Measuring Skin Elasticity Research Articles

In vivo measurements of human neck skin elasticity using MRI and finite element modeling.

The assessment of mechanical properties of the human skin is very important in investigating the mechanism of obstructive sleep apnea, a common disorder characterized by repetitive collapse and obstruction of the upper airway during sleep. In this study, a unique method, combining magnetic resonance imaging (MRI) and finite element modeling (FEM), was developed to obtain the value of the in vivo elastic modulus of the neck skin. A total of 22 subjects, 16 males and six females, were recruited to participate in the MRI studies. The changes in the airway and the neck size resulting from fluid shift from the lower body to the neck were measured based on the MR images. A two-dimensional plane strain FE model was built to simulate such changes in the neck cross-section for each subject. Solving an inverse problem using FEM by matching the measured data, we obtained the in vivo elastic modulus of the neck skin to be 1.78 ± 1.73 MPa. Results showed that the elastic modulus tended to increase with age and body mass index for these subjects. A sensitivity analysis of the muscle and fat mechanical parameters was also performed to test their effects on the predicted skin elasticity. The unique method developed in this study for measuring the in vivo elastic modulus of the neck skin is quite effective, and the skin elasticity value obtained using this method is credible.

Mexametric and cutometric assessment of the signs of aging of the skin area around the eyes after the use of non-ablative fractional laser, non-ablative radiofrequency and intense pulsed light.

The assessment of the signs of aging within eyes area in cutometric (skin elasticity) and mexametric (discoloration and severity of erythema) examination after the treatment with: non-ablative fractional laser, non-ablative radiofrequency (RF) and intense light source (IPL). This study included 71 patients, aged 33-63 years (the average age was 45.81) with Fitzpatrick skin type II and III. 24 patients received 5 successive treatment sessions with a 1,410-nm non-ablative fractional laser in two-week intervals, 23 patients received 5 successive treatment sessions with a non-ablative RF in one-week intervals and 24 patients received 5 successive treatment sessions with an IPL in two-week intervals. The treatment was performed for the skin in the eye area. The Cutometer and Mexameter (Courage + Khazaka electronic) reference test was used as an objective method for the assessment of skin properties: elasticity, skin pigmentation and erythema. Measurements of skin elasticity were made in three or four sites within eye area. The results of cutometric measurements for R7 showed the improvement in skin elasticity in case of all treatment methods. The largest statistically significant improvement (p < .0001) was observed in case of laser and RF, during treatment sessions, at sites at upper and lower eyelid. The smallest change in skin elasticity for the laser, RF and IPL - p = .017, p = .003 and p = .001, respectively-was observed in a site within the outer corner of the eye. In all sites of measurements and for all methods, the greatest improvement in skin elasticity was demonstrated between the first and second measurement (after 3rd procedures). The majority of the results of mexametric measurements-MEX (melanin level) and ERYT (the severity of erythema) are statistically insignificant. Fractional, non-ablative laser, non-ablation RF and intense light source can be considered as methods significantly affecting elasticity and to a lesser extent erythema and skin pigmentation around the eyes. Fractional non-ablative laser is a method which, in comparison to other methods, has the greatest impact on skin viscoelasticity. These procedures are well tolerated and are associated with a low risk of side effects.

Nonablative fractional laser treatment for the skin in the eye area - clinical and cutometric analysis.

The purpose of the research was to evaluate skin elasticity and reduction in the aging eye area using a 1410-nm nonablative fractional laser treatment, cutometric measurements and photographic documentation. This study included 24 patients (21 women, three men), aged 33-50 years (the average age was 44.6) with Fitzpatrick skin type II and III. They received five successive treatment sessions with a 1410-nm nonablative fractional laser in 2-week intervals. Biomechanical properties of the skin were measured by using Cutometer (Courage+Khazaka electronic). Measurements of skin elasticity were made in three places of the eye area. A photographic documentation was used to compare changes after the series of treatment sessions. Additionally, the patients filled in a survey in which they were asked to make a self-evaluation of the administered procedure. Cutometric analysis showed a significant improvement of skin elasticity. Changes in the measurements of R2 and R6 parameters indicate that the statistical significance level is mostly P < 0.0001 for the differences in the measurements. The analysis of clinical results of the therapy, using photographic documentation, showed a 47% decrease in the quantity and depth of wrinkles in the eye area. A 1410-nm nonablative fractional laser treatment seems to be an effective method aiming at reducing wrinkles in the eye area and improving tightness. Cutometric measurements provide invaluable help in the objective evaluation of the anti-aging treatment and the photographic documentation is an excellent addition to the clinical analysis.

Reviscometer Evaluation of the Skin Condition after Applying Retinol and Vitamin C Complex in Menopausal Women

Background: Topical application of retinol connected with the improvement of various parameters of aging skin is often used in post- and menopausal women. Vitamin A - vitamin C complex treatments may influence skin surface lipids and boost the fibroblasts activity as well as increase their number, thus inducing the improvement of its elasticity. Objective: In the current paper, we demonstrate and evaluate the impact of retinol and vitamin C complex on the face and neck skin elasticity level in a group of women aged 50 - 69. Method: Reviscometer RVM 600 (Courage & Khazaka, Germany) was used to measure forehead, cheeks and neck skin elasticity in a group of 21 women. Each of the patients was subjected to four treatment sessions that included skin elasticity measurements before each of the three retinol peels at 3-week intervals and one 3-week after the completion of the therapy. Results: Significant increase in the cheeks and neck skin elasticity was observed in the study group. Conclusion: Treatments including retinol with vitamin C - vitamin A complex significantly influence the improvement of skin elasticity, thus reducing the signs of skin aging.

Increase in skin surface elasticity in normal volunteer subjects following the use of copper oxide impregnated socks.

Copper is an essential mineral involved in the formation and stabilisation of extracellular skin proteins. As copper can be absorbed through intact skin, we reasoned that using socks containing copper-impregnated fibres may have an effect on skin elasticity. A double blind, placebo controlled study was conducted in which one group of healthy volunteers (n = 32) wore socks with fibres containing microscopic copper oxide particles and the other group wore identical socks without copper oxide (n = 28). The socks were worn for at least 10 h a day for 4 weeks. Skin elasticity measurements were taken from three separate test sites on the side of the ankle using a Cutometer at baseline and after 2 and 4 weeks of product use. There was an increase in the mean net skin elasticity (R5) of 6.4% (P = 0.6) and 31.4% (P = 0.004) after 2 and 4 weeks respectively, in the group of individuals that used the copper oxide containing socks, but no increase in the group of individuals that used the control socks. Similarly, there was an increase in the mean biological elasticity (R7 values) of 3% (P = 0.55) and 20.7% (0.014) after 2 and 4 weeks, respectively, only in the group of individuals that used the copper oxide containing socks. The differences between treatments (i.e. socks used) were statistically significant at 4 weeks (P = 0.0058 and P = 0.0327 for R5 and R7, respectively). Using copper oxide containing socks results in an increase in skin elasticity of the feet.

Biophysical properties of Striae Distensae evaluated in vivo using non-invasive assays.

Striae Distensae (SD) or stretch marks are manifestations of epidermal atrophy that occurs after tissue tearing due to rapid growth or over-stretching and are characterized by distinct microstructural features. The objective of this in vivo study was to investigate the biophysical properties of SD lesions, including skin barrier function, skin surface hydration, mechanical properties, and chromophore concentrations, compared to normal adjacent skin. Non-invasive methods were used on 29 volunteers with SD to characterize: (i) visual appearance (visual assessment and clinical imaging), (ii) skin barrier function by measuring transepidermal water loss, (iii) skin surface hydration using corneometry (skin capacitance), (iv) mechanical properties measuring skin elasticity under vacuum and surface propagation of a sonic wave, (v) the presence of erythema and pigmentation using diffuse reflectance spectroscopy, and (vi) the levels of interleukin-1α on the skin surface. No difference was observed in skin barrier function and a slight difference in skin hydration between the striae and adjacent uninvolved skin. Viscoelasticity measurements showed that SD lesions were significantly less firm, less elastic, and less deformable than normal skin (P < 0.05). Mechanical anisotropy was increased in SD compared to normal skin, reflecting the skin surface anisotropy reported previously. Diffuse reflectance spectroscopy showed no differences in the apparent hemoglobin concentrations between SD and control. Skin pigmentation and light scattering values were significantly lower in SD (P < 0.001) compared to adjacent skin and there was no correlation between them indicating independent causes: lower melanin production for pigmentation and altered collagen fiber structure in the dermis for light scattering. Based on these results, the distinct microstructural features characterizing SD lesions are accompanied by changes in the mechanical and optical properties. These changes however do not seem to affect the skin barrier and moisturization properties.

Alteration of biomechanical properties of skin in acute cold contact injury

BackgroundThe prevalence of acute cold injury has increased recently. Despite new research findings, these injuries and their resulting tissue damage are still not entirely understood. Especially, little is known about alteration of skin biomechanical properties. MethodsA total of 36 acute cold contact wounds with different depths were generated on the abdomen of six Göttingen minipigs. Alteration of biomechanical properties of skin was evaluated objectively after 15 and 360min using a Cutometer device. Biopsies for histological evaluation were taken, and the depth of injury was correlated with biomechanical properties. ResultsCalculated elasticity (Ue), firmness of skin (R0) and overall elasticity (R8) demonstrated a continuous decrease, whereas other parameters demonstrated an initial increase with increasing depth of injury 15min after wound generation. All parameters showed an increase compared to healthy skin, 360min after wound generation. Furthermore, an alteration of values over time was detected. ConclusionAlteration of biomechanical properties of skin is a function of damaged tissue structures. The presented results demonstrate a decrease of main elastic parameters with increasing depth of injury and indicate progressive tissue damage over time. Skin elasticity measurements are a valuable tool in acute cold contact injury depth assessment and may act as an influencing factor in management decisions.

Comparison of skin elasticity test results from the Ballistometer® and Cutometer®

Long-term exposure to sunlight changes skin features like amount of facial wrinkling and skin elasticity, which is useful in estimating skin health and age-related changes. Skin elasticity is evaluated by quantitative methods such as the noninvasive suction device Cutometer(®) , which is widely used to evaluate regional body-elasticity differences and correlate these findings with the results of other instrumental data. Few field studies have been done with the Ballistometer(®) device, another noninvasive method for measuring skin elasticity. In this study, we measured the skin elasticity of each subject's forehead, cheek, and volar forearm using two devices with different means of obtaining quantitative measurements - Ballistometer(®) (Diastron Ltd.) and Cutometer(®) (CK electronics). The results from testing with the Ballistometer(®) and Cutometer(®) devices showed that the degree of skin elasticity of the volar forearm is greater than those found on the cheek and forehead. The parameters measured by the Ballistometer(®) showed high correlation patterns. On the cheek skin, the correlation coefficient between Ballisto-parameters and R parameters (R0, R3, R8) was higher than other skin sites. Taken together, R parameters measured by the Cutometer(®) device have been widely distributed in the evaluation of skin elasticity in research and cosmetics. Although the methodologies are different, the Ballistometer(®) device is also a useful tool to evaluate skin elasticity.

Measurement of skin thickness and skin elasticity to evaluate the effectiveness of intensive decongestive treatment in patients with lymphoedema: a prospective study

Complex decongestive physiotherapy (CDP) is used to treat patients with severe lymphoedema. The efficacy of CDP is usually quantified by calculating limb volume from repeated measurements of circumference at least 10 points before and after treatment of an affected limb. Measurement is time-consuming and operator-dependent. To determine whether decreased dermal thickness is correlated with decreased volume after intensive CDP. A consecutive series of patients admitted for intensive CDP were studied over a 6-month period. Before and after CDP, we measured circumference, dermal thickness elasticity and finally improvement in quality of life using a visual analogue scale (VAS). Thirty patients were included in the study. Only three patients were previously untreated. The average relative reduction in limb volume was 4% and the reduction in the dermal thickness was 15% (correlation: r = 0.37, P = 0.05). Viscoelasticity was decreased by 13%. VAS quality of life score was improved by 30%. Changes in dermal thickness are slightly correlated with volume changes before and after 5-day intensive CDP in a selected series of patients previously treated at home.

Single Treatment of Grades II and III Cellulite Using a Minimally Invasive 1,440-nm Pulsed Nd:YAG Laser and Side-Firing Fiber: An Institutional Review Board-Approved Study with a 24-Month Follow-Up Period

Cellulite represents one of the common topographic alterations to the skin surface and one of the structural changes to the subdermal fat and septal band of the posterolateral thighs. Currently, no treatment exists to address this entity with a multifactorial genesis that produces long-term beneficial outcomes. This clinical study evaluated the safety and efficacy of the 1,440-nm laser and the duration of the clinical benefits during 2 years. Initially, 25 healthy women with thigh cellulite were enrolled in this prospective institutional review board (IRB)-approved study. For grade II cellulite, the laser fiber delivered up to 1,000 J of energy to the undersurface of the entire involved skin. For grade III cellulite, the laser fiber distributed 1,300 to 1,500 J of energy to melt the subdermal fat, subcise the taut septal bands, and heat the reticular dermis. Baseline and posttreatment analyses included standardized high-resolution photography, skin elasticity measurements, ultrasound scanning for dermal thickness, histology, investigator global assessment scores, and recording of adverse events. Of the 24 subjects who underwent treatment, only 20 were available for the 6-month follow-up assessment. Objective measurements at 2 years demonstrated an increase over the baseline mean skin elasticity (34 %) and mean dermal thickness (11 %), as well as an increase in the average percentage of dermal thickening determined by ultrasound imaging. Independent investigator global assessments were rated higher for grade II subjects than for grade III subjects throughout the 2-year follow-up period. Mild adverse events disappeared by the third month. This IRB-conducted clinical trial, as part of a multicenter study for Food and Drug Administration approval, demonstrated the safety and efficacy of a single minimally invasive treatment for grades II and III thigh cellulite during a 2-year follow-up period. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Improvement of the methods for skin mechanical properties evaluation through correlation between different techniques and factor analysis

In the past decades, many instruments have been developed to measure skin elasticity and firmness. The offer is extensive and is constantly increasing, becoming difficult to decide which equipment and mechanical property measurement are better to portrait the desired characteristics. The aim of this study was to compare and correlate parameters assessed with different probes, based on different methodologies, to understand which probe characterizes each skin elasticity property. Measurements were performed in the abdomen region of 34 female volunteers, with three different probes: Cutometer(®) SEM575, Reviscometer(®) RVM600 and Frictiometer(®) FR700. Statistical data analysis was performed by Factor Analysis on IBM SPSS Statistics 17.0. Frictiometer(®) and Reviscometer(®) measurements showed significant correlations with Cutometer's Uf, Ua, Ur and Ue parameters. Ue was strongly and significantly correlated to Uf and Ur. Ua was strongly and significantly correlated with Ur, Uf and Ue. Reviscometer(®) measurements were similar along the same axis, and measurements performed in a specific direction are significantly correlated with age. A simpler and faster methodology for the complete assessment of elasticity and firmness of human skin is possible, in alternative to elaborate and time consuming methods, involving several equipments and parameters. The simpler methodology does not reduce the information obtained about the skin properties.

Long-pulsed Nd:YAG laser on periorbital wrinkles in Asian patients: randomized split face study

Background and objective: This study evaluated clinical usefulness of long-pulsed Nd:YAG laser (LPNY) for periorbital wrinkles in Asian patients. Methods: Twenty seven Korean patients were treated with several passes of LPNY (5 mm spot size, fluence: 54.7–61.8 J/cm2, pulse duration: 56.5 microseconds). Three treatment sessions were conducted every 2 weeks on the half side of face that was randomly assigned. Outcome assessments included photography, global evaluation by two blinded independent dermatologists (using Fitzpatrick Wrinkle Classification System), and objective measurements of skin elasticity. Adverse events were documented. Patients reported their degree of satisfaction on a 6-point {0–5) visual analog scale (VAS). Results: All patients showed modest improvement. The mean wrinkle score on the treated side decreased by 34.9% (p < 0.05), while it did not change significantly on the control site. Skin elasticity (R2) increased significantly on the treated site. The average VAS score was 2.85 at 2 months but it dropped down to 1.05 at 6 months follow-up. No adverse effects were noted except 2 weeks lasting erythema in one patient. Conclusion: LPNY may be considered as a safe treatment option for periorbital wrinkles in Asian patients. However, three treatment sessions are not enough for maintaining optimal clinical outcome.

Skin Elasticity as a Measure of Radiation Fibrosis: Is it Reproducible and Does it Correlate with Patient and Physician-reported Measures?

Current means of measuring RT-induced fibrosis are subjective. We evaluated the DermaLab suction cup system to measure objectively skin deflection as a surrogate for fibrosis. Sixty-nine patients with E-STS were treated with limb-sparing surgery and 50-66 Grays (Gy) of RT. Using a “scleroderma” DermaLab Suction Cup, the skin stiffness was measured by two clinicians. The National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) scale, the Musculoskeletal Tumor Rating Scale (MSTS) and Toronto Extremity Salvage Score (TESS) questionnaires were completed for each patient. Levels of agreement between measurers were estimated using the Kappa (κ) coefficient and the concordance correlation coefficient (CCC). All sixty-nine patients were included. The level of agreement between measurers for NCI-CTCAE grading was moderate (range κ = 0.41-0.59). The CCC for the elasticity measurements were higher, with CCC = 0.82 for fibrotic skin and CCC = 0.84 for normal skin. The elasticity measurements were significantly higher when MSTS scores were <30 and or TESS scores were <90. Suction Cup measurement of skin elasticity is more reproducible than CTCAE grading and shows promise in generating reproducible measurements for radiation-induced skin fibrosis. Furthermore, it correlates well with the MSTS and TESS.

Does massage postapplication improve moisturizer’s efficacy? A 2‐week regression study

Combining massage with moisturizer application is a popular technique in beauty spa sessions. The subjective positive psychological effects of massage with moisturizer application in hand and face beauty treatment are documented by many people attending spa sessions. The aim of this study was to objectively evaluate the effect of local effleurage massage as an external intervention on moisturizer efficacy. In a regression-type study of 2-week, twice-daily application followed by 1 week of regression, 13 female subjects applied "off the shelf" moisturizer twice daily on both forearms followed by 1 min superficial massage for one forearm randomized among subjects. The influence of massage after moisturizer application on skin barrier properties was evaluated by noninvasive measurements of transepidermal water loss (TEWL), skin capacitance, and skin elasticity at baseline, day 7, and day 14 during the treatment phase, and day 21 following a 1-week regression period, in which no moisturizer and no massage were performed on forearms. The tested "off the shelf" moisturizer in both "massage" and "no-massage" application protocols caused a comparable progressive improvement in skin hydration level and barrier permeability over the 2-week treatment period, which was maintained during the 1-week regression (no moisturizer) period. In addition, skin elasticity was similarly improved by both application protocols. In this long-term study, the daily performance of massage after moisturizer application was not an effective external intervention for enhancing moisturizer efficacy.

In vivo measurement of breast skin elasticity and breast skin thickness

The mechanical properties of the breast skin play an important role in explaining the changes associated with radiotherapy, tissue expansion, and breast reconstruction surgery. Quantitative measurement of mechanical properties of breast skin is essential for surgical preplanning and outcome prediction. We have measured the skin elasticity properties and skin thickness of the breast using noninvasive methods. The DermaLab suction cup and the DermaScanC ultrasound were used to measure the modulus of elasticity and the skin thickness, respectively. Measurements were taken in 16 different locations on the breast in 23 female patients, also with patients in supine and upright position. Different analytical models (plate, membrane, large deformation) that can represent the experiment were studied to extract the elasticity modulus. The average modulus of breast skin elasticity found was 344 ± 88 kPa (Mean ± SD) with 95% confidence interval being 306-382 kPa. The range of the modulus was 195-480 kPa. The average thickness of breast skin was 1.55 ± 0.25 mm with a range of 0.83-2.4 mm. Regional variations of breast skin elasticity properties and breast skin thickness were observed. No direct correlations of biomechanical properties with age or breast thickness were observed. No significant difference was observed in the elasticity modulus between the supine and upright patient positions.

“Assessment of chronic sclerodermoid Graft‐versus‐Host Disease patients, using 20MHz high‐frequency ultrasonography and cutometer methods”

The development of an adverse graft-versus-host disease (GvHD) is a major complication of stem cell transplantations, which are widely used to cure increasing number of hematologic malignancies. Patients with chronic GvHD are at risk of joint contractures secondary to sclerodermatous skin changes. Several clinical scores or serologic markers have been used to assess skin sclerosis in scleroderma patients. Evaluation of sclerotic skin changes using biometric tools remains to be challenging. The purpose of this study was to illustrate and exemplify ultrasound measurement and measurement of skin elasticity of five chronic sclerodermoid GvHD patients. There is still a substantial lack of studies using objective and non-invasive methods helpful in assessment of patients with skin involvement of GvHD. Although ultrasound is not the ideal method, it is worth emphasizing that it is still useful, non-invasive, and repeatable device in monitoring patients suffering from GvHD. It should also be added, that it seems to be advisable to repeat USG examination at an interval of 3 months after the treatment. In addition, skin echogenicity may be a more sensitive parameter than skin thickness in assessment of cGvHD patients.

Capturing skin properties from dynamic mechanical analyses

Existing skin mechanical testing devices focus on measuring skin elasticity and are not tailored to assess the dynamic behavior of skin. Additionally, the mathematical techniques used in existing devices are often not optimal. A new dynamic mechanical device that measures the linear dynamics of skin was developed and tested. The mechanical properties of skin were evaluated in experiments in which stiffness and damping parameters were measured (i) at different locations on the arm and hand, (ii) when stratum corneum hydration was varied by controlled changes in environmental humidity, and (iii) following the application of film-forming polymers. Parallel measurements were made with the Cutometer so that the two devices could be compared. The findings revealed that reliable and valid measurements of skin mechanical properties can be obtained from the device. The stiffness of the skin was shown to vary significantly as a function of skin site, changes in stratum corneum hydration and following application of the polymer films. Changes in the damping parameter were less consistently associated with varying the condition of the skin. The high reliability and speed of measurement make this device and analytic procedure an attractive option for testing skin mechanics.

저출력 레이저 요법이 안면피부 탄력도와 멜라닌 양에 미치는 효과

본 연구는 피부 관리 측면의 노화방지 프로그램을 개발하는 기초자료를 제공할 목적으로 수기 요법과 저출력 레이저 요법을 이용하여 각각의 요법에 8명씩의 41세에서 58세 사이의 여성들에게 2011년 6월 20일부터 8월 26일까지 주 2회씩 4주 동안 총 8회에 걸쳐 안면 마사지를 시행하였다. 시행 2, 4, 6, 8회후 눈 밑과 볼의 피부 탄력도와 눈가와 볼의 멜라닌 양을 측정하여 평균값과 표준편차를 내고 비교 분석한 결과 두 집단 모두에서 탄력도가 유의적으로 증가하고 멜라닌양은 유의적으로 감소하는 결과가 나타났다. 또한, 탄력도의 증가율과 멜라닌양의 감소율 모두에서 수기 요법보다 저출력 레이저 요법이 더 효과가 높은 것으로 나타나 저출력 레이저 요법이 안면 피부의 탄력도와 멜라닌 양에 미치는 효과가 수기 요법보다 높은 것으로 분석되었다. 따라서 저출력 레이저를 이용한 피부 관리는 안면 피부의 노화방지에 유의하며 새로운 피부 관리의 프로그램으로 활용할 수 있을 것으로 분석되었다. This study aims to provide fundamental data to develop anti-aging programs in the aspect of skin care. To attain the goal, manual therapy and low-power laser therapy were conducted separately to 8 women inthe 40's and 50's. They received the facial massage total 8 times twice a week for 4 weeks. According to the result of calculating the average and standard deviation by measuring skin elasticity of the area below their eyes and cheeks and also melanin around eyes and cheeks and conducting comparative analysis, both groups showed significant increase in elasticity and their melanin decreased significantly. The low-power laser therapy showed higher values than the manual therapy both in elasticity increase and melanin reduction; thus, it was analyzed that the low-power laser therapy more highly affects skin elasticity and the amount of melanin in facial skin is greater than that in manual therapy. Therefore, it was analyzed that skin care using low level laser can be significant in anti-aging of facial skin and can be utilized as a program for a new type of skin care.

Commentary on: Treatment of Cellulite Using a 1440-nm Pulsed Laser With One-Year Follow-Up: Preliminary Report

In my opinion, there are four holy grails of cosmetic surgery that the baby boomer generation has been actively pursuing over the last 20 years: noninvasive skin tightening, localized noninvasive fat reduction, stretch mark improvement, and treatment of cellulite. In his study, Dr. DiBernardo introduces an interesting, novel, and promising new approach to the last of these goals. As the author points out, his study is limited by a small number of patients (10). However, this study is well designed as a prospective controlled model. The clear strengths of the study include the full year of follow-up, the clearly-demonstrated photographic improvement, and the objective measurements of skin elasticity and thickness. One of the most confusing areas of laser surgery is the area of optimal wavelength utilization. Anderson et al outlined the optimal wavelengths for fat absorption.1 However, that study actually outlined fat absorption from external laser radiation and did not examine the effectiveness of absorption when the laser was fired into the hypodermis in direct contact with the fat itself. Many wavelengths are utilized in the melting of fat (eg, 920 nm, 975 nm, 1064 nm, 1320 nm, and 1440 nm), and the characteristics of each are beyond the scope of this commentary. However, the 1440-nm wavelength—the one administered in Dr. …

A novel approach to measuring skin elasticity in systemic sclerosis: results from a pilot study

Objectives: Systemic sclerosis (SSc) is characterized by progressive fibrosis of various organs, and causes hard, tethered, and inelastic skin. The modified Rodnan score is used to quantify skin involvement, but this method is subjective and user dependent. The aim of this study was to test the ability of a new skin torsion device to measure skin elasticity in patients with SSc.Methods: The study included 16 female SSc patients and 58 healthy controls. Skin elasticity was assessed on the forearms and backs of the hands using a new hand-held device that gently rotates the skin for 15 s to a maximum of 40 deg, and measures the speed of rotation and the angle of rotation at 15 s. Total and localized modified Rodnan scores were also documented.Results: Measurements produced by the skin torsion device had good intra-subject reproducibility, particularly in the control group. The SSc patients had significantly lower skin elasticity than an age-matched subgroup of control subjects, as determined by the median speed of rotation of the device in the hands (1.91 vs. 2.60 deg/s, p < 0.0001) and forearms (1.84 vs. 2.46 deg/s, p < 0.0001), and the rotation at 15 s in the hands (28.6 vs. 39.0 deg, p < 0.0001) and forearms (27.6 vs. 36.9 deg, p < 0.0001). The presence of SSc disease was the only independent predictor of skin elasticity.Conclusions: This pilot study has shown the potential value of a new skin torsion device to assess skin involvement in patients with SSc.