Spectroscopic assessment of cutaneous hemodynamics in the presence of high epidermal melanin concentration

Background: For individuals with lightly pigmented skin, early stage pressure ulcers appear as areas of redness, which have compromised microcirculation and do not blanch in response to pressure. The lack of a visible blanch (hemodynamic response) to pressure is a convenient diagnostic test for stage I sores. However, the blanch response is not visually apparent in people with highly pigmented skin color due to the overwhelming contribution of melanin to the reflectance of skin. Methods: A simple least squares projection operator method is described, which can separate the reflectance contributions from melanin and hemoglobin. The methodology was tested in a study population of 20 subjects with healthy skin. The study population was evenly divided into a lightly pigmented skin group (visible blanch response) and a highly pigmented skin group (no visible blanch response). Results: The hemodynamic response to pressure being applied to the skin could clearly be distinguished spectroscopically in both groups at a high level of statistical significance. Conclusion: The specific aim of this work was directed towards developing a spectroscopic basis for distinguishing the healthy blanch response in a manner that was independent of skin pigmentation. However, the technique has a general application when optical hemodynamic measurements are being made over a diverse patient population or under conditions of varying pigmentation such as the seasonal changes in skin color. (C) 2002 Elsevier Science B.V. All rights reserved.