Albert M. Kligman

The anatomy and pathogenesis of wrinkles

The anatomy of linear wrinkles (‘crows feet’ and temporal frown lines), fine criss‐cross wrinkles of the face and wrinkling of the general body surface of elderly persons, was studied by light and scanning electron microscopy. No histological features distinguished the various wrinkles from surrounding skin. It was concluded that the wrinkle is a configurational change, like the grooves worn into an old glove, without specific structural alterations at the histological level. As regards pathogenesis, the common setting was found to be deterioration of the elastic tissue network. The skin becomes looser, excessive, and loses the ability to snap back to its original state after being deformed.

Characterization of inflammatory infiltrates in male pattern alopecia: implications for pathogenesis

Summary Hair‐bearing, transitional, and alopecic scalp from three males and one female with progressive pattern alopecia were examined. Ultrastructural studies disclosed measurable thickening of the follicular adventitial sheaths of transitional and alopecic zones compared with those in the nonalopecic zones. This finding was associated with mast cell degranulation and fibroblast activation within the fibrous sheaths. Immunohistochemically, control biopsies were devoid of follicular inflammation (n= 3), while transitional regions consistently showed the presence of activated T‐cell infiltrates about the lower portions of follicular infundibula. These infiltrates were associated with the induction of class II antigens on the endothelial linings of venules within follicular adventitia and with apparent hyperplasia of follicular dendritic cells displaying the CDl epitope. Inflammatory cells infiltrated the region of the follicular bulge, the putative source of stem cells in cycling follicles. The data suggest that progressive fibrosis of the perifollicular sheath occurs in lesions of pattern alopecia, and may begin with T‐cell infiltration of follicular stem cell epithelium. Injury to follicular stem cell epithelium and/or thickening of adventitial sheaths may impair normal pilar cycling and result in hair loss.

Anatomy of striae

The histopathology of striae distensae is disputed; different authorities give contradictory accounts of the microscopic changes, especially in elastic fibres.

Communication of gender from human axillary odors: relationship to perceived intensity and hedonicity.

In an in vitro test situation, human observers estimated the relative intensity and pleasantness of human axillary odors using the method of magnitude estimation. In addition, the likely gender of the donor of each odor was also estimated. Under these test conditions, only a small proportion of the observers predicted the sex of the odor donor above chance levels. The results support the following conclusions: (1) male and female responses to axillary odors are generally similar in both magnitude and direction (regardless of the sex from which the odors are sampled); (2) the assignment of a gender referent is closely related to the perceived intensity and pleasantness of axillary odors, with the stronger and less pleasant odors being more frequently assigned to a male gender category; and (3) the intensity and pleasantness of axillary odors, on the average, are inversely related.

A critical commentary and updating of the guinea pig maximization test

The guinea pig maximization test (GPMT) of Magnusson and Kligman was published in 1969. Since then, a vast body of practical experience with the test has been accumulated. New information requires that certain aspects of the procedure be reevaluated, especially with regard to the interpretation of challenge results. In particular, awareness of the phenomenon of hyperirritable skin (the ‘angry back’ phenomenon) suggests that presently used controls are not always adequate and may overstate allergenicity owing to false‐positive reactions. The control group should be exposed to a chemical insult at induction which provokes an inflammatory reaction comparable to the test substance. We present strategies to distinguish irritant from allergic responses. Allergic reactions should persist on rechallenge weeks later, while nonspecific irritant reactions generally fade and are irreproducible in particular animals. Finally, when a chemical is identified as a contact sensitizer of risk is necessary to estimate the relevance of the test result to usage in the real world.

Determination of density of follicles on various regions of the face by cyanoacrylate biopsy: correlation with sebum output

The density of follicles on various regions of the human face has received scant attention. We used cyanoacrylate follicular biopsies to determine the number of follicles on the forehead, cheek, chin and nose of 12 healthy adult white women. Sebum output was assessed on the same regions by means of Sebutape®. The density of follicles and sebum output followed a centrolateral decreasing gradient. There was no correlation between these two parameters. These regional patterns are important for studies of the pathogenesis of common disorders of the face and their response to treatment.

Treatment of photodamaged skin with trichloroacetic acid and topical tretinoin

BACKGROUND Photodamaged skin typically displays lentigines, actinic keratoses, wrinkles, and textural alteration. Chemical peeling has been used to treat these, but few controlled studies have been performed to determine its efficacy. OBJECTIVE Our purpose was to compare the efficacy of a medium-depth chemical peel with and without tretinoin before and after treatment. METHODS Sixteen men with actinic damage including actinic keratoses were treated with a 40% trichloroacetic acid(TCA) chemical peel. Half were pretreated for 6 weeks with topical tretinoin; they also used tretinoin after the peel. Photographs were obtained at baseline and at 6 weeks and 6 months after treatment. Changes in specific features were rated by a panel of three examiners. RESULTS Some improvement was noted in all patients. More rapid and even frosting was observed in the patients pretreated with tretinoin. Solar lentigines, actinic keratoses, and skin texture were the features of photoaging most affected; wrinkles were least affected. No statistically significant difference was found between patients treated with TCA and tretinoin (before and after peel) and those with TCA alone. CONCLUSION A medium-depth chemical peel with 40% TCA alone produced moderate improvement in some manifestations of actinic damage but had little effect on wrinkles. Treatment with tretinoin before and after TCA did not significantly enhance the efficacy of the peel.

Pretreatment of photoaged forearm skin with topical tretinoin accelerates healing of full‐thickness wounds

Pretreatment of skin with all‐trans retinoic acid (tretinoin) has been shown to enhance wound healing. Previous studies have mainly used animal models to demonstrate this effect. We wanted to determine whether pretreatment could promote wound healing in severely photoaged dorsal forearm skin.

Topical retinol improves cellulite

A group of 20 women with moderate cellulite of the thighs were treated twice daily on one side for 6 months with a 0.3% stabilized retinol cream while the opposite side was treated with the vehicle, following a double-blind format. Objective measurements included ultrasound measurement of thickness using a 20 MHz B-scan, and laser Doppler velocimetry for blood flow. The panelists and a dermatologist estimated the degree of improvement on a global scale. Of 19 subjects, 13 rated the retinol side as more improved, 7 registering good effects. The dermatologists estimates were largely congruent with those of the subjects. There was also a marked reduction in the density of hypoechogenic areas on the retinol sides, from 53% to 18% of black pixels on image analysis. Blood flow measurements were unchanged on the vehicle sides but increased significantly on the retinol sides. Thickness measurements by ultrasound scan were unchanged on the vehicle sides but increased significantly on the retinol sides, from 1.44 ...

An improved rabbit ear model for assessing comedogenic substances.

A simplified comedogenic assay is described in which test materials are applied for 2 weeks to the ears of rabbits just external to the ear canal. Excised tissue is thus immersed in water at 60°C for 2 min, yielding a sheet of epidermis with microcomedones attached. The magnitude of follicular hyperkeratosis is extracted with the stereomicroscope.