Measurement of Epidermis, Dermis, and Total Skin Thicknesses from Six Different Body Regions with a new Ethical Histometric Technique

I

6NLQZKLFKLVFRPSRVHGRIWKHHSLGHUPLVDQGWKHGHUPLVLV

WKHRXWHUPRVWWLVVXHRIWKHKXPDQERG\7KHHSLGHUPLVFRQVLVWV

RIWKHIROORZLQJIRXUOD\HUVIURPGHHSWRVXSHU¿FLDOEDVDO

OD\HUVSLQRXVOD\HUJUDQXODUFHOOOD\HUDQGVWUDWXPFRUQHXP

ZKHUHDV WKH GHUPLV LQYROYHV FHOOV FRQQHFWLYH WLVVXH DQG

JURXQGVXEVWDQFHDQGFRQWDLQVEORRGDQGO\PSKDWLFYHVVHOV

QHUYHVJODQGVDQGKDLUIROOLFOHV7KHGHUPLVLVGLYLGHGLQWR

WZROD\HUVDVWKHSDSLOODU\GHUPLVDQGWKHUHWLFXODUGHUPLV

7KHUHLVDYDULDEOHDPRXQWRIVXEFXWDQHRXVIDWW\WLVVXHEHQHDWK

WKHVNLQ^>@

6HYHUDOVWXGLHVKDYHUHSRUWHGWKDWKXPDQHSLGHUPLVGHUPLV

DQG WRWDO VNLQ WKLFNQHVVHV 67 YDU\ DFFRUGLQJ WR GLIIHUHQW

ERG\ UHJLRQ JHQGHU DJH DQG HWKQLF RULJLQ^>@$ IHZ

KLVWRSDWKRORJLFDO VWXGLHV LQYHVWLJDWLQJ GLIIHUHQFHV LQ WKH

WKLFNQHVVHVRIWKHVNLQOD\HUVIURPGLIIHUHQWVLWHVRIKXPDQ

ERG\EDVHGRQHWKQLFLW\KDYHEHHQUHSRUWHGLQWKHOLWHUDWXUH

7KHVHVWXGLHVVKRZGDWDIURP$PHULFDQ$VLDQDQG&DXFDVLDQ

SHRSOH>@7RWKHEHVWRIRXUNQRZOHGJHZLWKWKHH[FHSWLRQ

RIRQHSUHYLRXVVWXG\^>@RQWKHHSLGHUPLVRIWKHKXPDQEUHDVW

QRRWKHUKLVWRSDWKRORJLFDOVWXGLHVRQWKHWKLFNQHVVHVRIWKHVNLQ

OD\HUVRIKXPDQEUHDVWKDYHEHHQUHSRUWHGLQWKHOLWHUDWXUHDQG

QRVWXG\KDVEHHQFRQGXFWHGRQWKH67RI$QDWROLDQSHRSOH

$OWKRXJKLWLVLPSRUWDQWWRNQRZWKHQRUPDOYDOXHVRIGHUPLV

HSLGHUPLVRUWRWDO67IRUVRPHGUXJDQGYDFFLQHUHVHDUFK

VNLQUHODWHGFOLQLFDOLQYHVWLJDWLRQVDQGVNLQWUDQVIHURSHUDWLRQV

Abstract

Introduction: $OWKRXJKLWLVLPSRUWDQWWRNQRZWKHQRUPDOYDOXHVRIGHUPLVHSLGHUPLVRUWRWDOVNLQWKLFNQHVVHV67IRUVRPHGUXJVDQG

YDFFLQHUHVHDUFKVNLQUHODWHGFOLQLFDOLQYHVWLJDWLRQVDQGVNLQWUDQVIHURSHUDWLRQVXVHGLQSODVWLFVXUJHU\LWZRXOGQRWEHHWKLFDOWRWDNHQHZ

ELRSVLHVIURPKHDOWK\YROXQWHHUVWRPHDVXUHWKHLU677KLVVWXG\DLPVWRGHVFULEHDQHZHWKLFDOKLVWRPHWULFWHFKQLTXHIRUWKHPHDVXUHPHQW

RIVNLQOD\HUVDQGWRGHWHUPLQHWKHPHDQ67RIVRPHPDMRUERG\UHJLRQVLQWKHSHRSOHOLYLQJLQRXUUHJLRQMaterials and Methods: $WRWDO

RIVNLQVDPSOHVIURPVL[PDMRUERG\UHJLRQVRIPDOHVDQGIHPDOHVZHUHHQUROOHGLQWKHVWXG\7KHPHDVXUHPHQWVZHUHSHUIRUPHG

KLVWRPHWULFDOO\IURPDSSURSULDWHVNLQVDPSOHVREWDLQHGIURPWKHSDWKRORJ\DUFKLYH7KHVDPSOHVZHUHFODVVL¿HGDFFRUGLQJWRWKHVL[GLIIHUHQW

SDUWVRIWKHERG\VFDOSDEGRPHQEDFNGRUVXPRIIRRWGRUVXPRIKDQGDQGWKHEUHDVWResults: 7KHPHDQHSLGHUPDOWKLFNQHVVUDQJHGIURP

“WR“PP7KHWKLFNHVWHSLGHUPLVZDVIRXQGLQWKHGRUVXPRIIRRWLQZRPHQ“PPZKLOHWKHWKLQQHVWZDV

IRXQGLQWKHEUHDVWLQZRPHQ“PP7KHPHDQGHUPDOWKLFNQHVVUDQJHGIURP“WR“PP7KHWKLFNHVWGHUPLV

ZDVIRXQGLQWKHEUHDVWLQPHQ“PPZKLOHWKHWKLQQHVWGHUPLVZDVIRXQGLQWKHGRUVXPRIKDQGLQZRPHQ“PP

Conclusions:+XPDQ67YDULHVDFFRUGLQJWRHWKQLFRULJLQ,WZDVGHWHUPLQHGWKDWWKHGHUPLVDQGHSLGHUPLVRI$QDWROLDQSHRSOHDUHWKLFNHU

WKDQWKDWRIWKHSUHYLRXVO\UHSRUWHGRWKHUHWKQLFJURXSV7KHVNLQSDWKRORJ\DUFKLYHFDQEHXVHGWRFUHDWHPDSVRIWKHERG\¶VVNLQVWUXFWXUH

Keywords:'HUPLVHSLGHUPLVKLVWRPHWULFVNLQWKLFNQHVV

Address for correspondence: Dr. Pembe Oltulu, Department of Pathology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey.

E-mail: drpembe@yahoo.com

Access this article online Quick Response Code:

Website:

KWWSZZZWXUNMSODVWVXUJRUJ

DOI:

WMSVWMSVBB

dŚŝƐŝƐĂŶŽƉĞŶĂĐĐĞƐƐũŽƵƌŶĂů͕ĂŶĚĂƌƟĐůĞƐĂƌĞĚŝƐƚƌŝďƵƚĞĚƵŶĚĞƌƚŚĞƚĞƌŵƐŽĨƚŚĞƌĞĂƟǀĞ

ŽŵŵŽŶƐƩƌŝďƵƟŽŶͲEŽŶŽŵŵĞƌĐŝĂůͲ^ŚĂƌĞůŝŬĞϰ͘Ϭ>ŝĐĞŶƐĞ͕ǁŚŝĐŚĂůůŽǁƐŽƚŚĞƌƐƚŽ

ƌĞŵŝdž͕ƚǁĞĂŬ͕ĂŶĚďƵŝůĚƵƉŽŶƚŚĞǁŽƌŬŶŽŶͲĐŽŵŵĞƌĐŝĂůůLJ͕ĂƐůŽŶŐĂƐĂƉƉƌŽƉƌŝĂƚĞĐƌĞĚŝƚ

ŝƐŐŝǀĞŶĂŶĚƚŚĞŶĞǁĐƌĞĂƟŽŶƐĂƌĞůŝĐĞŶƐĞĚƵŶĚĞƌƚŚĞŝĚĞŶƟĐĂůƚĞƌŵƐ͘

For reprints contact:ƌĞƉƌŝŶƚƐΛŵĞĚŬŶŽǁ͘ĐŽŵ

How to cite this article: 2OWXOX3,QFH%.RNEXGDN1)LQGLN6.LOLQF)

0HDVXUHPHQW RI HSLGHUPLV GHUPLV DQG WRWDO VNLQ WKLFNQHVVHV IURP VL[

ERG\UHJLRQVZLWKDQHZHWKLFDOKLVWRPHWULFWHFKQLTXH7XUN-3ODVW6XUJ



Measurement of Epidermis, Dermis, and Total Skin Thicknesses from Six Different Body Regions with a new Ethical Histometric

Technique

Pembe Oltulu, Bilsev Ince¹, Naile Kokbudak², Sidika Findik, Fahriye Kilinc

Departments of Pathology and ¹Plastic and Reconstructive and Aesthetic Surgery, Meram Faculty of Medicine, Necmettin Erbakan University,

2Department of Pathology, Numune State Hospital, Konya, Turkey

XVHGLQSODVWLFVXUJHU\LWZRXOGQRWEHHWKLFDOWRWDNHQHZ

ELRSVLHVIURPKHDOWK\YROXQWHHUVWRPHDVXUHWKHLU67

7KLV VWXG\ DLPV WR GHVFULEH D QHZ DQG HWKLFDO KLVWRPHWULF

WHFKQLTXHIRUWKHPHDVXUHPHQWRIVNLQOD\HUV7KLVVWXG\DOVR

DLPVWRGHWHUPLQHWKHPHDVXUHPHQWRIHSLGHUPLVGHUPLVDQG

WRWDO67RIFHUWDLQPDMRUERG\UHJLRQVLQVRPHSHRSOHOLYLQJ

LQRXUUHJLRQ

M

M

$WRWDORIVNLQVDPSOHVIURPVL[PDMRUERG\UHJLRQVRI

PDOHVDQGIHPDOHVZHUHHQUROOHGLQWKLVUHWURVSHFWLYH

DUFKLYH VWXG\:H IRFXVHG RQ SHRSOH DJHG EHWZHHQ  DQG

\HDUVLQRUGHUWRPLQLPL]HWKHHIIHFWRIDJHIDFWRURQ67

3HRSOHZKRKDGDERG\PDVVLQGH[•ZHUHH[FOXGHGIURP

WKHVWXG\

7KLUW\VNLQVDPSOHVHDFKIURPPDOHVDQGIHPDOHVIURP

HDFKERG\UHJLRQZHUHHYDOXDWHG7KHVWXG\ZDVDSSURYHGE\

WKHORFDO(WKLFV&RPPLWWHH

+HPDWR[\OLQ DQG HRVLQVWDLQHG VNLQ SUHSDUDWLRQV RI WKHVH

UHJLRQVZHUHREWDLQHGIURPWKHSDWKRORJ\DUFKLYHV$OOWKH

VDPSOHVZHUHH[DPLQHGXQGHUDOLJKWPLFURVFRSHDQGWKHVNLQ

VDPSOHVWKDWGLGQRWKDYHDWOHDVW±PPRIKHDOWK\VNLQ

WLVVXHDGMDFHQWWRWKHVXUJLFDOPDUJLQVZHUHH[FOXGHG$OOWKH

PHDVXUHPHQWVZHUHSHUIRUPHGRQWKLV±PPRIKHDOWK\VNLQ

DUHDEHWZHHQWKHOHVLRQDQGWKHVXUJLFDOPDUJLQDQGFODVVL¿HG

DFFRUGLQJWRWKHVL[GLIIHUHQWSDUWVRIWKHERG\VFDOSDEGRPHQ

EDFN GRUVXP RI IRRW GRUVXP RI KDQG DQG WKH EUHDVW DQG

DFFRUGLQJWRJHQGHU

2QH RU WZR PLFURSKRWRJUDSKV ZLWK ; REMHFWLYH ZHUH

WDNHQ IURP HDFK VNLQ VSHFLPHQ XVLQJ D GLJLWDO FDPHUD

PRXQWHG RQ DQ2O\PSXV %[ PLFURVFRSH 2O\PSXV &R

6KLQMXNXNX7RN\R-DSDQ7KLFNQHVVRIWKHHSLGHUPLVDQG

GHUPLV ZHUH FDOFXODWH DV PLFURPHWHUV ȝP GLJLWDOO\ XVLQJ

3L[HUD VRIWZDUH LPDJH DQDO\]LQJ V\VWHP &RPSL[ ,QF

7KH HSLGHUPLV ZDV PHDVXUHG WKUHH RU IRXU WLPHV IURP WKH

IUHHPDUJLQRIVNLQWRWKHGHUPDOSDSLOODHDQGHSLGHUPDOUHWH

ULGJH7KHGHUPLVZDVPHDVXUHGWKUHHRUIRXUWLPHVIURPWKH

HSLGHUPDOULGJHDQGGHUPDOSDSLOODHWRWKHLUUHJXODUGHUPDO±IDW

MXQFWLRQ>)LJXUHV@

7KH PHDQ DQG PHGLDQ ZLWK VWDQGDUG GHYLDWLRQ 6' 4

DQG4YDOXHVRIHSLGHUPLVDQGGHUPLVDQGWRWDO67ZHUH

FDOFXODWHG VWDWLVWLFDOO\ XVLQJ0LFURVRIW ([FHO^® 0LFURVRIW

&RUSRUDWLRQ5HGPRQG:DVKLQJWRQ7KHPHDQPP“6'

YDOXHVZHUHUHSRUWHGIRUJHQGHUDQGHDFKERG\UHJLRQ

R

'LIIHUHQWUHVXOWVZHUHREWDLQHGIRUWKHIHPDOHDQGPDOHVDPSOHV

LQWKHGLIIHUHQWERG\UHJLRQVDVVKRZQLQ)LJXUHV7KH

UHVXOWVRIIHPDOHVDQGPDOHVDUHDVIROORZV

7KHPHDQDJHRIIHPDOHVZDV\HDUVUDQJH±\HDUV

(SLGHUPDOWKLFNQHVVUDQJHGIURP“WR“PP

2IWKHVL[ERG\UHJLRQVWKHWKLFNHVWHSLGHUPLVZDVIRXQGLQ

Figure 1: Histopathological images of female breast dermis (left) and epidermis (right) (H&E, ×2, ×40)

Figure 2: Histopathological images of male back dermis (left) and epidermis (right) (H&E, ×2, ×40)

Figure 3: Histopathological images of dermis (left) and epidermis (right) of male dorsum of hand (H&E, ×2, ×10)

Figure 4: Histopathological images of skin of male breast (left) and female dorsum of foot (right) (H&E, ×2, ×4)

WKHGRUVXPRIIRRW“PPZKLOHWKHWKLQQHVWLQ

WKHEUHDVW“PP'HUPDOWKLFNQHVVUDQJHGIURP

 “  WR  “ PP7KHWKLFNHVWGHUPLV

ZDV IRXQG LQ WKH EUHDVW  “ PP ZKLOH WKH

WKLQQHVW LQ WKH GRUVXP RI KDQG  “ PP7RWDO

67 UDQJHG IURP  “  WR  “ PP2I

WKH VL[ ERG\ UHJLRQV WKH WKLFNHVW VNLQ ZDV IRXQG LQ WKH

EUHDVW“PPZKLOHWKHWKLQQHVWLQWKHGRUVXP

RIKDQG“PP>7DEOH@

7KHPHDQDJHRIPDOHVZDV\HDUVUDQJH±\HDUV

(SLGHUPDOWKLFNQHVVUDQJHGIURP“WR“PP

2IWKHVL[ERG\UHJLRQVWKHWKLFNHVWHSLGHUPLVZDVIRXQGLQ

WKH GRUVXP RI KDQG  “ PPZKLOHWKHWKLQQHVW

LQ WKH VFDOS  “ PP 'HUPDO WKLFNQHVV UDQJHG

IURP  “  WR  “ PP 7KH WKLFNHVW

GHUPLVZDVIRXQGLQWKHEUHDVW“PPZKLOH

WKHWKLQQHVWLQWKHGRUVXPRIIRRW“PP7RWDO

67UDQJHGIURP“WR“PP2IWKH

VL[ ERG\ UHJLRQV WKH WKLFNHVW VNLQ ZDV IRXQG LQ WKH EUHDVW

“PPZKLOHWKHWKLQQHVWLQWKHGRUVXPRI

KDQG“PP>7DEOH@

D

(SLGHUPLV GHUPLV DQG WRWDO 67 YDU\ LQ GLIIHUHQW KHDOWK\

KXPDQERG\UHJLRQVDFFRUGLQJWRERG\VLWHJHQGHUDJHDQG

HWKQLFRULJLQ^>@,WLVLPSRUWDQWWRNQRZWKHQRUPDOYDOXHV

RIGHUPLVHSLGHUPLVRUWRWDO67IRUVRPHGUXJDQGYDFFLQH

UHVHDUFKVNLQUHODWHGFOLQLFDOLQYHVWLJDWLRQVDQGVNLQWUDQVIHU

RSHUDWLRQVXVHGLQSODVWLFVXUJHU\>@$OWKRXJKLWZDV

FODLPHGWKDWLQFUHDVHGGHUPDOWKLFNQHVVLVDULVNIDFWRUIRUZLGH

VFDUIRUPDWLRQ^>@WKHQRUPDOWKLFNQHVVRIGLIIHUHQWKXPDQERG\

UHJLRQVLVQRW\HWIXOO\NQRZQ

)RU WKLV SXUSRVH PDQ\ VWXGLHV RQ KXPDQ 67 IURP PDQ\

GLIIHUHQW UHJLRQV KDYH EHHQ SXEOLVKHG LQ WKH OLWHUDWXUH ,Q

WKHVHVWXGLHVDZLGHYDULHW\RIPHDVXUHPHQWPHWKRGVKDYH

EHHQXVHGHSLGHUPLVDQGGHUPLVWKLFNQHVVHVRIGLIIHUHQWERG\

UHJLRQVKDYHEHHQPHDVXUHGDQGWKHUHODWLRQVKLSVZLWKDJH

JHQGHUDQGHWKQLFLW\KDYHEHHQHYDOXDWHG7KHVHVWXGLHVKDYH

IRXQGVRPHVLPLODULWLHVDQGVRPHGLIIHUHQFHV^>@

6SOLWWKLFNQHVVVNLQJUDIWVXVHGLQSODVWLFVXUJHU\FDQEHWDNHQ

PDQ\WLPHVIURPWKHVDPHUHJLRQ7KHJUHDWHVWOLPLWDWLRQRI

WKLVJUDIWUHPRYDOLVGHUPLVWKLFNQHVV$VVRPHGHUPLVLVWDNHQ

GXULQJ HDFK JUDIW RSHUDWLRQ D WKLFN GHUPLV LV DQ LPSRUWDQW

VRXUFHLQDUHFXUUHQWVSOLWWKLFNQHVVJUDIWGRQRUDUHD5HSHDW

VSOLWWKLFNQHVV VNLQ JUDIWV DUH YHU\ LPSRUWDQW HVSHFLDOO\ LQ

SDWLHQWV ZLWK H[WHQVLYH EXUQV .QRZLQJ WKH WKLFNQHVV RI

WKH HSLGHUPLV LV LPSRUWDQW WR SUHYHQW WKH GHYHORSPHQW RI

SRVWRSHUDWLYH K\SHUSLJPHQWDWLRQ DIWHU VNLQ UHJHQHUDWLRQ

WHFKQLTXHVVXFKDVSHHOLQJGHUPDEUDVLRQ^>@

,WKDVEHHQNQRZQWKDWWKHWKLQQHVW67LVLQWKHH\HOLGV^>@DQG

K\SHUWURSKLFVFDUVYHU\UDUHO\RFFXURQWKHVFDOSH\HOLGVDQG

DQWHULRUORZHUOHJ^>@,QFRQWUDVWWKHVWHUQXPVKRXOGHUVXSSHU

DUPVHDUOREHVDQGFKHHNVDUHWKHPRVWVXVFHSWLEOHUHJLRQVWR

NHORLGDQGK\SHUWURSKLFVFDUIRUPDWLRQ,WZDVFODLPHGWKDW

WKLVGLIIHUHQFHLVDVVRFLDWHGZLWKLQFUHDVHGGHUPLVWKLFNQHVV^>@ 2XUUHVXOWVVXSSRUWWKLVFODLPEHFDXVHDOWKRXJKWKLFNQHVVRI

WKHH\HOLGVNLQZDVQRWPHDVXUHGZHIRXQGWKDWVFDOSLVRQH

RIWKHWKLQERG\UHJLRQV.QRZLQJWKHDSSUR[LPDWHWKLFNQHVV

RIWKHGHUPLVEHIRUHVXUJHU\PLJKWKHOSWRPLWLJDWHWKHULVN

RIK\SHUWURSKLFVFDU

0HDVXULQJWKHWKLFNQHVVRIVNLQOD\HUVKDVVRPHOLPLWDWLRQV

2QHOLPLWDWLRQLVWKDWWKHUHDUHPDQ\PHDVXUHPHQWPHWKRGV

DQG WKHUH LV QR VWDQGDUGL]DWLRQ ,QYDVLYH DQG QRQLQYDVLYH

PHWKRGV DUH ERWK XVHG LQ WKH PHDVXUHPHQWV RI HSLGHUPLV

GHUPLV DQG HSLGHUPLV  GHUPLV ZKLFK LQFOXGH FRPSXWHG

WRPRJUDSK\ &7 PDJQHWLF UHVRQDQFH LPDJLQJ 05,

RU XOWUDVRQRJUDSKLF 86* HYDOXDWLRQV WLVVXH ELRSVLHV

IRU KLVWRPHWULF HYDOXDWLRQ RU FDGDYHULF VWXGLHV DQG QHZ

WHFKQLTXHV VXFK DV FRQIRFDO PLFURVFRS\>@ 05, DQG

&7DUHH[SHQVLYHWHFKQLTXHVIRUPHDVXULQJRI67DQGWKH\

FDQQRWSURYLGHGHWDLOHGLQIRUPDWLRQDVPXFKDVPLFURVFRSLF

H[DPLQDWLRQV &RQH EHDP &7 DOWKRXJK ORZ UDWHV KDYH

EHHQUHSRUWHGDOVRKDVUDGLDWLRQHIIHFWV:KLOHWKHUHDUHQR

UDGLDWLRQHIIHFWVZLWK86*DGH¿QLWHREMHFWLYHUHVXOWFDQQRWEH

REWDLQHGZLWKWKLVPHWKRG,QDGGLWLRQWKHUHSRUWHG67YDULHV

VLJQL¿FDQWO\DPRQJVWXGLHVLQZKLFKLPDJLQJSURFHGXUHVDUH

XVHGWRGHWHUPLQH67^>@&RQIRFDOPLFURVFRS\LQVWUXPHQWDWLRQ

PHWKRGVFDQSURYLGHDFFXUDWHPHDVXUHPHQWV+RZHYHULWLV

VWLOOLQWKHGHYHORSPHQWSKDVH^>@,QVRPHVWXGLHVEUHDVW67LQ

ZRPHQZDVPHDVXUHGRQ¿OPVFUHHQPDPPRJUDPV^>@'LUHFW

UDGLRJUDSK\LVQRWDVXLWDEOHPHWKRGIRUPHDVXULQJZKROHERG\

VNLQUHJLRQVDVLWSURGXFHVUDGLDWLRQHIIHFWVDQGHSLGHUPLVDQG

GHUPLVWKLFNQHVVHVFDQQRWEHPHDVXUHGVHSDUDWHO\

7LVVXHFROOHFWLRQIRUKLVWRPHWULFHYDOXDWLRQRI67LVDQLQYDVLYH

PHWKRG DQG LW LV QRW HWKLFDO WR WDNH D SXQFK ELRSV\ IURP

KHDOWK\KXPDQYROXQWHHUVIRUH[SHULPHQWDOSXUSRVHVRQO\,Q

WKHOLWHUDWXUHWKHUHDUHRQO\WZRVWXGLHVPHDVXULQJ67ZLWK

SXQFKELRSV\^>@,WLVQRWHWKLFDOWRSHUIRUPDSXQFKELRSV\

IURPKHDOWK\LQGLYLGXDOVWRPHDVXUH677KDWLVZK\ZHXVHG

VNLQ ELRSVLHV RI SDWLHQWV ZKR ZHUH SUHYLRXVO\ RSHUDWHG IRU

VNLQOHVLRQVZKLFKZHREWDLQHGIURPWKHSDWKRORJ\DUFKLYH

RIRXULQVWLWXWH2XUWHFKQLTXHIRUPHDVXULQJ67LVVXLWDEOH

IRUDOOUHJLRQVRIWKHERG\ZKHUHSDWKRORJLFDOVNLQVDPSOLQJLV

SRVVLEOHDQGDOVRHWKLFDO7RWKHEHVWRIRXUNQRZOHGJHWKHUH

DUHQRVWXGLHVGH¿QLQJDPHDVXUHPHQWWHFKQLTXHOLNHRXUV

$QRWKHUWHFKQLTXHXVHGWRGHWHUPLQH67LVFDGDYHUVWXGLHV

,QYHVWLJDWRUV FDQQRW SURYLGH HQRXJK PDOH DQG IHPDOH

FDGDYHUV IRU DGHTXDWH VWDWLVWLFDO UHVXOWV RU FDQQRW REWDLQ

SHUPLVVLRQ IURP UHODWLYHV RI WKH GHFHDVHG SHUVRQ WR WDNH D

ELRSV\IURPDXWRSVLHV+RZHYHUKLVWRPHWULFVWXGLHVUHPDLQ

WKHJROGVWDQGDUGIRUVWXGLHVLQYROYLQJWKHPHDVXUHPHQWRI

67DVWKH\SURYLGHPRUHREMHFWLYHLQIRUPDWLRQWKDQWKHRWKHU

PHWKRGV>@7KXVVWXGLHVXVLQJKLVWRPHWULFPHDVXUHPHQW

PHWKRGV DQG LQYROYLQJ PRVW RI WKH ERG\ UHJLRQV DUH YHU\

UDUHGXHWRWKHVHQHJDWLYHDVSHFWV,QWKHSUHVHQWVWXG\ZH

PHDVXUHG HSLGHUPLV GHUPLV DQG WRWDO 67 RI VL[ GLIIHUHQW

UHJLRQVRIWKHERG\VXUIDFHLQDGXOW$QDWROLDQPDOHDQGIHPDOH

SDWLHQWVXVLQJWKHWUDGLWLRQDOKLVWRPHWULFPHWKRG+RZHYHUZH

SHUIRUPHGWKHVHPHDVXUHPHQWVZLWKRXWWDNLQJQHZELRSVLHV

IURP KHDOWK\ YROXQWHHUV DXWRSVLHV RU FDGDYHUV WR PHDVXUH

67GXHWRLQWHUQDWLRQDOHWKLFDOUXOHV$OOWKHPHDVXUHPHQWV

ZHUH PDGH UHWURVSHFWLYHO\ IURP WKH VNLQ ELRSV\ PDWHULDOV

REWDLQHGIURPWKHSDWKRORJ\DUFKLYHRIRXULQVWLWXWH7KHVNLQ

VOLGHVWREHHYDOXDWHGIRUPHDVXUHPHQWZHUHREWDLQHGIURPWKH

VOLGHV¶DUFKLYHDQGH[DPLQHGXQGHUDOLJKWPLFURVFRSH7KH

VNLQELRSVLHVWKDWKDGDWOHDVW±PPRIKHDOWK\VNLQWLVVXH

DGMDFHQWWRWKHVXUJLFDOPDUJLQVDQGVPDOOGLDPHWHUWXPRUDO

OHVLRQVWKDWGLGQRWFKDQJHWKHQRUPDOVWUXFWXUHRIWKHVNLQLQ

PDOHDQGIHPDOHSDWLHQWVZKRXQGHUZHQWVXUJHU\IRUDVNLQ

OHVLRQZHUHLQFOXGHGLQWKLVVWXG\7KHPHDVXUHPHQWVZHUH

SHUIRUPHG IURP WKLV KHDOWK\ VNLQ DUHDV :KHQ SHUIRUPLQJ

FDOFXODWLRQV RI WKH HSLGHUPLV DQG GHUPLV WKLFNQHVVHV WKH

PRVWLPSRUWDQWSRLQWVWRSD\DWWHQWLRQWRZHUHLUUHJXODUORZHU

OLPLWVRIWKHGHUPLVDQGUHWHULGJHVRIWKHHSLGHUPLVDVWKHVH

LUUHJXODULWLHVRIWKHHSLGHUPLVDQGGHUPLVFRXOGEHDSRWHQWLDO

SUREOHPIRUWKHVWDQGDUGL]DWLRQRIPHDVXUHPHQWV7RPLQLPL]H

WKLVSUREOHPWKUHHRUIRXUPHDVXUHPHQWVZHUHPDGHRIWKH

WKLQQHVWDQGWKLFNHVWVHJPHQWVRIHSLGHUPLVDQGGHUPLVDQG

WKHQWKHREWDLQHGYDOXHVZHUHDYHUDJHGDQGUHFRUGHGIRUHDFK

FDVHDVVKRZQLQ)LJXUHV

,QDFDGDYHULFVWXG\HYDOXDWLQJ67LQKXPDQIDFHIXOOWKLFNQHVV

PPSXQFKELRSV\VDPSOHVZHUHREWDLQHGIURPVXUJLFDOO\

UHOHYDQW DQDWRPLF ORFDWLRQV RI WKH IDFH IURP  KXPDQ

FDGDYHULF KHDGV +RZHYHU LQ WKDW VWXG\ RQO\ WKH IDFH 67

ZDVGHWHUPLQHGRWKHUERG\UHJLRQVZHUHQRWVWXGLHGDQGWKH

PHDQDJHRIWKHWHQFDGDYHUVZDVDOVR^>@,QRXUVWXG\

WKHQXPEHURIVDPSOHVZDVIRUHDFKDQDWRPLFDOUHJLRQDQG

WKHDJHVUDQJHGEHWZHHQDQG\HDUV6LQFHWKHVNLQJHWV

WKLQQHUZLWKDJHWKLVDJHUDQJHZDVSUHIHUUHGDQGWKHUHVXOWV

ZHUHVWDQGDUGL]HG

,Q WKH OLWHUDWXUH RQH RI WKH PRVW FRPSUHKHQVLYH VWXGLHV

PHDVXULQJ 67 LV WKH VWXG\ RI .RUHDQV ZLWK DQ DYHUDJH RI

 VDPSOHV SHU UHJLRQ +RZHYHU LQ WKDW VWXG\ RQO\ WKUHH

VDPSOHV ZHUH WDNHQ IURP VRPH UHJLRQV DQG WKH QXPEHU RI

PDOHDQGIHPDOHVDPSOHVDOVRYDULHGDFFRUGLQJWRUHJLRQV,Q

RXUVWXG\WKHQXPEHURIIHPDOHDQGPDOHVDPSOHVZDVHTXDO

DQG WZR WLPHV PRUH VDPSOHV SHU DQDWRPLFDO UHJLRQ ZHUH

LQFOXGHGLQWKHVWXG\FRPSDUHGWRWKHVWXG\E\.RUHDQV:KHQ

FRPSDUHGWRWKHVHWZRVWXGLHVWKHPRVWLPSRUWDQWDGYDQWDJH

RIRXUVWXG\ZDVWKHHYDOXDWLRQRISUHYLRXVSUHSDUDWLRQVLQ

WKHSDWKRORJ\DUFKLYHZLWKRXWDQHHGIRUDGGLWLRQDOELRSVLHV

)URPWKLVSHUVSHFWLYHRXUVWXG\GH¿QHVDQHZHDV\DQGD

Table 1: Female epidermis, dermis and total skin thickness acording to six body regions

Regions (n: 90) Epidermis (Ep)(ȝm) Dermis (Dm )(ȝm) Total skin thickness (Ep + Dm) (ȝm)

Mean SD Median Q1 Mean SD Median Q1 Mean SD Median Q1

%UHDVWn            

6FDOSn            

$EGRPHQn            

%DFNn            

'RUVXPRIKDQGn            

'RUVXPRIIRRWn            

Table 2: Male epidermis, dermis and total skin thickness acording to six body regions

Regions (n: 90) Epidermis (Ep)(ȝm) Dermis (Dm )(ȝm) Total skin thickness (Ep + Dm) (ȝm)

Mean SD Median Q1 Mean SD Median Q1 Mean SD Median Q1

%UHDVWn            

6FDOSn            

$EGRPHQn            

%DFNn            

'RUVXPRIKDQGn            

'RUVXPRIIRRWn            

Table 3: Epidermis and Dermis thickness according to ethnic origin

Epidermis (ȝm) Dermis (ȝm)

Caucasian Korean Anatolian Caucasian Korean Anatolian

Southwood* Lee** Current study (n: 180) Southwood* Lee** Current study (n: 180)

%UHDVW   n)0   n)0

6FDOS   n)0   n)0

$EGRPHQ   n)0   n)0

%DFN   n)0   n)0

+DQGEDFN   n)0   n)0

)RRWEDFN   n)0   n)0

&DXFDVLDQYDOXHVWDNHQIURP 6RXWKZRRGet al^>@DQG .RUHDQYDOXHVWDNHQIURP/HHet al^>@

GLIIHUHQWHWKLFDOWHFKQLTXHIRUPHDVXULQJ67)XUWKHUVWXGLHV

FDQPHDVXUHWKHHSLGHUPLVDQGGHUPLVWKLFNQHVVHVRIPDQ\

PRUHDQDWRPLFDOUHJLRQVZLWKWKLVWHFKQLTXH

,QWKHSUHVHQWVWXG\ZHVSHFL¿FDOO\H[DPLQHGVDPSOHVIURP

WR\HDUROGDGXOWVWRPLQLPL]HWKHHIIHFWVRIWKHDJH

IDFWRU:HIRXQGWKDW67YDULHVEHWZHHQUHJLRQVRIWKHERG\

VXUIDFH0HDQEUHDVWEDFNDQGDEGRPLQDO67ZHUHKLJKHU

LQERWKPDOHVDQGIHPDOHVWKDQWKDWRIWKHRWKHUUHJLRQV7KH

GHUPLVRIWKHVHWKUHHUHJLRQVZDVDOVRWKLFNHUWKDQWKRVHRI

WKHRWKHUUHJLRQV$FFRUGLQJWRRXUUHVXOWVVFDUFDQEHPRUH

FRPPRQLQWKHVHUHJLRQV^>@+RZHYHUWKHWZRUHJLRQVZLWK

WKHWKLFNHVWHSLGHUPLVLQERWKIHPDOHVDQGPDOHVZHUHWKHEDFN

RIWKHIRRWDQGWKHEDFNRIWKHKDQG7KHWKLUGUHJLRQZLWK

WKLFNHVWHSLGHUPLVZDVWKHEUHDVWLQIHPDOHVDQGWKHEDFNLQ

PDOHV>7DEOHVDQG@0HDQEUHDVW67ZDV“PP

LQPDOHVDQG“PPLQIHPDOHV7KHEUHDVWVNLQKDG

WKHWKLFNHVWGHUPLVLQPDOHVDQGIHPDOHV“PP

DQG  “ PP UHVSHFWLYHO\ EXW WKH WKLQQHVW

HSLGHUPLVZDVREVHUYHGLQIHPDOHV“PP7KHUH

DUHGLIIHUHQFHVEHWZHHQWKHPHDVXUHPHQWVRIRXUVWXG\DQG

WKRVHRIWKHRWKHUVWXGLHVIRXQGLQWKHOLWHUDWXUH^>@:HIRXQG

WKDWWKHGHUPLVDQGHSLGHUPLVRI$QDWROLDQSHRSOHDUHPXFK

WKLFNHUWKDQWKRVHRIRWKHUHWKQLFJURXSV(SLGHUPLVWKLFNQHVV

RIEDFNKDVEHHQPHDVXUHGDVPPLQ&DXFDVLDQSHRSOHDQG

PPLQ.RUHDQSHRSOH:HIRXQGWKLVWKLFNQHVVDVPP

7KHHSLGHUPLVWKLFNQHVVRIDEGRPHQKDVEHHQIRXQGDVDQG

PPLQ&DXFDVLDQSHRSOHDQG.RUHDQSHRSOHUHVSHFWLYHO\

DQGZHIRXQGWKLVYDOXHDVPPLQRXUVWXG\7KHGHUPLV

WKLFNQHVVRIEDFNKDVEHHQPHDVXUHGDVDQGPPLQ

&DXFDVLDQSHRSOHDQG.RUHDQSHRSOHUHVSHFWLYHO\:HIRXQG

WKHGHUPLVWKLFNQHVVRIEDFNDVPPLQRXUVWXG\7KH

GHUPLV WKLFNQHVV RI DEGRPHQ KDV EHHQ IRXQG DV  DQG

PPLQ&DXFDVLDQSHRSOHDQG.RUHDQSHRSOHUHVSHFWLYHO\

DQGZHIRXQGWKLVYDOXHDVPP7KHUHVXOWVIRURWKHU

UHJLRQVDUHVKRZQLQ7DEOH

$PDMRUOLPLWDWLRQRIWKHSUHVHQWVWXG\LVWKDWLWKDVDORZ

QXPEHU RI ERG\ UHJLRQV 2QO\ VL[ GLIIHUHQW ERG\ UHJLRQV

KDGEHHQLQFOXGHGLQWKHVWXG\EHFDXVHRIWKHQHHGIRUODUJH

VDPSOHVRIKHDOWK\WLVVXH,WZDVYHU\GLI¿FXOWWRFROOHFWDORW

RIVDPSOHVZLWKDZLGHVXUJLFDOPDUJLQDWOHDVW±PP IURP D ZLGH YDULHW\ RI KXPDQ ERG\ UHJLRQV LQ WKLV HWKLFDO

KLVWRPHWULFPHWKRG+RZHYHURXUPDLQJRDODW¿UVWZDVWR

FUHDWH PDSV RI WKH ERG\¶V VNLQ VWUXFWXUH E\ FRPSDULQJ VL[

GLIIHUHQWUHJLRQV,QIXWXUHVWXGLHV67RIDOOERG\VXUIDFHV

RIERWKWKH$QDWROLDQSHRSOHDQGRWKHUHWKQLFJURXSVFDQEH

PHDVXUHGXVLQJWKLVHWKLFDOKLVWRPHWULFPHWKRGLQFHQWHUVZLWK

ZLGHUFDVHSRSXODWLRQV

$OO WKH VNLQ VDPSOHV LQ WKH SUHVHQW VWXG\ EHORQJHG WR WKH

SHRSOHOLYLQJLQ$QDWROLD$OWKRXJKWKHFDVHQXPEHURIJURXSV

LVORZWKHVHSUHOLPLQDU\UHVXOWVFDQSURYLGHSLRQHHULQJGDWD

IRUGHWHUPLQLQJWKH67RI$QDWROLDQSHRSOH,WLVLPSRUWDQWWR

NQRZWKHQRUPDOYDOXHVRIKXPDQ67HVSHFLDOO\DFFRUGLQJWR

HWKQLFRULJLQ0DQ\HWKQLFJURXSVFDQEHDQDO\]HGXVLQJRXU

WHFKQLTXH 8VLQJ ERWK KLVWRPHWULF DQG HWKLFDO PHWKRGV WKH

FXUUHQWVWXG\PHDVXUHGWKHWKLFNQHVVRIVNLQIURPGLIIHUHQW

ERG\UHJLRQVRIDVPDOOSRSXODWLRQRIWKH$QDWROLDQSHRSOH

$OWKRXJK VWXGLHV RQ 67 UHODWHG WR$PHULFDQ$VLDQ DQG

&DXFDVLDQSHRSOHDUHDYDLODEOHWKHSUHVHQWVWXG\LVWKH¿UVW

WRFRQGXFWKLVWRPHWULFPHDVXUHPHQWVRIWKH$QDWROLDQSHRSOH

C

+XPDQ67YDULHVDFFRUGLQJWRHWKQLFRULJLQ,QWKLVVWXG\LW

ZDVGHWHUPLQHGWKDWWKHGHUPLVDQGHSLGHUPLVRI$QDWROLDQ

SHRSOHDUHWKLFNHUWKDQWKDWRIRWKHUHWKQLFJURXSVZKLFKKDYH

EHHQUHSRUWHGLQWKHOLWHUDWXUH7KHH[LVWLQJSDWKRORJLFDOVNLQ

VDPSOHV REWDLQHG IURP SDWKRORJ\ DUFKLYHV FDQ EH XVHG WR

FUHDWHPDSVRIWKHERG\¶VVNLQVWUXFWXUH,QIXWXUHVWXGLHVWKLV

PDSFDQEHIXUWKHULPSURYHGXVLQJWKLVPHWKRGZLWKELRSV\

PDWHULDOVIURPRWKHUERG\UHJLRQV

Financial support and sponsorship 1LO

Conflicts of interest

7KHUHDUHQRFRQÀLFWVRILQWHUHVW

R

 (OGHU'(/HYHU¶V+LVWRSDWKRORJ\RIWKH6NLQ^WKHG3KLODGHOSKLD3$

86$%\/LSSLQFRWW:LOOLDPV :LONLQVD:ROWHUV.OXZHU%XVLQHVV

S

 /HH < +ZDQJ . 6NLQ WKLFNQHVV RI .RUHDQ DGXOWV 6XUJ

5DGLRO$QDW

 +RIIPDQQ . 6WXFNHU 0 'LUVFKND 7 *R|UW] 6 (O*DPPDO 6

'LUWLQJ . et al 7ZHQW\ 0+] %VFDQ VRQRJUDSK\ IRU YLVXDOL]DWLRQ

DQGVNLQWKLFNQHVVPHDVXUHPHQWRIKXPDQVNLQ-(XU$FDG'HUPDWRO

9HQHUHRO

 6HLGHQDUL 6 3DJQRQL $ 'L 1DUGR $ *LDQQHWWL $ (FKRJUDSKLF

HYDOXDWLRQZLWKLPDJHDQDO\VLVRIQRUPDOVNLQ9DULDWLRQVDFFRUGLQJWR

DJHDQGVH[6NLQ3KDUPDFRO

 6DQGE\0¡OOHU-3RXOVHQ7:XOI+&(SLGHUPDOWKLFNQHVVDWGLIIHUHQW

ERG\ VLWHV 5HODWLRQVKLS WR DJH JHQGHU SLJPHQWDWLRQ EORRG FRQWHQW

VNLQW\SHDQGVPRNLQJKDELWV$FWD'HUP9HQHUHRO

 'DR + -U .D]LQ 5$ *HQGHU GLIIHUHQFHV LQ VNLQ $ UHYLHZ RI WKH

OLWHUDWXUH*HQG0HG

 6KXVWHU6%ODFN000F9LWLH(7KHLQÀXHQFHRIDJHDQGVH[RQVNLQ

WKLFNQHVVVNLQFROODJHQDQGGHQVLW\%U-'HUPDWRO

 6RXWKZRRG:)7KHWKLFNQHVVRIWKHVNLQ3ODVW5HFRQVWU6XUJ



 &KRSUD.&DOYD'6RVLQ07DGLVLQD..%DQGD$'H/D&UX]&

et al. A FRPSUHKHQVLYHH[DPLQDWLRQRIWRSRJUDSKLFWKLFNQHVVRIVNLQLQ

WKHKXPDQIDFH$HVWKHW6XUJ-

 *OWHNLQ%&DQELOHQ$7KH(IIHFWVRI$JHDQG6H[RQ7KH7KLFNQHVV

RI (SLGHUPLV DQG 7KH 1XPEHU RI 0HODQRF\WHV ZHUH 'HWHUPLQHG LQ

+XPDQ6NLQ6DPSOHVE\8VLQJ+LVWRORJLFDO0HWKRGV6HOoXNhQLY7ÕS

'HUJ

 $QDQG66*XSWD0.6FKXO]H.0'HVDL'$EGDOOD1:DKL*et al.

:KDW DFFRXQWV IRU HWKQLF GLIIHUHQFHV LQ QHZERUQ VNLQIROG WKLFNQHVV

FRPSDULQJ 6RXWK $VLDQV DQG :KLWH &DXFDVLDQV" )LQGLQJV IURP WKH

67$57DQG)$0,/<ELUWKFRKRUWV,QW-2EHV/RQG

 /LEVKLW] +, 0RQWDJXH (' 3DXOXV '' -U 6NLQ WKLFNQHVV LQ WKH

WKHUDSHXWLFDOO\LUUDGLDWHGEUHDVW$-5$P-5RHQWJHQRO

 ,QFH % 'DGDFL 0 2OWXOX 3 $OWXQWDV = %LOJHQ ) (IIHFW RI GHUPDO

WKLFNQHVVRQVFDUVLQZRPHQZLWKW\SH,,,,9)LW]SDWULFNVNLQ$HVWKHWLF

3ODVW6XUJ

 /DXUHQW$ 0LVWUHWWD ) %RWWLJLROL ' 'DKHO . *RXMRQ & 1LFRODV -)

et al. (FKRJUDSKLF PHDVXUHPHQW RI VNLQ WKLFNQHVV LQ DGXOWV E\ KLJK

IUHTXHQF\XOWUDVRXQGWRDVVHVVWKHDSSURSULDWHPLFURQHHGOHOHQJWKIRU

LQWUDGHUPDOGHOLYHU\RIYDFFLQHV9DFFLQH

 '\NHV3-0DUNV50HDVXUHPHQWRIVNLQWKLFNQHVV$FRPSDULVRQRI

WZR in vivo WHFKQLTXHVZLWKDFRQYHQWLRQDOKLVWRPHWULFPHWKRG-,QYHVW

'HUPDWRO

 $OH[DQGHU+0LOOHU'/'HWHUPLQLQJVNLQWKLFNQHVVZLWKSXOVHGXOWUD

VRXQG-,QYHVW'HUPDWRO

 5DMDGK\DNVKD0*RQ]iOH]6=DYLVODQ-0$QGHUVRQ55:HEE5+

In vivo FRQIRFDOVFDQQLQJODVHUPLFURVFRS\RIKXPDQVNLQ,,$GYDQFHV

LQ LQVWUXPHQWDWLRQ DQG FRPSDULVRQ ZLWK KLVWRORJ\ - ,QYHVW 'HUPDWRO



 3RSH7/-U5HDG0(0HGVNHU7%XVFKL$-%UHQEULGJH$1%UHDVW

VNLQ WKLFNQHVV 1RUPDO UDQJH DQG FDXVHV RI WKLFNHQLQJ VKRZQ RQ

¿OPVFUHHQPDPPRJUDSK\-&DQ$VVRF5DGLRO

 ,QFH%'DGDFL=$OWXQWDV='DGDFL0%LOJHQ)8VDJHRIELSHGLFOH

ÀDSDQGPLGIDFHOLIWLQWKHWUHDWPHQWRIODJRSKWKDOPXVGHYHORSHGDIWHU

EOHSKDURSODVW\&DVHUHSRUW6HOFXN0HG-

 0XUDNDPL02JDZD51LVKLNDZD0+\DNXVRNX+$UDUHFDVHRI

K\SHUWURSKLFVFDURQWKHVFDOS3ODVW5HFRQVWU6XUJ

 9HULP $ 'X\PXú 5 dDOLP g) .DUDFD d7 g]NXO 0+ <DVDU +

et al. (IIHFW RI QRVH VNLQ RQ WKH FROXPHOODU LQFLVLRQ VFDU LQ D7XUNLVK

SRSXODWLRQ2WRODU\QJRO+HDG1HFN6XUJ