Title: PhototheRapy Enhanced Via Artificially Intelligent Lasers (PREVAIL)
Funder: Department of Health and Social Care

Abstract: Psoriasis is a common inflammatory skin disease affecting 2.8% of the UK population and >125 million people globally. Due to its visible nature, psoriasis has significant psychosocial/socioeconomic effects, impacting negatively on quality of life, social relationships, education, and employment. Ultraviolet light (UVB) is a highly effective treatment for psoriasis, where patients are treated in a cabinet incorporating a cylindrical array of 2m long UV fluorescent lamps. This approach is advocated by the National Institute for Health and Care Excellence (NICE). However, irradiation of healthy skin during treatment presents significant limitations due to risk of sunburning and even skin cancer. Ideally, only the psoriatic skin requires UV treatment. In this proposal we describe an automated, safe, and robust method for targeted irradiation of UV light, via a neural network that processes a live video feed of a patient and scans an UV laser source accordingly over the afflicted psoriatic skin, whilst not irradiating any healthy skin. In this 12-month Phase 1 study, the primary objective is to provide a proof-of-principle demonstration of this capability by the automated scanning of a UV laser over regions of psoriasis in printed photographs of patients with psoriasis. To train a neural network to detect psoriasis in photographs, we will collect, and subsequently label, photographs of patients/people with psoriasis visiting the psoriasis clinic at the University Hospital Southampton (NHS) and via the Psoriasis Association. We will take active steps to ensure that this project includes a broad range of patients, including across gender, ethnicity, and age. To date we have not published, or made public, any of our preliminary data. Through support from the university’s research and innovation services we have started the process of patent identification, searching, and writing. The proposal team are already well-versed in this process and are owners of several medical patents.

Lay abstract: Psoriasis is a common, long-term skin disease affecting >1 million people in the UK, >125 million people worldwide, and documented as &ldquo;a serious global problem&rdquo; by the World Health Organisation. Psoriasis is a risk factor for developing arthritis and other diseases (heart disease, stroke, diabetes), and the fact that psoriasis is visible on the skin causes stress, depression, embarrassment, etc. and a lower quality of life for affected people. In the UK, NHS costs for treating psoriasis are up to approximately &pound;10,000 per patient each year. Ultraviolet light (UV) is a common treatment for psoriasis and the National Institute for Health and Care Excellence (NICE) advises doctors to offer UV treatment to people with psoriasis that cannot be controlled with creams or ointments alone. UV treatment is available in most dermatology departments in the UK (and Europe, USA, etc.), and patients with psoriasis are usually treated inside UV cabinets that shine UV on all areas of the skin. However, there are two problems with this approach; (i) exposure of normal skin can cause sunburn, so UV doses have to be lower than doses that the psoriasis can cope with, therefore treatment is given 3 times per week and the course takes several weeks to complete, and (ii) exposure of normal skin can lead to later development of skin cancer. In certain cases, a hand-held UV instrument can be used, where a trained nurse moves the UV over specific areas of the patient s skin, but this approach for all patients would require vast numbers of additional nurses and is well beyond the funding of the NHS. We plan to develop an automatic, safe and robust method of treating psoriasis where only the psoriatic skin, and not the normal skin, is treated with UV, without the need for a nurse to direct the UV beam onto the psoriatic skin. Whilst this approach would have been unthinkable five years ago, the recent developments in artificial intelligence (specifically in allowing computers to &ldquo;identify&rdquo; things) now makes this possible. Similar to a self-driving car that uses cameras to monitor the road and drive safely around pedestrians whilst following the rules of the road, here we are proposing a &ldquo;self-driving UV laser&rdquo; that uses cameras to scan a patient s skin to identify where the psoriasis is and then shine the UV treatment only onto the psoriasis. This will allow personalised treatment for each patient at potentially very low costs, and would bring many benefits, including (a) patients needing fewer treatment visits, (b) quicker clearance of their psoriasis, (c) better safety through lower risk of skin cancer, (d) reduced time on waiting list for treatment, (e) the ability to treat more patients, and (f) reduced staff costs.

Research activity codes: 5.5 RADIOTHERAPY AND OTHER NON-INVASIVE THERAPIES;7.3 MANAGEMENT AND DECISION MAKING
Health categories: SKIN