at both the arm and leg when compared to HNL) or AD (0.6781 and 0.7224 at the arm and leg, p=0.09 at the arm and p=0.48 at the leg).
Comparison of SHS Measurements with ODS Scores
SHS measurements range from 0 to 1, calibrated with standardized silicone models with known hydration levels. ODS scores ranged from 0-3 for the arm and leg. No subjects received an ODS score of 2 or higher for the forehead. Median SHS measurements at the arm were 0.6140 (95% CI: 0.6006-0.6274, n=66), 0.5540 (CI: 0.5340-0.5741, n=43), 0.4832 (CI: 0.4246-0.4923, n=14) and 0.3858 (CI: 0.3563-0.4154, n=3) for ODS 0, 1, 2, and 3, respectively. Comparison by Kruskal Wallis yielded p<0.001 for all comparisons, with the exception of between 2 and 3 (p=0.04). Median SHS measurements at the leg were 0.6525 (CI: 0.6305-0.6745, n=37), 0.5955 (CI: 0.5631-0.6278, n=23), 0.5331 (CI: 0.5103-0.5559, n=44) and 0.3642 (CI: 0.3406-0.3878, n=32) for ODS 0, 1, 2, and 3, respectively. Comparison by Kruskal Wallis yielded p<0.001 for all comparisons, with the exception of between 0 and 1 (p=0.03). Median SHS measurements at the forehead were 0.6898 (CI: 0.6811-0.6985, n=133) and 0.4635 (CI: 0.3242-0.6029, n=3) for ODS 0 and 1, respectively with p=0.003 by Kruskal Wallis comparison.
At all sites, a linear relationship can be observed, with a 37.2% and 44.2% relative decrease in median measurement when comparing ODS 0 to ODS 3 at the arm and leg, respectively. A 32.8% relative decrease in median measurement was seen at the forehead from ODS 0 to ODS 1. Of note, 133 of 136 forehead images in this study were consistent with an ODS score of 0. The forehead was found to have higher hydration than arm (p<0.001) or leg (p=0.001) at ODS 0 by Kruskal Wallis. Mean hydration readings for ODS 0 were 0.6175, 0.6476, and 0.6842 at the arm, leg, and forehead, respectively.
49 subjects participated in the moisturizer extension of the study. One subject was excluded from the forehead analysis due to technical failure while collecting post-moisturizer measurements.
A comparison of SHS measurements organized by skin conditions is shown in
The mean ODS scores in subjects with AD were 1.6, 2.1, and 0.1 at the arm, leg, and forehead, respectively. The mean ODS scores in subjects without AD at the arm, leg, and forehead were all slightly lower at 0.7, 1.5, and 0, respectively. Median values at ODS 0 between subjects with and without AD were 0.6781 vs 0.6070 at the arm (p=0.09), 0.7224 vs 0.6501 at the leg (p=0.48), and 0.6940 vs 0.6882 at the forehead (p=0.94). The absolute difference of means at ODS 0 between subjects with vs. without AD were 0.0843 (14% decrease from HNL), 0.0773 (12%), and 0.0148 (2%) at the arm, leg, and forehead. P values from a Wilcoxon rank sum test comparing SHS measurements taken from ODS 0 with vs. without AD at the arm, leg, and forehead were 0.006 (n=4 vs 62, with vs. without AD), 0.08 (n=2 vs. 35), and 0.73 (n=17 vs. 125). While not a primary objective of the study, measurements of the SHS correlated with corneometers readings (r2=0.32, p<0.001), as shown in
There is a need for more objective outcome measures across the field of dermatology. Given the importance of skin barrier function to the pathogenesis of a wide range of skin diseases, there is a specific need for assessment tools in this area. Both AD and XC are conditions that have complex and varying courses with nuances that are likely underappreciated when solely evaluated with subjective scoring. While subjective measures and patient reported outcomes have value, objective digital biomarkers offer the opportunity to evaluate, compare, and detect changes in disease severity in a multitude of contexts from triggers to treatment without memory bias or inter-reviewer bias. With more reliable measurements comes the ability to derive more powerful and definitive insights from trials and follow up in clinical management. Additionally, as the fund of knowledge surrounding the skin barrier evolves and becomes more refined, the tools available for clinical evaluation of the skin barrier need to evolve in tandem. The Harmonising Outcome Measures for Eczema (HOME) initiative has previously established recommendations for measurement instruments such as the EASI and SCORAD to be standardized across trials. However, there is a need for biophysical measurements beyond physician-scales that offers more sensitivity, reliability, and scalability.
Previous work has already demonstrated the consistency of SHS measurements. In the current study, the SHS illustrates the ability of the system to provide reliable measurements that correlate with subjective clinical assessment tools, such as the ODS scoring system, across a spectrum of dry skin severity, as seen in
Consideration must be given to areas of skin that have discordant ODS scores and SHS measurements, seen as outliers in
Additionally, the novel use of dermoscopy to improve the ODS scoring system may be a more reliable and consistent means of scoring than general examination. The use of dermoscopy in this study enhanced the level of detail in the images and consistency in lighting and skin surface area. These attributes also allowed the study authors to achieve greater consistency in applying the ODS scoring system.
Looking at the effects of moisturizer, the role of absorption time must be considered to address the concern of measuring a layer of moisturizer. The possibility that a thin layer of moisturizer was retained on the surface of the skin and impacted subsequent measurements in our study cannot be definitively ruled out. However, the protocol was informed by a previous study that established moisturizer absorption time to be less than 10 minutes by infrared imaging and the increase in skin hydration after moisturizer application is consistent with previous findings as well.
In the study, it is important to note that the definition of healthy normal and xerotic skin is not an exact representation of healthy normal versus xerotic skin as seen clinically. Since XC is a clinical diagnosis that does not require assignment of an overall dry skin score, it is possible that there are patients who have been diagnosed with xerosis cutis but would not meet our criteria and vice versa. Here again, the limitations of the ODS scoring system must be acknowledged, especially the issues of repeatability and inter-reviewer reliability. Additionally, in the comparison of healthy normal and atopic skin, our study did not further stratify the AD group by ODS due to a limited number of AD subjects (n=18).
The SHS offers benefits of small size, portability, accessibility, reliability, and consistency compared to existing devices used for research purposes. When compared specifically with traditional impedance devices, the use of thermal conductivity allows the SHS to take measurements across a greater range of tissue depths. Reliance on thermal conductivity rather than electrical impedance is also a likely reason that the SHS can be encapsulated without requiring direct contact between electronics components and the skin, resulting in greater flexibility and patient comfort. Considering practicality, the Bluetooth® capability and external data storage of the SHS means that users can easily organize their data on their own personal mobile device enabling home use. Given these considerations, there are several potential uses for the device as a diagnostic support tool, for longitudinal measurements to detect changes in disease severity and/or treatment response, and as an objective measure of efficacy that would allow for cross-comparison in clinical trials.
The foregoing description of the exemplary embodiments of the invention has been presented only for the purposes of illustration and description and is not intended to be exhaustive or to limit the invention to the precise forms disclosed. Many modifications and variations are possible in light of the above teaching.
The embodiments were chosen and described in order to explain the principles of the invention and their practical application so as to enable others skilled in the art to utilize the invention and various embodiments and with various modifications as are suited to the particular use contemplated. Alternative embodiments will become apparent to those skilled in the art to which the present invention pertains without departing from its spirit and scope. Accordingly, the scope of the present invention is defined by the appended claims rather than the foregoing description and the exemplary embodiments described therein.
Some references, which may include patents, patent applications and various publications, are cited and discussed in the description of this invention. The citation and/or discussion of such references is provided merely to clarify the description of the present invention and is not an admission that any such reference is “prior art” to the invention described herein. All references cited and discussed in this specification are incorporated herein by reference in their entireties and to the same extent as if each reference was individually incorporated by reference.
This application claims priority to and the benefit of U.S. Provisional Application Ser. No. 63/092,555, filed Oct. 16, 2020. This application is also a continuation-in-part application of PCT Patent Application Serial No. PCT/US2021/036765, filed Jun. 10, 2021, which itself claims priority to and the benefit of U.S. Provisional Patent Application Ser. No. 63/037,092, filed Jun. 10, 2020. This application is also a continuation-in-part application of U.S. patent application Ser. No. 17/043,161, filed Sep. 29, 2020, which is a national stage entry of PCT Patent Application Serial No. PCT/US2019/025031, filed Mar. 29, 2019, which itself claims priority to and the benefit of U.S. Provisional Patent Application Ser. No. 62/650,826, filed Mar. 30, 2018, 62/696,685 filed Jul. 11, 2018, and 62/791,390, filed Jan. 11, 2019. Each of the above-identified applications is incorporated herein by reference in its entirety.
This invention was made with government support under 1635443 awarded by the National Science Foundation. The government has certain rights in the invention.
Filing Document | Filing Date | Country | Kind |
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PCT/US2021/055357 | 10/18/2021 | WO |
Number | Date | Country | |
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63092555 | Oct 2020 | US | |
63037092 | Jun 2020 | US | |
62650826 | Mar 2018 | US | |
62696685 | Jul 2018 | US | |
62791390 | Jan 2019 | US |
Number | Date | Country | |
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Parent | PCT/US2021/036765 | Jun 2021 | US |
Child | 18031389 | US | |
Parent | 17043161 | Sep 2020 | US |
Child | PCT/US2021/055357 | US |