No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Ethnic differences in the structural properties of facial skin
Abstract
Conspicuous facial pores are one type of serious aesthetic defects for many women. However, the mechanism(s) that underlie the conspicuousness of facial pores remains unclear. We previously characterized the epidermal architecture around facial pores that correlated with the appearance of those pores.
A survey was carried out to elucidate ethnic-dependent differences in facial pore size and in epidermal architecture.
The subjects included 80 healthy women (aged 30-39: Caucasians, Asians, Hispanics and African Americans) living in Dallas in the USA. First, surface replicas were collected to compare pore sizes of cheek skin. Second, horizontal cross-sectioned images from cheek skin were obtained non-invasively from the same subjects using in vivo confocal laser scanning microscopy (CLSM) and the severity of impairment of epidermal architecture around facial pores was determined. Finally, to compare racial differences in the architecture of the interfollicular epidermis of facial cheek skin, horizontal cross-sectioned images were obtained and the numbers of dermal papillae were counted.
Asians had the smallest pore areas compared with other racial groups. Regarding the epidermal architecture around facial pores, all ethnic groups observed in this study had similar morphological features and African Americans showed substantially more severe impairment of architecture around facial pores than any other racial group. In addition, significant differences were observed in the architecture of the interfollicular epidermis between ethnic groups.
These results suggest that facial pore size, the epidermal architecture around facial pores and the architecture of the interfollicular epidermis differ between ethnic groups. This might affect the appearance of facial pores.
... Recent global consumer surveys on the primary cosmetic concerns of women have identified that not only are the presence of wrinkles and uneven skin tone perceived as major signs of ageing but also the presence of conspicuous skin pores (unpublished data). Moreover, there are ethnic differences in frequency of expression of such skin problems, with the presence of enlarged pores and age spots being of major cosmetic concern for Asian women [3][4][5]. ...
... Visible skin pores are enlarged funnel-shaped or cylindrical openings of the pilosebaceous follicles that become more dilated and more conspicuous caused by the continuous hydrostatic pressure induced by sebum on the pilosebaceous duct in the presence of decreased skin elasticity or slackening in the surrounding areas of the duct caused by ageing [6]. Morphological changes in the dermoepidermal junction (DEJ) are also clearly observed in subjects with conspicuous pores in vivo [5]. Moreover, abnormal keratinocyte differentiation has also been reported with the accumulation of parakeratotic nucleated corneocytes, clearly indicative of UV light irradiation damage to the epidermal keratinocytes [7]. ...
... Both skin problems are induced by oxidative stress to the skin and have some similarities in their pathophysiology. Poor keratinocyte differentiation and aberrations to the DEJ are characteristic to both [5,7,17,18,[26][27][28][29]. As a result, agents that improve epidermal differentiation or reduce the negative effects of UV irradiation on keratinocyte differentiation are likely to be beneficial. ...
As we age, our skin develops visible signs of aging [1]. In contrast to other body organs, the skin as our first line of defense is constantly exposed to challenges from the environment. Ultraviolet (UV) irradiation, and to some extent visible light, climate changes and pollution are the major external environmental contributory factors whereas psychological stress, fatigue and dietary habits are internal stress factors also contribute to the skin aging exposome [2]. Recent global consumer surveys on the primary cosmetic concerns of women have identified that not only are the presence of wrinkles and uneven skin tone perceived as major signs of aging but also the presence of conspicuous skin pores (unpublished data). Moreover, there are ethnic differences in frequency of expression of such skin problems, with the presence of enlarged pores and age spots being of major cosmetic concern for Asian women [3‐5].
This article is protected by copyright. All rights reserved.
... Contributing factors may be due to differences in structure, composition, architecture, and function of skin of various ethnicities. [8][9][10][11][12][13][14][15][16][17] In addition, the aging changes among different ethnic groups may be due to variability in environmental influences depending on geographical location 18,19 and these together with behavioral habits are considered to be important aging factors which have been coined the skin aging exposome. 20,21 To tackle and counteract ethnic-specific aging phenomena and the resulting unwanted skin conditions, understanding ethnic differences in skin architecture and signs of aging is key. ...
... 44 Nevertheless, East Asian subjects (Japan, China, and Korea) are reported to have consistently low numbers of skin pores. 9,23 Ethnic differences between African American and Caucasian females in the appearance of wrinkles are consistent between studies but not the differences in the number of skin pores. This may be due to methodological differences 46-48 especially as pore volume is reported to be the parameter most highly correlated with the visual assessment of skin pores. ...
... 15,17,75 In other studies, African Americans have been studied. 9,23,76,77 Although our data on facial wrinkles are mostly in line with skin aging data from previous studies despite the relatively small number of subjects (50 for Caucasians, 46 for Black Africans), differences in lip lines and pores are apparent. It has been shown that, for example, for Asians the appearance of wrinkles and pores can be different depending on precise ethnicity, for example, Chinese, Thai, or Japanese. ...
Background
Facial wrinkles, pores, and uneven skin tone are major beauty concerns. There is differential manifestation of aging signs in different ethnic groups. In this regard, studies on Black Africans from the African continent are scarce.
Objective
To investigate facial wrinkles, pores, and skin tone in Black African women from Mauritius Island and elucidate the differences to Caucasian women from France.
Methods
Facial images were taken using the imaging system ColorFace®. Wrinkles and pores were measured by their length, depth, surface, volume, and number; for skin tone, we measured L*a*b* and calculated ITA, IWANewtone, and color homogeneity.
Results
We found good correlations of wrinkle and pore scores with expert ranking done on ColorFace® images for Caucasians (Spearman's rho = 0.78 and 0.72) and Black Africans (Spearman's rho = 0.86 and 0.65). Caucasians showed more advanced facial signs of aging than Black Africans. Exceptions were vertical lines on upper lip and the depth of pores which were greatest for the Black African subjects. Black Africans had higher heterogeneity scores indicative for uneven skin tone. Luminance (L*) was significantly higher in Caucasians but a* and b* values were significantly higher in the Black African subjects. ITA and IWANewtone were significantly higher for Caucasians.
Conclusions
The high correlation between expert ranking and wrinkle and pore measurements prove ColorFace® a valid imaging system to study skin aging. Our results show that Africans from the African continent show delayed signs of aging compared to Caucasians. Some exceptions suggest that ethnic differences in facial aging are a complex phenomenon.
... 40 In addition, age-related changes in pigmentation, pore size, elasticity, oiliness, and thickness may differ between men and women of the same ethnicity. [41][42][43] The appearance of facial pores also varies among ethnic groups, with Asians having the smallest pores compared with African American, white, and Hispanic subjects, and African Americans having the most severe impairment of the structure surrounding facial pores. 43 Furthermore, the effects of photoaging differ across skin phototypes, with lighter skin more prone to depigmentation, atrophic changes, and skin cancers, and darker skin more prone to hypertrophic skin changes, deep wrinkles, and skin thickening. ...
... [41][42][43] The appearance of facial pores also varies among ethnic groups, with Asians having the smallest pores compared with African American, white, and Hispanic subjects, and African Americans having the most severe impairment of the structure surrounding facial pores. 43 Furthermore, the effects of photoaging differ across skin phototypes, with lighter skin more prone to depigmentation, atrophic changes, and skin cancers, and darker skin more prone to hypertrophic skin changes, deep wrinkles, and skin thickening. 33 In short, the appearance of skin speaks to the biological underpinnings of health and reproductive fitness, with important, but understudied, differences across ethnicities. ...
Background:
Flawless skin is one of the most universally desired features, and demand for improvements in skin quality is growing rapidly. Skin quality has been shown to substantially impact emotional health, quality of life, self-perception, and interactions with others. Although skin quality improvements are a common end point in studies of cosmeceuticals, they are rarely assessed in clinical studies of other aesthetic treatments and products. Descriptive terminology for skin quality parameters also varies considerably within the aesthetic field, relying on a range of redundant and occasionally contradictory descriptors. In short, skin quality has not been clearly defined.
Objective:
The goal of this review is to highlight the importance of skin quality to patients and physicians, explore known and unknown factors comprising skin quality, and provide clarity regarding terminology, descriptors, and evaluation tools for assessing skin quality.
Materials and methods:
A review of the literature on skin quality was performed without limitation on publication date. Relevant articles are presented.
Results and conclusion:
We propose a framework of attributes contributing to skin quality rooted in 3 fundamental categories-visible, mechanical, and topographical-with the aim to provide information to help guide clinicians and inform future clinical studies.
... 19 Chinese women exhibit notably lower pore size and density across all the age groups compared to other ethnicities. 20 Highly pigmented skin individuals have aberrant epidermal architecture, with stalagmite-like structures at the dermo-epidermal junctions, correlating with an enlarged pore size compared to individuals from other ethnicities. 20,21 Research shows that wrinkles appears at early stages in Caucasian, compared to other ethnic groups. ...
... 20 Highly pigmented skin individuals have aberrant epidermal architecture, with stalagmite-like structures at the dermo-epidermal junctions, correlating with an enlarged pore size compared to individuals from other ethnicities. 20,21 Research shows that wrinkles appears at early stages in Caucasian, compared to other ethnic groups. In fact, Chinese women exhibit a prevalence of pigmented spot and a delayed appearance of wrinkles by 10 years, when compared with French women 22 (Figure 2). ...
Higher demands on skin care cosmetic products for strong performance drive intense research to understand the mechanisms of skin aging and design strategies to improve overall skin health. Today we know that our needs and influencers of skin health and skin aging change throughout our life journey due to both extrinsic factors, such as environmental factors and lifestyle factors, as well as our intrinsic factors. Furthermore, we need to consider our microflora, a collection of micro-organisms such as bacteria, viruses, and fungi, which is a living ecosystem in our gut and on our skin, that can have a major impact on our health. Here, we are viewing a holistic approach to understand the collective effect of the key influencers of skin health and skin aging both reviewing how each of them impact the skin, but more importantly to identify molecular conjunction pathways of these different factors in order to get a better understanding of the integrated “genome-microbiome-exposome” effect. For this purpose and in order to translate molecularly the impact of the key influencers of skin health and skin aging, we built a digital model based on system biology using different bioinformatics tools. This model is considering both the positive and negative impact of our genome (genes, age/gender), exposome: external (sun, pollution, climate) and lifestyle factors (sleep, stress, exercise, nutrition, skin care routine), as well as the role of our skin microbiome, and allowed us in a first application to evaluate the effect of the genome in the synthesis of collagen in the skin and the determination of a suitable target for boosting pro-collagen synthesis. In conclusion, we have, through our digital holistic approach, defined the skin interactome concept, as an advanced tool to better understand the molecular genesis of skin aging and further develop a strategy to balance the influence of the exposome and microbiome to protect, prevent, and delay the appearance of skin aging signs and preserve good skin health condition. In addition, this model will aid in identifying and optimizing skin treatment options based on external triggers, as well as helping to design optimal treatments modulating the intrinsic pathways.
... 29 Asian women show smaller pore areas compared with other racial groups. 30 African Americans showed substantially more severe impairment of architecture around facial pores than any other racial group. 30 The incidence of acne is similar across diverse racial groups but acne responses appear to show differences between the ...
... 30 African Americans showed substantially more severe impairment of architecture around facial pores than any other racial group. 30 The incidence of acne is similar across diverse racial groups but acne responses appear to show differences between the ...
Skin aging is a complex process and underlies multiple influences with the probable involvement of heritable and various environmental factors. Several theories have been conducted regarding the pathomechanisms of aged skin, however fundamental mechanisms still remain poorly understood. This article addresses the influence of genetics on skin aging and in particular deals with the differences observed in ethnic populations and between both genders. Recent studies indicate that male and female aged skin differs as far as the type, the consistency and the sensitivity to external factors is concerned. The same has been also documented between elderly people of different origin. Consequently, the aging process taking place in both genders and in diverse ethnic groups should be examined separately and products specialized to each population should be developed in order to satisfy the special needs.
... [1][2][3][4][5][6][7][8][9] Many dermatologists and researchers of skin science have also studied the differences of skin properties by ethnic or racial groups. [10][11][12][13][14][15][16][17] Although there are reports of ethnic skin differences, there are some limitations because many studies were carried out between two or three ethnic or racial groups (black, white or Asian) 13 and studies that compare among different intraracial population (Southeast Asian) are not as popular compared with studies that involve comparison between races. Another reason is very small numbers of subjects participated in the studies except for the most recent publications. ...
... Recently, it was reported that ethnic differences in the structural properties of facial pores exist and enlarged pore sizes are associated with increased sebum levels. 10,17 In this study, there was only a significant difference between Indonesian and Singaporean women foreheads. Therefore, there may be a difference in pore size among Southeast Asians. ...
Background:
Regional and ethnic (racial) differences in skin properties are well known. However, regional and racial studies are limited and have studied skin properties using an insufficient number of subjects and limited ethnic groups, except in the case of some recent studies.
Objective:
The aim of this study was (1) to compare the skin biophysical parameter among the large scale of Southeast Asia females group and (2) to compare skin properties of the forehead and cheek.
Methods:
We measured and compared seven skin biophysical parameters, such as skin hydration, sebum, skin pH, melanin index, erythema index, skin elasticity and transepidermal water loss (TEWL), of the forehead and cheek of a large population of Indonesian (n = 200), Vietnamese (n = 100) and Singaporean females (n = 97).
Results:
At the point of site difference, there were significant differences in five biophysical parameters (skin hydration, skin pH, melanin index, erythema index and skin elasticity) in Indonesian females. In Vietnamese and Singaporean women, they were significant differences in five biophysical parameters (skin hydration, skin pH, melanin index, erythema index and TEWL). At the point of ethnic difference, the Indonesian women had the highest skin pH and melanin index between the different ethnic groups. Vietnamese women had the highest skin hydration and TEWL in the forehead, whereas Singaporean women had the highest skin elasticity.
Conclusion:
The skin biophysical parameters are different between the forehead and cheek among Southeast Asian females. It also reveals that the biophysical parameters are different in same racial group.
... Facespecific variations exist in the quantity of enlarged pores (e.g., nose, forehead, cheek) [3]. Asians exhibit smaller pore size and less pronounced epidermal architectures surrounding facial pores in comparison to Hispanics and African Americans [4,5]. However, excessive sebum production, decreased skin elasticity, and larger hair follicles are the three main causes that contribute to enlarged facial pores. ...
Background
Various therapeutic options have been introduced for enlarged facial pores including low cross‐linked hyaluronic acid (HA) fillers. Newer formulations of HA‐based dermal fillers are continuously introduced into the market, but their effectiveness in reducing enlarged facial pores has not yet been determined.
Objectives
To compare the efficacy of HA‐based dermal fillers (Cohesive Polydensified Matrix HA filler; CPM‐HA20) versus CPM‐HA20 with glycerol (CPM‐HA20G) in terms of minimizing enlarged facial pores and skin quality improvement.
Methods
Thirty subjects with enlarged facial pores were enrolled in this randomized, double‐blinded, split‐face study. Participants were randomly assigned to be injected with 1 mL of CPM‐HA20 filler on one side of their medial cheek and 1 mL of CPM‐HA20G on the contralateral side for 3 sessions spaced 4 weeks apart. Pore volume was objectively measured by an Antera 3D. Skin biophysical properties were evaluated. Participant satisfaction and adverse events were recorded.
Results
Twenty‐nine participants completed the study. Both treatment groups showed a reduction in the mean pore volume from the baseline through Week 32. The CPM‐HA20G treated side showed a 24.2% higher reduction in mean pore volume from baseline compared to the CPM‐HA20 treated side (p = 0.038). Both treatment groups showed improvement in skin hydration from baseline to Week 32. There was no significant difference in patient satisfaction between the CPM‐HA20G and CPM‐HA20 treated sides. Only mild adverse events such as pain, edema, and bruising were reported.
Conclusion
Three‐monthly injections of CPM‐HA20G and CPM‐HA20 were effective in minimizing enlarged face pores and improving skin hydration. CPM‐HA20G demonstrated superior efficacy in terms of pore size reduction. Adverse events were generally mild and tolerable.
... Wykonano badania porównawcze replik powierzchni skóry policzków u osób pochodzenia azjatyckiego, kaukaskiego, afroamerykańskiego i hiszpańskiego. Wyniki badań wykazały, że u przedstawicieli rasy żółtej wielkość porów była najmniejsza [30]. ...
Polska jest krajem, gdzie większość mieszkańców jest rasy kaukaskiej, jednak coraz częściej zgłaszają się pacjenci o innym kolorze skóry. Celem pracy jest przybliżenie specyfiki przebiegu wybranych chorób dermatologicznych u osób pochodzenia innego niż kaukaskie, związanej z odmiennością niektórych objawów skórnych oraz możliwym rozwojem powikłań, głównie o typie przebarwień. Zwrócono również uwagę na problemy mogące pojawiać się w związku z wykonywaniem peelingów czy stosowaniem zabiegów z wykorzystaniem światła.
... 13 Besides, pore size and density can vary by ethnicity. 14,15 On the other hand, exogenous changes are known to lead to differentiation in skin features as well. For instance, Flament et al. showed that observable skin darkening was detected in a group of Chinese women without sun protection. ...
Background
Enlarged pores are amidst one of the top cosmetic concerns, especially among Chinese. Many small‐group studies have been conducted in understanding their prevalence and beauty relevance. Nonetheless, population‐level investigations are still lacking because of gaps in data collection and processing of large‐scale studies. Owing to the recent technological advancement enabled by artificial intelligence, databases on the scale of millions can be processed and analyzed readily.
Materials and methods
Powered by big data capabilities, revealed a number of novel trends on pore conditions among over‐a‐million Chinese participants recruited via the “You Look Great Today” mobile application. A scoring model was constructed, which demonstrated high consistency with conventional grading method from dermatologists. Environmental data (weather, air pollution, light at night satellite) were applied to correlate with pore severity.
Results
Intraclass correlations between the two scoring systems were strong, with coefficients ranging from 0.79 to 0.92 for different facial areas. Statistical differences in pore severity among all four facial areas (cheek, forehead, nose, and overall) were observed, with the cheek exhibiting the most severe pore condition. Interestingly, Chinese men suffer from more severe pore condition than females. Multiple environmental factors exhibited strong correlations with cheek pore severity and were statistically fitted into linear regressions. Specifically, incremental risk with Each Low Temperature, Low Humidity, And High Solar Exposure correlate to worse cheek pore conditions. Although the Pearson correlation was low between cheek pore severity and light at night, comparison between representative cities demonstrated that in geologically similar cities, higher light at night corresponds to more severe cheek pore conditions.
Conclusion
Our study is showcasing a robust and reliable AI model in facial pore evaluation. More importantly, insights uncovered using this facile approach also bear significant cosmetic ramifications in treatment of pore enlargement.
... However, the different skin properties between Asian people and other ethnic groups including Caucasians, Hispanics and African Americans have been well highlighted in the past studies and reviews. 2,[5][6][7][8][9][10][11] Some differences on the structural and biophysical characteristics are highlighted in Table 1. ...
Asian is home to dozens of different ethnic groups that are characterised by fascinating social and cultural variations. Unfortunately, existing literature on the skin properties of Asians tends to group this diverse population solely based on skin colour, perpetuating the misconception and stereotype that all Asian skin is the same. While Asia is one of the largest continents in the world, the difference in the geographical location and climate have long shaped the population into various ethnic groups with significant differences in the collective and diverse customs, traditions, cultures and living habits. The diverse ethnic groups in this region hint us that their skin biophysical characteristics can be very different from each other. This review features the profiling of the distinctive skin biophysical properties of Asians. We learn more about the different ethnic groups in Asia and acknowledge the unique skin biophysical properties even from the same country.
... In the case of Asiatic facial pores, the pores are the smallest. For Caucasians, the skin values are in the middle, ranging between 40,000 and 55,000 µm 2 (calculated as the area of a circle) [42]. All of these pore sizes can be studied with these kinds of membranes; the mean pore size was 39,045 µm 2 for the blank activated membrane, which had even lower values than those of Caucasian skin at some concentrations of EL and HC. ...
The use of animal testing in the cosmetic industry is already prohibited in more than 40 countries, including those of the EU. The pressure for it to be banned worldwide in the future is increasing, so the need for animal alternatives is of great interest today. In addition, using animals and humans in scientific research is ethically reprehensible. This study aimed to prove some of the anti-aging properties of elastin (EL), hydrolyzed collagen (HC), and two vegan collagen-like products (Veg Col) in a tri-layered chitosan membrane that was ionically crosslinked with sodium tripolyphosphate (TPP). In the first approach, as a way of representing different layers of a biological system, such as the epidermis and the two dermis sublayers, EL, HC, or Veg Col were independently introduced into the two inner layers (2L(i+b)). Their effects were compared with those of their introduction into three layers (3L). Different experiments were performed on the membrane to test its elasticity, hydration, moisture retention, and pore reduction at different concentrations of EL, HC, and Veg Col, and the results were normalized vs. a blank membrane. This new alternative to animal or human testing can be suitable for proving certain efficacy claims for active ingredients or products in the pharmaceutical, nutritional, and cosmetic fields.
... Higher rates of facial sebum production may be associated with larger pore sizes (5). Skin oiliness and pore size may differ by race, with some studies demonstrating larger amounts of sebum secretion or larger pore sizes in Black patients (1,6,7) and others finding no difference (8,9). Sebum composition and production can also vary by age and gender, and in patients with or without acne (10)(11)(12)(13)(14). ...
Background
Excessive sebum production is a factor in acne development. Tazarotene 0.045% lotion has demonstrated reductions in acne lesions and acne-induced sequelae.
Objective
Evaluate efficacy, changes in skin oiliness, and safety with tazarotene 0.045% lotion in participants with moderate-to-severe acne and oily skin.
Methods
In two phase 3, double-blind, 12-week studies (NCT03168321; NCT03168334), participants aged ≥ 9 years with moderate-to-severe acne were randomized 1:1 to once-daily tazarotene 0.045% lotion or vehicle lotion (N = 1614). This pooled, post hoc analysis included only participants self-categorized with oily skin at baseline on the Acne-Specific Quality of Life questionnaire item 19 (scores: 0 [extremely oily] to 6 [not at all oily]). Inflammatory/noninflammatory lesion counts, treatment success, skin oiliness, treatment-emergent adverse events (TEAEs), and cutaneous safety/tolerability were evaluated.
Results
In all participants with oily skin (n = 793), tazarotene provided greater reductions in inflammatory/noninflammatory lesions (p < 0.001, both) and greater treatment success rates versus vehicle (p < 0.01) at week 12. Over two-thirds of polymeric lotion-treated participants had subjective skin oiliness reductions by week 12, with around a third reporting ‘low/not’ oily skin. Tazarotene TEAE rates were similar to the overall population.
Conclusions
Once-daily treatment with tazarotene 0.045% polymeric emulsion lotion may help improve patient-perceived skin oiliness in those with moderate-to-severe acne.
... As can be viewed in the referenced paper, depending on the human race, the facial pore size can vary from 15,000 µm 2 for the Chinese race up to 92,500 µm 2 for the Brazilian race. As has already been shown in other studies, it can be highlighted that Asiatic facial pores represent the race with the smallest pores and Caucasian skin values are in the middle, being between 40,000 and 55,000 µm 2 , calculated as the area of a circle [50]. ...
In 2023, new legislation will ban the use of animals in the cosmetic industry worldwide. This fact, together with ethical considerations concerning the use of animals or humans in scientific research, highlights the need to propose new alternatives for replacing their use. The aim of this study is to create a tri-layered chitosan membrane ionically crosslinked with sodium tripolyphosphate (TPP) in order to simulate the number of layers in human skin. The current article highlights the creation of a membrane where pores were induced by a novel method. Swelling index, pore creation, and mechanical property measurements revealed that the swelling index of chitosan membranes decreased and, their pore formation and elasticity increased with an increase in the Deacetylation Grade (DDA). Additionally, the results demonstrate that chitosan’s origin can influence the elastic modulus value and reproducibility, with higher values being obtained with seashell than snow crab or shrimp shells. Furthermore, the data show that the addition of each layer, until reaching three layers, increases the elastic modulus. Moreover, if layers are crosslinked, the elastic modulus increases to a much greater extent. The characterization of three kinds of chitosan membranes was performed to find the most suitable material for studying different human skin properties.
... The in vivo design of this trial represents a major strength as it reflects the dynamic response to topical agents, the biodistribution of carrier systems and the clinical reality. To address the sparsely studied impact of ethnic diversity in hair follicle morphology and sebum production on acne treatment and transfollicular delivery, 44,45 larger studies with a multiracial patient population are needed. ...
Background
Adapalene–benzoyl peroxide (A‐BPO) is a first‐line topical treatment for acne vulgaris. In vivo reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) detect micromorphological changes over time and visualize transfollicular delivery.
Objectives
To visualize temporal, subclinical effects of A‐BPO on acne micromorphology using RCM and OCT, and evaluate their impact on transfollicular delivery of microparticulate carrier systems.
Methods
Fifteen patients with mild to moderate acne received a 6‐week course of A‐BPO. Micromorphological changes were evaluated at time 0, 3 and 6 weeks with RCM (n = 1190 images) and OCT (n = 210 scans). Transfollicular delivery of microparticles was assessed at baseline and week 6.
Results
In vivo imaging visualized steady normalization of skin micromorphology in response to A‐BPO over 6 weeks, including decreased hyperkeratinization of follicular borders (RCM median decrease −71.2%, P < 0.05), reduced intrafollicular keratinous content (RCM median decrease −47.7%, P < 0.05) and increased epidermal thickness (OCT median increase of 25.25%, P < 0.05). Imaging visualized microparticles in the follicular unit. Despite a visible reduction in keratin and sebum, transfollicular microparticle delivery appeared unaffected.
Conclusions
Reflectance confocal microscopy and OCT detect A‐BPO‐induced changes in micromorphology and visualize transfollicular microparticle delivery. Keratolysis and sebolysis did not have a measurable effect on transfollicular delivery of microparticles.
... Finally, ethnicity also plays a role: the size and the density of enlarged facial skin pores is much greater in African American while it is the lowest in the Asian population, Caucasian being intermediate. 6,7 So far, little is known about the morphological structure of the skin surrounding enlarged facial pores. Macroscopically, they appear as empty funnel-shaped structures or as cornified cylindrical plugs corresponding to comedones. ...
Background
Many factors relate to enlargement and visibility of facial pores. However, how enlargement relates to modification of the skin structure is still poorly analysed. Therefore, our aim was to characterise the visible features and the micro‐environment of facial pores.
Materials and Methods
We recruited 160 women, half of them with normal‐size facial pores, the other half presenting enlarged pores. We analysed their right cheek using standardised photography, in vivo reflectance microscopy and optical coherence tomography.
Results
If the area of pores is indeed the most differentiating visible characteristic, enlarged facial pores are also denser and more contrasted. At the structural level, enlarged facial pores present a more regular organisation of keratinocytes, an irregular dermo‐epidermal junction and a higher attenuation of collagen between the surface and deeper layers. Still, the most relevant alterations of enlarged facial pores are the presence of bright tubular structures surrounding hair follicles and enlarged hair shafts.
Conclusion
These observations suggest that alterations of the stroma could result in altered skin tensions, leading to the dilation of the infundibulum and enlarged hair shaft. The modified tension would also explain the more regular organisation of the keratinocytes and the irregular dermo‐epidermal junction.
... People leverage multiple features to identify racial-ethnic categories in others; facial structures, body types, voice timbre, gestures, contextual reactivity, roles, values, and behaviors have all been shown to convey race-ethnicity [14,36,37,63,112]. Interpretation of these features is always situated within a cultural context and transmits cultural differences perceived even by infants [55]. ...
A lack of racial-ethnic diversity in game characters and limited customization options render in-game self-representation by players of colour fraught. We present a mixed-methods study of what players from different race-ethnicities require to feel digitally represented by in-game characters. Although skin tone emerged as a predominant feature among players from all racial-ethnic groupings, there were significant group differences for more nuanced aspects of representation, including hair texture, style, and colour, facial physiognomy, body shape, personality, and eye colour and dimension. Situated within theories of how race is conveyed, we discuss how developers can support players of colour to feel represented by in-game characters while avoiding stereotyping, tokenism, prototypicality, and high-tech blackface. Our results reinforce player needs for self-representation and suggest that customization options must be more than skin deep.
... Moreover, the literature writes about different patterns of skin aging for various human races. It is irrefutable that the slower aging is described to be for Asian race people, followed by the african-american population [30]. ...
POH (Peri Orbital Hyperpigmentation) represents a minor clinical entity that attracts immense aesthetic damages and it generates social integration difficulties. This review focuses on the etiopathogenic causes of this entity, differentiating and reclassifying this defect as having, on the one hand, genetic causes of melanic hyperproduction – for Fitzpatrick cutaneous phototypes IV and V – and, on the other hand, both genetic and acquired vascular causes, in individuals with light-coloured skin phototypes. Hence, there is a big difference in the field of pathogenic treatment, for the two entities. In addition, this study notes the direct relationship between skin aging and POH, especially for aquired vascular causes. In this reasoning, other aesthetic deficiencies of the skin in the palpebral area should be also considered, like: blepharochalasis, wrinkles, the anatomical causes of the lower eyelid shading, symmetrical or asymmetric suborbital oedema. All of these issues will complicate the therapeutic decision and subsidiary, the pharmaceutical advice. In this context, the review shows the guidelines for a honest councelling of the patients, pointing the efficiency limit for the topical pharmaceutical medication (depigmentants, exfoliants) versus the necessity of minimally invasive or/ and surgical treatments (in blefarochalasis).
... African Americans exhibited substantially bigger pores than East Asian, Caucasians, Indians and Hispanic in a study by Hillbrand et al. 4 Another investigation pointed out that Asians had the smallest pores, compared to Caucasians, Africans and Hispanic skin. 5 In a more recent large scale study by L'Oréal, Chinese women stood out with very low densities and size vs Indian, Caucasian and Japanese women. Additional data including Brazilian women showed that this portion of the panel displayed the largest visible pores, followed by women from India. ...
Background
The cause of enlarged pores remains obscure but still remains of concern for women. To complement subjective methods, bioengineered methods are needed for quantification of pores visibility following treatments. The study objective was to demonstrate the suitability of pore measurements from the Antera 3D.
Material and methods
Pore measurements were collected on 22 female volunteers aged 18‐65 years with the Antera 3D, the DermaTOP and image analysis on photographs. Additionally, 4 raters graded pore size on photographs on a scale 0‐5. Repeatability of Antera 3D parameters was ascertained and the benefit of a pore minimizer product on the cheek was assessed on a sub panel of seven female volunteers.
Results
Pore parameters using the Antera were shown to depict pore severity similar to raters on photographs, except for Max Depth. Mean pore volume, mean pore area and count were moderately correlated with DermaTOP parameters (up to r = .50). No relationship was seen between the Antera 3D and pore visibility analysis on photographs. The most repeatable parameters were found to be mean pore volume, mean pore area and max depth, especially for the small and medium filters. The benefits of a pore minimizer product were the most striking for mean pore volume and mean pore area when using the small filter for analysis, rather than the medium/large ones.
Conclusion
Pore measurements with the Antera 3D represent a reliable tool for efficacy and field studies, with an emphasis of the small filter for analysis for the mean pore volume/mean pore area parameters.
... Identity is comprised of multiple, nuanced facets (e.g. hair textures, facial structures, body types, voice timbre, movement styles, contextual reactivity, roles, values, behaviors, etc.) [10,14,45,46,75,88,141]. Emphasis on these facets is always contextual and cultural in origin; how and where faces communicate emotions, convey nonverbal "accents", how bodies move all show cultural differences [8,39,40,62,75,76,123,136]-differences that are perceptible to infants [70]. ...
People of color comprise a large proportion of the US player base, yet are systematically and grossly underrepresented in digital games. We constructed a survey to assess if players perceive this underrepresentation, how they experience these representations, and sample their beliefs about diversity and gaming. Mixed-methods analyses show significant differences between players of color and White players on perception of racial norms in gaming, effects on behavior, emotions, player satisfaction, engagement, and beliefs stemming from a lack of diversity. Players from all races-ethnicities overwhelmingly expressed a desire for greater diversity. We discuss reasons why our methodology shows higher dissatisfaction than previous research and discuss our findings in the context of industry's challenge to meet audience demands for greater racial diversity in games.
... 43,66 In contrast, African skin frequently shows the most severe damage around facial pores. 67 The differences between ethnic skin types in response to the environmental factors can also manifest in the dermis, with Caucasian skin being more prone to inflammatory lesions and African skin presenting more often with hypertrophic scarring and keloids. 34,43 The phenotypic variations and challenges in defining specific genome-drug interactions can also be applicable to the field of dermatology. ...
Individual responses of human skin to the environmental stress are determined by differences in the anatomy and physiology that are closely linked to the genetic characteristics such as pigmentation. Ethnic skin phenotypes can be distinguished based on defined genotypic traits, structural organization and compartmentalized sensitivity to distinct extrinsic aging factors. These differences are not only responsible for the variation in skin performance after exposure to damaging conditions, but can also affect the mechanisms of drug absorption, sensitization and other longer term effects. The unique characteristics of the individual skin function and, particularly, of the ethnic skin type are currently considered to shape the future of clinical and pharmacologic interventions as a basis for personalized skincare. Individual approaches to skincare render a novel and actively growing area with a range of biomedical and commercial applications within cosmetics industry. In this review, we summarize the aspects of the molecular and clinical manifestations of the environmental stress on human skin and proposed protective mechanisms that are linked to ethnic differences and pathophysiology of extrinsic skin aging. We subsequently discuss the possible applications and translation of this knowledge into personalized skincare.
... Black subjects showed the strongest pigmentation with refractile melanocytes and keratinocytes in the DEJ, whereas edged papillae with refractile borders were hardly visible in Caucasian subjects. Consistent with a previous report [29], we found a lower pore count and size in Asian subjects. On the other hand, Black subjects showed the greatest pore count and size in RCM, which could also be visualized through videodermoscopic imaging (Fig. 1). ...
Background/aims:
Ethnic skin types are known to differ in their morphological and physiological features. Thus, treatment responses may vary among different races. We aimed to assess skin morphology of different ethnicities and to compare the effect of short-term moisturizer application using optical coherence tomography (OCT) and reflectance confocal microscopy (RCM).
Methods:
Thirty healthy female subjects of European, Asian and Black ethnicity at 30-45 years of age were included in the study. OCT and RCM imaging was performed on the cheek to compare morphology. Following the 2-week application of a moisturizer cream (Sebamed® lotion) on one forearm, imaging was performed on both forearms to assess and compare treatment responses.
Results:
Epidermal thickness and morphology of pores varied between the three ethnic groups, with Black subjects displaying the thickest epidermis and largest skin pores. On the treated forearm, OCT measurements revealed a significantly thicker epidermis in all groups as compared to the untreated forearm. Width of skin folds on the treated forearm was measured by RCM to be significantly lower in all ethnic groups as compared to the untreated forearm.
Conclusion:
Different ethnic skin types showed variations in skin morphology and treatment response to short-term moisturizer application. OCT and RCM were useful methods for noninvasive, real-time, repeated assessment of ethnic skin.
... Black subjects showed the strongest pigmentation with refractile melanocytes and keratinocytes in the DEJ, whereas edged papillae with refractile borders were hardly visible in Caucasian subjects. Consistent with a previous report [29], we found a lower pore count and size in Asian subjects. On the other hand, Black subjects showed the greatest pore count and size in RCM, which could also be visualized through videodermoscopic imaging (Fig. 1). ...
... 7 This noninvasive confocal laser microscopy showed structural changes in dermal papilla and an isotropic dermal fiber structure that underlies SP. These observations are, we believe, highly relevant as they are in agreement with associations to functional criteria through growth factors (IGF-1) 21 and hormonal balance that strongly controls epidermal, dermal, and skin appendages, 22,23 including sebaceous function, which are all greatly affected by puberty. ...
Skin pores (SP), as they are called by laymen, are common and benign features mostly located on the face (nose, cheeks, etc) that generate many aesthetic concerns or complaints. Despite the prevalence of skin pores, related literature is scarce. With the aim of describing the prevalence of skin pores and anatomic features among ethnic groups, a dermatoscopic instrument, using polarized lighting, coupled to a digital camera recorded the major features of skin pores (size, density, coverage) on the cheeks of 2,585 women in different countries and continents. A detection threshold of 250 μm, correlated to clinical scorings by experts, was input into a specific software to further allow for automatic counting of the SP density (N/cm²) and determination of their respective sizes in mm². Integrating both criteria also led to establishing the relative part of the skin surface (as a percentage) that is actually covered by SP on cheeks. The results showed that the values of respective sizes, densities, and skin coverage: 1) were recorded in all studied subjects; 2) varied greatly with ethnicity; 3) plateaued with age in most cases; and 4) globally refected self-assessment by subjects, in particular those who self-declare having “enlarged pores” like Brazilian women. Inversely, Chinese women were clearly distinct from other ethnicities in having very low density and sizes. Analyzing the present results suggests that facial skin pore’s morphology as perceived by human eye less result from functional criteria of associated appendages such as sebaceous glands. To what extent skin pores may be viewed as additional criteria of a photo-altered skin is an issue to be further addressed.
Skin of color (SOC) populations include those who identify as Black/African, Hispanic/Latinx, Asian/Pacific Islander, American Indian/Native Alaskan, Indigenous Australian, Middle Eastern, biracial/multiracial, or non-White; this list is far from exhaustive and may vary between and within cultures. Recent genetic and immunological studies have suggested that cutaneous inflammatory disorders (atopic dermatitis, psoriasis, and hidradenitis suppurativa) and malignancies (melanoma, basal cell carcinoma, and cutaneous T-cell lymphoma) may have variations in their immunophenotype among SOC. Additionally, there is growing recognition of the substantial role social determinants of health play in driving health inequalities in SOC communities. It is critically important to understand that social determinants of health often play a larger role than biological or genetic factors attributed to "race" in healthcare outcomes. Herein, we describe the structural, genetic, and immunological variations and the potential implications of these variations in populations with SOC. This article underscores the importance of increasing the number of large, robust genetic studies of cutaneous disorders in SOC to create more targeted, effective therapies for this often underserved and understudied population. Part II of this CME will highlight the clinical differences in the phenotypic presentation of and the health disparities associated with the aforementioned cutaneous disorders in SOC.
Background
Enlarged facial pores are a common cosmetic complaint in practice. Microfocused ultrasound with visualization (MFU-V) and low-degree crosslinked hyaluronic acid filler (L-HA) injection has recently become a popular procedure for skin rejuvenation. The effectiveness of the combined MFU-V and L-HA injection in the treatment of enlarged pores has not been evaluated.
Objectives
To compare the efficacy of MFU-V monotherapy (single technique) and MFU-V combined with L-HA injection (combined technique) for the treatment of enlarged facial pores in Asians.
Methods
We conducted a randomized, single-blinded, split-face study on participants with enlarged facial pores. Each side of the face was randomly assigned to treatment with one session of single technique or combined technique. Pore volume was objectively measured by an Antera 3D® system. Subjective assessment was evaluated by one-blinded physician using a pore grading score (0–4). Patients rated the improvement in terms of satisfaction using the visual analog scale (VAS, 0–10).
Results
Forty-six participants completed the study. The mean pore volume of both sides declined with statistical significance at every visit compared to baseline, with the lowest mean at 4 months post-treatment. The combined technique showed a lower mean pore volume than single technique throughout the follow-ups. Physician's subjective evaluation showed no statistically significant difference between the two techniques. The patient satisfaction score showed a similar trend to the mean pore volume, with a statistically significant difference at 4 and 6 months post-treatment.
Conclusions
Both techniques are effectively minimize enlarged facial pores. The combined technique resulted in more patient satisfaction.
Introduction:
Seborrhea or oily skin has been one of the most common complaints affecting both men and women physically and psychologically. Chitosan is a biopolymer obtained from the alkaline deacetylation of chitin. Due to its positively charged nature, chitosan can effectively bind to lipids. Therefore, chitosan nanoparticle (CN) formulation may benefit in the reduction of skin sebum.
Objective:
The aim of this study was to evaluate the efficacy and safety of CN formulation in the reduction of skin sebum.
Method:
The study was a randomized, double-blinded, placebo-controlled trial in 24 participants aged 18-40 years with clinical seborrhea. Participants were randomly assigned to apply the CN and gum (CN-G) or placebo (gum alone) twice daily for 4 weeks. Sebum level, corneometry, transepidermal water loss (TEWL), and clinical seborrhea grading were evaluated at baseline and week 2 and 4.
Results:
In the T-zone, sebum levels in the CN-G group were significantly lower than the placebo group at week 4 (p = 0.043), while for the U-zone, sebum levels were not different between groups. There were no statistical differences in corneometry and TEWL at any visit. Although the clinical seborrhea grading in CN-G was lower, it was not significantly different from the placebo. A few cases reported mild and self-limiting scaling and acneiform eruption.
Conclusion:
The CN-G gel could significantly reduce sebum levels on seborrhea patients with acceptable safety profiles.
Background
This study aimed to examine the effectiveness of botulinum toxin type A (BTX‐A) in the treatment of acne.
Methods
The study was conducted in 2018 on 12 patients, 10 females and two males, aged 35 years on average. The injections with BTX‐A were given during 2 weeks into the face skin in a dosage of 0.125–0.250 units.
Results
Skin moisture indexes increased during the therapy by 4% (P ≤ 0.05), and porosity decreased by 7% (P ≤ 0.01). Maximal changes were recorded for the sulci and pigmentation of the skin, namely, its values decreased by 10 and 9%, respectively (P ≤ 0.01). BTX‐A is recommended for an application not only in plastic surgeries but also for local correction of acne on the patient's skin.
Conclusion
A positive correlation was revealed between the duration of treatment and reduction of skin oiliness (0.87), pigmentation (0.78), skin sulci (0.84), and skin porosity (0.88), and negative correlation was established with increased skin moisture (−0.64). The obtained dependencies apply for the therapy period of up to 2 weeks. Pharmacological properties of BTX‐A allow recommending it as a drug used in post‐acne therapy.
Background
It would be mandatory for plastic surgeons to consider anthropometric and anatomical differences between Asians and Caucasians in performing facial rejuvenation procedures using absorbable threadlifts in Asians.
Methods
A consensus meeting was convened to discuss indications, treatment procedures, possible combination treatments, clinical outcomes and safety of an absorbable polydioxanone (PDO) monofilament threadlift (Mint Lift®; HansBiomed Co. Ltd., Seoul, Korea), for which the “Mint Aesthetics Expert Group” was organized with four Korean board‐certified specialists in plastic and reconstructive surgery.
Results
Our recommendations are as follows: First, the entry and exit points should be determined considering anatomical characteristics of the face (Level of evidence III). Second, treatment procedures may vary depending on indications (Level of evidence III). Third, short‐term efficacy and safety of facial rejuvenation using the Mint Lift® have been well documented (Level of evidence I and III). Third, facial rejuvenation using the Mint Lift® may be combined with a liposuction (Level of evidence III).
Conclusions
Here, we propose expert consensus on facial rejuvenation using a novel absorbable PDO monofilament threadlift in Koreans. Of note, this is the only expert consensus prepared by board‐certified specialists in plastic surgery in Korea. But more evidence‐based efforts should be made to update and to expand the current recommendations.
Background and Objectives
Enlarged pores are one of the most common causes of skin surface irregularities. Existing studies supporting the benefit of lasers and energy‐based devices (EBD) for this condition are limited, with a short duration of follow‐up period. We aimed to evaluate the efficacy and adverse effects of Er:YAG laser for treatment of enlarged pores in dark‐skinned patients.
Study Design/Materials and Methods
Nineteen subjects (aged 26–47 years) with skin phototypes III (21.1%) and IV (78.9%) and enlarged pores were treated with 4 monthly sessions of Erbium:YAG laser. Objective (ultraviolet light A video camera) and subjective (clinical evaluation by two blinded dermatologists) assessments were obtained at baseline, 1‐month after each treatment and at 1, 3, and 6 months after the final treatment.
Results
The weighted mean score of quartile grading scales showed significant improvement in pore size from baseline starting at 1‐month after the third treatment and continued until 3 months after the fourth (final) treatment (P < 0.001). However, the improvement dropped significantly at 6 months after the final treatment. Objective measurements of the improvements in skin surface smoothness and wrinkles corresponded with the physician raters’ clinical evaluation.
Conclusions
Erbium:YAG laser is a safe and effective treatment for enlarged pores in dark‐skinned individuals. Maintenance treatments are recommended to achieve a longer‐lasting outcome. Lasers Surg. Med. © 2020 Wiley Periodicals LLC
Microneedles (MNs) allow transdermal delivery of skin-impermeable drugs by creating transient epidermal micropores, and micropore lifetime directly affects drug diffusion timeframes. Healthy subjects (n = 111) completed the study, self-identifying as Asian (n = 32), Bi-/multi-racial (n = 10), Black (n = 22), White (n = 23), Latino (n = 23), and Native American/Hawaiian (n = 1). L* was measured with tristimulus colorimetry to objectively describe skin lightness/darkness. MNs were applied to the upper arm; impedance and transepidermal water loss (TEWL) were measured at baseline and post-MN to confirm micropore formation. Impedance was repeated for 4 days to determine micropore lifetime. Post-MN changes in TEWL and impedance were significant in all groups (p < 0.05), confirming micropore formation regardless of skin type. Micropore lifetime was significantly longer in Blacks (66.5 ± 19.5 h) versus Asians (44.1 ± 14.0 h), Bi-/multi-racial (48.0 ± 16.0 h), and Whites (50.2 ± 2.6 h). Latinos (61.1 ± 16.1 h) had significantly longer micropore closure time versus Asians (44.1 ± 14.0 h). When categorizing data according to L*, micropore lifetime was significantly longer in darker skin. We report for the first time that micropore lifetime differences are present in human subjects of different ethnic/racial backgrounds, with longer micropore lifetime in skin of color. These results also suggest that objectively measured skin color is a better predictor of micropore lifetime than self-identified race/ethnicity.
Background
Visible facial pores are an important cosmetic concern especially among young females. Number of different methodologies is used today to assess facial pores and efficacy of technologies. Main limitations of these methods are, however, (a) moderate correlation with visual perception, (b) characterization is mostly limited to size or number of pores, (c) measurement is limited to a smaller area of face, and (d) operational difficulties. In order to address these limitations, we developed a 2D image analysis tool to assess and characterize visible facial pores.
Materials and Methods
Two clinical studies were conducted with northeast Asian skin type females. In the first study, 40 subjects age between 20 and 40 with different degree of pore severity were recruited. In the second study, 15 subjects age between 20 and 40 with enlarged pores were recruited to evaluate pore product efficacy. In both studies, full face images were taken using Visia‐CR and assessed by means of the newly developed tool and visual grading.
Results
A high correlation between visual grading and pore size was obtained (r = 0.86). New methodology was able to differentiate products similar to visual grading.
Conclusion
Novel pore image analysis method using 2D skin surface imaging with standard photography has been developed and validated. In addition to pore size measurements, we propose this method to be used to measure pore shape, color, and orientation for a comprehensive characterization of facial pores.
Background:
Increasing the number of enlarged pores causes cosmetic problems. The difference in the number of enlarged pores according to facial site, age, and sex is unclear.
Objective:
To analyze the distribution of the number of enlarged pores according to facial site, age, and sex.
Methods and materials:
We analyzed the number of the enlarged pores and the percentage of wrinkles in the nose, forehead, and cheek from 434 polarized images. The measurement results were analyzed according to site, age, and sex. Relationship between enlarged pore counts and wrinkle severity was also analyzed. The study was conducted by using DermaVision,™ which can take cross-polarization, parallel polarization, and ultraviolet light images.
Results:
The enlarged pores of the nose and forehead were more prominent than in the cheeks. Pore counts were increased with age, and the increment was significant between the 30's and 40's. There was no significant difference by gender. Enlarged pore counts were related to wrinkle severity.
Conclusions:
The number of enlarged pores differs depending on body site and increased with age. The enlarged pore counts correlate with wrinkle severity and the correlation varies depending on the body site.
Background:
Enlarged facial pores and changes in pore area are of concern for cosmetic reasons. To evaluate pores, measuring tools based on 3D methodology are used. Yet, these methods are limited by their measuring ranges. In this study, we performed pore analysis by measuring the whole face using 2D optical images. We further sought to understand how the pores of Korean women change with age.
Materials and methods:
One hundred sixteen Korean female subjects aged 20-60 years were recruited for this study. Facial images were taken using the VISIA-CR® adjusted light source. Images were processed using Image-Pro Plus 9.2. Statistical significance was assumed when P < .05.
Results:
The pore area, as indicated by pixel count, gradually increased in patients through their 40s, but decreased through their 50s and 60s. Facial pores generally exhibited directionality through the patients' 30s, but this isotropic feature was more prominent in their 50s. Pore elongation increased stepwise. The first increase occurred during the transition from patients' 30s to their 40s and the second increase occurred during the transition from patients' 50s to their 60s. This indicated that the pores deformed from a circular shape to a long elliptic shape over time.
Conclusion:
A new evaluation method using 2D optical images facilitates the analysis of pore distribution and elongation throughout the entire cheek. This is an improvement over an analysis of pores over a narrow region of interest.
One of the most common dermatologic concerns is oily skin, and the demand for effective treatment options is ever apparent. this review article addresses numerous topical treatment options such as retinoids, olumacostat glasaretil, and various cosmeceutical agents. several systemic and procedural techniques that incorporate isotretinoin, spironolactone, oral contraceptives, botulinum toxin, photodynamic therapy, and lasers are reviewed as well. each treatment option is analyzed in terms of the proposed mechanism of action, etcacy reported in the literature, and potential adverse esects.
The structure and function of the various components of skin are well studied. In the last few decades, increasing research has examined whether the structure and function of skin may vary among skin types including those across different races and ethnicities. Certain similarities and differences have been discovered while other areas require further study. As physicians continue to treat diverse populations, an understanding of these similarities and differences is essential in providing appropriate medical care.
Minimalinvasive Systeme wie der nicht ablativ fraktionierte Laser werden zunehmend für die Therapie der chronisch lichtgeschädigten Haut sowie von Narben und weiteren Indikationen interessant. Derzeit werden die Laser am häufigsten zur Therapie von Falten und Narben eingesetzt.
Objective:
To measure skin wrinkles and rigidity in menopausal women of varying race/ethnicity with or without hormone therapy (HT) for up to four years.
Design:
Randomized, double-blind, placebo-controlled trial.
Setting:
Academic medical centers.
Patient(s):
Women (42-58 years of age) within 36 months of last menstrual period and enrolled in the Kronos Early Estrogen Prevention Study (KEEPS).
Intervention(s):
Treatment with 0.45 mg oral conjugated equine estrogens (CEE), transdermal E2 (50 μg/d) with micronized P (200 mg daily), or placebo for 4 years.
Main outcome measure(s):
Skin wrinkles were assessed at 11 locations on the face and neck, and skin rigidity was assessed at the forehead and cheek at baseline and yearly for 4 years.
Result(s):
Neither total wrinkle score nor total rigidity score was significantly different at baseline or over the 4-year follow-up among patients randomized to CEE, E2, or placebo. Skin wrinkle and rigidity scores were primarily affected by race/ethnicity, with scores being significantly different between races for almost all of the wrinkle parameters and for all of the rigidity measures. There was no association between race and response to HT for total wrinkle or rigidity scores. Black women had the lowest wrinkle scores compared with white women across all 4 years. In general, skin rigidity decreased in all groups over time, but black women had significantly reduced total facial rigidity compared with white women after 4 years.
Conclusion(s):
Race is the strongest predictor of the advancement of skin aging in the 4 years following menopause. HT does not appear to affect skin wrinkles or rigidity at most facial locations.
Clinical trial registration number:
NCT00154180.
Minimal invasive Systeme wie der nichtablativ fraktionierte Laser werden zunehmend für die Therapie der chronisch lichtgeschädigten Haut sowie von Aknenarben und weiteren Indikationen interessant. Fraktionierte Laser applizieren die Energie in Form mikroskopisch kleiner Spots (MTZ, ″microsopic treatment zone″), wobei dazwischen vitales Gewebe verbleibt. Damit wird eine schnelle Abheilung bei geringer Frequenz von Nebenwirkungen sichergestellt. In der Folge kann sicher ein epidermales und dermales Remodelling induziert werden, wobei Entzündungs-, Pigment- und andere Zellen die rasche Heilung sicherstellen. Derzeit werden die Laser am häufigsten zur Therapie von Falten und Narben eingesetzt. Inwiefern weitere Indikationen wie Pigmentverschiebungen und vaskuläre Veränderungen zur Standardindikation avancieren, bleibt abzuwarten. Zurzeit finden sich zahlreiche Systeme auf dem Markt, die nicht immer vergleichbar sind. Allen Systemen gemeinsam ist jedoch die limitierte klinische Effektivität.
طب سنتی ایران یک مکتب علمی با مبانی فکری آزموده شده است که از فلسفه و اصطلاحات خاص خود برای تشخیص و درمان بیماریها استفاده می کند. یکی از این موارد، واژه «مَسامّ» است (به معنی سوراخ یا منفذ) که مستقیماً یا با واسطه، موجب ظهور بعضی علایم و بیماریها می شود و نقش اصلی را در درمان بسیاری از بیماری ها ایفا می کند. در این مطالعه با جستجو درمقالات وکتب مرجع طب سنتی، عبارات مرتبط با موضوع مسام، گردآوری و بررسی شده اند. «مسام» به منافذ طبیعی بسیار کوچکی گفته می شود که بر سطح پوست و دیگر اعضای بدن از جمله پلک، جفت، رحم، غشای سینوویال، عضله وعروق ریه وجود دارند. این منافذ امکان ورود، خروج و تبادل مواد مختلف و داروها را ممکن می سازند؛ همچنین جهت تشخیص و درمان برخی بیماری ها از قابلیت تغییر در مسام استفاده می شود. حکمای طب ایرانی بدون استفاده از امکانات پیشرفته امروزی و تنها با مشاهده برخی آثار، به وجود عواملی غیرمحسوس جهت تبادل مواد پی برده بودند که به همه این عوامل واژه «مسام » داده بودند و با آنها به تشخیص و درمان بسیاری از بیماریها می پرداختند.
واژگان کلیدی: مسام، منافذ، پوست، طب سنتی ایران، طب ایرانی.
The skin is often viewed as a static barrier that protects the body from the outside world. Emphasis on studying the skin's architecture and biomechanics in the context of restoring skin movement and function is often ignored. It is fundamentally important that if skin is to be modeled or developed that we do not only focus on the biology of skin but also aim to understand its mechanical properties and structure in living dynamic tissue. In this review, we describe the architecture of skin and patterning seen in skin as viewed from a surgical perspective and highlight aspects of the microanatomy that have never fully been realized and provide evidence or concepts that support the importance of studying living skin's dynamic behaviour. We highlight how the structure of the skin has evolved to allow the body dynamic form and function; and how injury, disease or ageing results in a dramatic changes to the microarchitecture and change physical characteristics of skin. Therefore, appreciating the dynamic microanatomy of skin from the deep fascia through to the skin surface is vitally important from a dermatological and surgical perspective. This focus provides an alternative perspective and approach to addressing skin pathologies and skin ageing.This article is protected by copyright. All rights reserved.
Skin of color is defined as non-Caucasian skin types, which by Fitzpatricks’ classification comprise skin types III-VI. There is great variability in skin pigmentation among distinct racial and ethnic groups, making it difficult to define skin types simply by ethnicity, race, or culture. Individuals with darker skin comprise a wide range of racial and ethnic groups including Africans, African-Americans, African-Caribbean, Japanese, Chinese, Asians, Latinos, Indians, and Pakistanis, to name just a few. Presently, individuals with pigmented skin comprise 80% of the world population. As expected, demand for health care services by individuals with skin of color will grow substantially as this population grows. This demand will also expand as newer technologies and treatment for skin diseases develop. Therefore, the importance of studying the differences that exist in the structure, physiology, function, and culture of ethnic skin cannot be overemphasized. Most of the early literature on pigmented skin has produced conflicting results that are difficult to interpret or generalize. This is as a result of small sample sizes, non-standardized approaches and methodologies, varying anatomic sites, and the use of subjective parameters. This chapter will summarize the current data regarding ethnic skin differences. An understanding of structural, physiological, and functional differences in pigmented skin will lead to a better grasp of the pathophysiologic mechanisms of skin diseases particularly those that disproportionately affect the ethnic population.
Background/PurposeMany studies have been focused on evaluating assessment techniques for facial pores amid growing attention on skin care. Ubiquitous techniques used to assess the size of facial pores include visual assessment, cross-section images of the skin surface, and profilometric analysis of silicone replica of the facial skin. In addition, there are indirect assessment methods, including observation of pores based on confocal laser scanning microscopy and the analysis of sebum secretion and skin elasticity. The aim of this study was to identify parameters useful in estimating pore of surface in normal skin.Methods
The severity of pores on the cheek area by frontal optical images was divided on a 0–6 scale with ‘0’ being faint and small pore and ‘6’ being obvious and large pore.After the photos of the frontal cheek of 32 women aged between 35 and 49 were taken, the size of their pores was measured on a 0–6 scale; and the correlation between visual grading of pore and various evaluations (pore volume by 3-D image, pore area and number by Optical Image Analyzer) contributing to pore severity investigated using direct, objective, and noninvasive evaluations.ResultsThe visual score revealed that the size of pores was graded on a 1–6 scale. Visual grading of pore was highly correlated with pore volume measured from 3-D images and pore area measured from 2-D optical images in the order (P < 0.01). Visual grading of pore was also slightly correlated with the number of pores in size of over 0.04 mm2 (P < 0.05).Conclusion
High correlation between pore score and pore volume can be explained by 3-D structural characteristics of pores. It is concluded that pore volume and area serve as useful parameters in estimating pore of skin surface.
Minimally invasive laser therapies using fractionated laser beams have become increasingly more prevalent, especially for
treating wrinkled sun-damaged skin and acne scars. Moreover, indications for their use have also significantly increased.
Fractional lasers apply energy using microscopic dimensions and leave the surrounding tissue unaffected, intact, and therefore
vital. This permits a much shorter period of recovery than if a larger area was treated at once. Treating the skin with nonablative
fractional laser means results in a unique wound-healing process that is assisted by persistence of vital epidermis even in
treatment areas. Each laser spot also creates a deep dermal column of coagulated tissue, known as a microthermal treatment
zone. One of the advantages of this process is that keratinocytes, stem cells, melanocytes, inflammatory cells, and their
respective molecular signaling capacities remain intact, leading to fast dermal remodeling at depths up to one millimeter.
Currently, this technology is widely used to treat fine wrinkles and acne scars. The overall efficacy of these devices seems
to be comparable in both cases, and similar results have been demonstrated with both photodamaged skin and acne scars. Finally,
there is production and depositing of newly formed collagen over time. Despite these advantages and the availability of a
wide range of systems, the clinical effectiveness is most often rated as only moderate in magnitude.
Enlarged facial pores have been esthetic problems and have become a matter of cosmetic concern. Several factors are supposed to be related to the enlargement of facial pores, although scientific evaluations were not performed yet.
To assess the correlation between facial pores and possible relating factors such as age, gender, sebum secretion, skin elasticity, and the presence of acne, using objective bioengineering instruments.
Sixty volunteers, 30 males and 30 females, participated in this study. Various parameters of facial pores were assessed using the Robo Skin Analyzer®. The facial sebum secretion and skin elasticity were measured using the Sebumeter® and the Cutometer®, respectively. These data were compared and correlated to examine the possible relationship between facial pores and age, sebum secretion and skin elasticity, according to gender and the presence of acne.
Male gender and the existence of acne were correlated with higher number of facial pores. Sebum secretion levels showed positive correlation with facial pores. The R7 parameter of skin elasticity was negatively correlated with facial pores, suggesting increased facial pores with decreased skin elasticity. However, the age and the severity of acne did not show a definite relationship with facial pores.
Male, increased sebum and decreased skin elasticity were mostly correlated with facial pore development. Further studies on population with various demographic profiles and more severe acne may be helpful to elucidate the potential effect of aging and acne severity on facial pores.
To characterize skin wrinkles and rigidity in recently menopausal women.
Baseline assessment of participants before randomization to study drug.
Multicenter trial, university medical centers.
Recently menopausal participants enrolled in the Kronos Early Estrogen Prevention Study (KEEPS).
Skin wrinkles were assessed at 11 locations on the face and neck using the Lemperle wrinkle scale. Skin rigidity was assessed at the forehead and cheek using a durometer.
Skin wrinkles and rigidity were compared among race/ethnic groups. Skin wrinkles and rigidity were correlated with age, time since menopause, weight, and body mass index (BMI).
In early menopausal women, wrinkles, but not skin rigidity, vary significantly among races, where black women have the lowest wrinkle scores. In white women, chronological age was significantly correlated with worsening skin wrinkles, but not with rigidity. Skin rigidity correlated with increasing length of time since menopause, however, only in the white subgroup. In the combined study group, increasing weight was associated with less skin wrinkling.
Skin characteristics of recently menopausal women are not well studied. Ethnic differences in skin characteristics are widely accepted, but poorly described. In recently menopausal women not using hormone therapy (HT), significant racial differences in skin wrinkling and rigidity exist. Continued study of the KEEPS population will provide evidence of the effects of HT on the skin aging process in early menopausal women.
Although limited data are available, it is commonly considered that Europeans and Asians have different skin ageing features.
The present studies have been carried out to evaluate the influence of age and sun-exposure on the main clinical signs of Asian skin ageing.
One hundred and sixty Chinese and 160 French age-matched women (age range: 20-60 years old) were clinically examined and scored by the same dermatologist. Facial wrinkles (crow's-feet, glabella and perioral wrinkles) and pigmented spots (on face and hands) were assessed in situ and standardized photographs of the face were taken. Lifelong sun-exposure was estimated from answers to a questionnaire. Comparisons were made between 10-year age groups.
Results show that, for each facial skin area, wrinkle onset is delayed by about 10 years in Chinese women as compared to French women. Facial wrinkling rate over the years is linear in French women and not linear in Chinese women who appear to experience a fast ageing process between age 40 and 50. Pigmented spot intensity is a much more important ageing sign in Chinese women (severe for 30% of women over 40) than in French women (severe for less than 8% of women, irrespective of age).
These first results underline that main skin ageing features (wrinkles, spots) progress differently in the Chinese and French women we have studied. They require to be confirmed on broad multicentre studies involving larger cohorts.
Physiological and morphological changes in the facial skin were investigated in relation to aging in British, French, American (caucasian), and Japanese women to clarify racial differences.The following parameters were measured; sebum secretion rate, transepidermal water loss, skin surface conductance, skin surface microtopography, corneocyte surface area, and skin color. In any ethnic group it was shown that sebum secretion rate was highest in the 20's to 30's, after which it declined with aging. However, Japanese women showed most remarkable age-associated change.Transepidermal water loss was inclined to decrease with increasing age and no racial difference was recognized. Skin conductance was low in young age group, and then it increased with aging until 30's or 40's. Caucasian people had higher conductance in every age group examined than Japanese. Skin surface microstructure was considerably changed during the aging process, showing that pore size and irregularity of furrows incresed with aging. From the change in these parameters it was appeared that the skin texture of Japanese women is finer than that of caucasian. British and Japanese women showed almost the same change in corneocyte surface area with aging and so, it was considered that there is little racial difference in the age-related change of turnover time of stratum corneum. It was also found that skin color changes from reddish to yellow and value decreases.
皮膚表面の形状解析はレプリカの画像解析により行われているが, 毛穴の大きさを直接的に解析したものはない。今回われわれは皮膚表面レプリカの画像解析により, 窪みとして認識できる大きな毛穴について解析を行った。10代から70代までの健常女性98名 (平均年齢45.0歳) の顔面4ヵ所, 頬上部・頬中部・頬下部・オトガイからレプリカを採取した。レプリカ画像を二値化し, 面積が0.02mm2以上のものを毛穴として面積・長さを解析した。レプリカ画像における毛穴の総面積は, 頬下部とオトガイにおいて加齢に伴い増加していた。年代別の解析によると頬中部は40代が最大であり, 頬下部とオトガイは60代が最大であった。毛穴の大きさは頬中部・頬下部・オトガイにおいて加齢に伴い増加しており, 大きい毛穴の数は頬下部・オトガイで増加していた。一方, 毛穴の形状は頬上部と頬中部において加齢に伴い長くなっていた。以上, 頬下部とオトガイの毛穴は加齢とともに大きくなっていたことから, 毛穴とその周囲の形状は加齢とともに大きくなるものと考えられる。頬上部と頬中部はたるみにより皮膚が伸長するため, 毛穴が長くなり加齢とともに大きくはなりにくいものと考えられた。
Differences in the characteristics of black and white skin were investigated in thirty black and thirty white female subjects between the ages of 18 and 45, using noninvasive methods. Parameters studied included transepidermal water loss (TEWL), electrical capacitance, skin pH, elasticity, dryness/scaling, and skin surface microflora. TEWL was found to be significantly lower on the cheeks and legs in blacks as compared to whites. Black facial skin exhibited higher elasticity and electrical capacitance values. The desquamation index was found to be higher in white subjects on the cheeks and forehead, whereas dryness scores were significantly higher for blacks on the legs. Whites had slightly higher pH than blacks. Overall density of Propionibacterium acnes was found to be higher in blacks. No significant differences were found in the aerobic skin surface microflora. Results from the present study will help gain a better understanding of the variations in characteristics of black and white skin.
Sebaceous gland activity has four distinct components which are sebum production (a secretion rate function), storage (a volume function), surface output (a delivery rate function) and stratum corneum permeation (an influx rate function). The oily appearance of skin results from an excess of sebum excretion and spreading over the body surface and its interaction with the skin surface. A multi-pronged approach is often useful to assess skin greasiness with precision. The clinical evaluation of skin greasiness and its shiny appearance should be further complemented by quantifying the large pores, follicular plugs and comedones. The sebum amount present at the skin surface can be measured non-invasively using one of several methods based on solvent extraction, cigarette paper pads, photometric assessment, bentonite clay and lipid-sensitive tapes. Quantitative parameters include the sebum casual level, the sebum excretion rate, the sebum replacement time, the instant sebum delivery, the follicular excretion rate, the density in sebum-enriched reservoirs and the sustainable rate of sebum excretion. A series of environmental and biological features influence the data. Hence rigorous methodological designs are mandatory to support claims. As a rule, accuracy of the methods is adversely affected by skin temperature, degree of hydration and surface roughness. An additional confounding factor is the inherent difficulty of collecting the surface lipids without a contribution from the follicular reservoir. A better understanding of factors that alter the sebum amount at the skin surface may well assist in the development of sebosuppressive agents to help the reduction of the skin greasiness and improve acne.
This study yielded the following findings on the morphologic facial skin differences between black and white women: The epidermis of black skin has more and larger singly distributed melanosomes in the keratinocytes and corneocytes than that of white skin. The stratum lucidum in black skin is not altered by sunlight exposure. The epidermis of black skin rarely shows atrophied areas. The elaunin and oxytalan fibers in black skin are not disposed in candelabra-like formations. Black skin has minimal elastosis and elastic fibers stain pink or red with the hematoxylin and Lee procedure; none stain lilac or blue. The dermis of black skin contains many more fiber fragments composed of collagen fibrils and glycoproteins. Fibroblasts are more numerous, larger, have more biosynthetic organelles than white skin, and are often binucleated and multinucleated. The dermis of black skin has many binucleated and multinucleated macrophages and multinucleated giant cells. Black skin has many more mixed apocrine-eccrine sweat glands than does white skin and more blood and lymphatic vessels.
The role of race in modulating skin responses has been investigated. Several parameters (skin thickness, transepidermal water loss, water content of the stratum corneum and skin biomechanics) have been measured using noninvasive tools in whites, Hispanics and blacks to assess whether the melanin content could induce changes in skin biophysical properties. Marked differences between races appear in stratum corneum water content and in skin extensibility, recovery and elastic modulus. Measurements done in different sun-exposed sites highlight the effects of solar irradiation on the skin and the role of melanin in preventing skin damage. The study shows that racial differences in skin physiology exist and are mainly related to the protective role of melanin present in races with darker skin. Moreover, differences in skin hydration are not fully explained according to the site and presence of hair.
After a review of the clinical aspects of acne, and the histology and physiology of the skin of the face, the histologic and dynamic aspects of comedones, pustules, papules, nodules, and scars are discussed. Moreover the role of the free fatty acids is discussed.
Sebaceous gland activity has four distinct components which are sebum production (a secretion rate function), storage (a volume function), surface output (a delivery rate function) and stratum corneum permeation (an influx rate function). The oily appearance of skin results from an excess of sebum excretion and spreading over the body surface and its interaction with the skin surface. A multi-pronged approach is often useful to assess skin greasiness with precision. The clinical evaluation of skin greasiness and its shiny appearance should be further complemented by quantifying the large pores, follicular plugs and comedones. The sebum amount present at the skin surface can be measured non-invasively using one of several methods based on solvent extraction, cigarette paper pads, photometric assessment, bentonite clay and lipid-sensitive tapes. Quantitative parameters include the sebum casual level, the sebum excretion rate, the sebum replacement time, the instant sebum delivery, the follicular excretion rate, the density in sebum-enriched reservoirs and the sustainable rate of sebum excretion. A series of environmental and biological features influence the data. Hence rigorous methodological designs are mandatory to support claims. As a rule, accuracy of the methods is adversely affected by skin temperature, degree of hydration and surface roughness. An additional confounding factor is the inherent difficulty of collecting the surface lipids without a contribution from the follicular reservoir. A better understanding of factors that alter the sebum amount at the skin surface may well assist in the development of sebosuppressive agents to help the reduction of the skin greasiness and improve acne.
We compared age-related changes in wrinkles in eight areas of facial skin (forehead, glabella, upper eyelid, corner of the eye, lower eyelid, nasolabial groove, cheek, and corner of the mouth) and sagging in the subzygomatic area of Caucasian females and of Japanese females. The subjects studied included 85 healthy Caucasian females (ages 20-69 years) living in Cincinnati in the U.S. and 70 Japanese females (ages 20-69 years) living in Tokyo. Photos of the face in frontal and in oblique 45 degrees views were analyzed. Wrinkles in the face and sagging in the subzygomatic area were graded on Japanese photoscales, respectively, by the same experienced observer. The wrinkle score increased with age in all eight areas of the face examined in Caucasian females as well as in Japanese females. In the group aged 20-29 years, the wrinkle score in each area was significantly higher in Caucasian females than in Japanese females. The wrinkle scores in the forehead, glabella, upper eyelid, and corner of the eye were similar at advanced ages between the two groups, while the wrinkle scores in lower areas of the face (lower eyelid, nasolabial groove, cheek, and corner of the mouth) were markedly higher in Caucasian females than in Japanese females in each age group, and reached an upper limit at advanced ages in Caucasian females. The sagging score also increased with age in Caucasian females as well as in Japanese females. The sagging score was significantly higher in Caucasian females than in Japanese females in the groups aged 40 years or more. These results suggest more marked wrinkle formation in all areas of the face in younger age groups of Caucasian females living in North America than in Japanese females living in Tokyo. In particular, Caucasian females showed marked age-related wrinkle formation in the lower areas of the face, probably due to sagging in the subzygomatic area, which suggests a higher susceptibility to sagging in the subzygomatic area of Caucasian females.
Conspicuous facial pores are one of the more serious esthetic defects of most concern to women. Previous microscopic observations of the skin surface around conspicuous pores have discovered large hollows and uneven skin tone. In this study, the observation area was extended from the skin surface to deeper skin to find the characteristic features of conspicuous pores in a wider spectrum.
First, a magnified surface image of the cheek skin was obtained using a video microscope. Second, replicas were collected from the same area. Third, the horizontal cross-sectioned images of the epidermis and papillary dermis in different depths were non-invasively obtained using in vivo confocal laser scanning microscopy. These images were compared with each other to find a correlation between features of the skin surface and those of deeper layers.
In cross-sectioned images of conspicuous pores, a strongly undulated epidermal-dermal junction was commonly observed around a pore's opening. Areas with this feature correlated well to the areas with larger hollows and an uneven skin tone.
Our results indicate that there is a positive correlation between the incidence of the characteristic feature at the epidermal-dermal junction and the visual appearance of a pore.
An overview of acne.
- Kligman A.M.