High-Frequency Ultrasound Assessment of Skin and Oral Mucosa in Metabolic Syndrome Patients-A Cross-Sectional Study

Abstract

Background: Exogenous factors (such as sun exposure, smoking habits, and diet) and endogenous (inflammatory status, general diseases) have a direct influence on skin and soft tissue characteristics. The study's objective was to assess the impact of metabolic syndrome (MS) on characteristics of skin layers in sun-exposed and non-exposed maxillofacial tissues evaluated by high-frequency ultrasound (HFU), as a potential diagnosis and monitoring tool for the aging process.

Material and methods: The present study included 102 subjects (24 with MS; 78 without MS). Anthropometric parameters and disease history were recorded, and blood samples were harvested in order to assess biochemical parameters of MS. Sun-exposed skin (zygomatic region) and non-exposed oral mucosa of the lower lip were assessed using HFU (DUB^® cutis, Taberna Pro Medicum) with a 22 MHz probe.

Results: Patients with cardiac disease had significantly lower values for epidermis density (p = 0.002). Gender was independently linked to the aged dermis depth (p < 0.001), aged dermis no. of px (pixels) (p < 0.001), dermis depth (p < 0.001), dermis no. of px (p < 0.001), and subcutaneous tissue density (p < 0.001). Patients with MS had thinner epidermis (p = 0.008) and thinner aged dermis (p = 0.037) when compared to non-MS subjects.

Conclusion: Patients with MS had thinner epidermis and a lower epidermis number of pixels in sun-exposed skin. Women had lower epidermis density and thicker dermis in sun-exposed skin. Our study showed that HFU, as a non-invasive investigation approach, is useful to diagnose and monitor the aging process in skin and oral mucosa, correlated with skin phenotype pathological conditions.

Keywords: aging; high-frequency ultrasound; inflammation; metabolic syndrome; oral mucosa; skin.

Figure 1

HFU assessment in zygomatic skin area. (A) HFU (DUB cutis, Taberna Pro Medicum, Lüneburg, Germany); (B) the transducer with a 22 MhZ frequency (red arrow); (C) assessment of the ecographic measurements; (D) HFU skin structures: 1—epidermis, 2—aged dermis, 3—healthy dermis, 4—hypodermis.

Figure 2

HFU (DUB cutis, Taberna Pro Medicum, Lüneburg, Germany) 22 MHz zygomatic skin evaluation. The images are exported in pixels in order to evidence tissue density (white and blue—very dense, green—dense, and black—low density). Yellow arrow—probe membrane and applied gel, red arrow—hyperpixeled epidermis; blue arrow—pixeled dermis, red arrow—low-density hypodermis.

Figure 3

Lower lip HFU examination. (A) Transducer position on inner surface of the lower lip, (B) the lower lip ultrasound structure: 1—superficial layer of the nonkeratinized epithelium, 2—spinosum and basal layers of the nonkeratinized epithelium, 3—papillary and reticular layers of the lamina propriae, 4—submucosa, 5—minor salivary gland, 6—orbicular oris muscle.

Figure 4

HFU (DUB cutis, Taberna Pro Medicum, Lüneburg, Germany) 22 MHz zygomatic skin evaluation: red arrow—superficial layer of the nonkeratinized epithelium, yellow arrow—spinosum and basal layers of the nonkeratinized epithelium, purple arrow—papillary and reticular layers of the lamina propriae, blue arrow—thin submucosa, pink arrow—orbicular oris muscle, yellow circle—minor salivary gland, orange arrow—conjunctiva–vascular axis.

Figure 5

Correlation between BMI and epidermis density. BMI—Body Mass Index (kg/m²).

Figure 6

Dermis depth in females and males.