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Perhaps in thinking of the title of this article, The Dermatologist and Facial Plastic Surgeon, the reader might find irresistible the temptation to see traces of some prior cultural or literary associations. No doubt many will have read past stories from Aesop’s Fables or Grimm’s Fairy Tales in which story titles of this type are commonplace. If, as an adult, these types of tales are revisited, it is difficult not to reach the conclusion that the morals illustrated within are not so much true revelations or object lessons as they are reminders of things most of us have already learned through past life experience or indoctrination—things about which we occasionally need to remind ourselves to remember or contemplate. It is in that spirit that this articles has been written. Because most practitioners do not need to be reminded of obvious opportunities (or necessities) for collaboration with colleagues in other specialties, the focus here is to increase the likelihood that missed opportunities for collaboration that can benefit both the surgeon and the patient will come to mind. Facial plastic surgeons will often be confronted with incidental findings on the skin that are either identified by the surgeon or the patient. Because it is often desirable to identify or formulate a treatment plan for these findings, the quick mental algorithms that are used by dermatologists when characterizing elements of a skin examination will be discussed.

Background: Polarized light photography has been used to selectively differentiate surface from subsurface features of photoaged skin. Objective: Our purpose was to compare acne assessments obtained from clinical evaluations with assessments from photographs obtained with flash photography and with perpendicular polarized light photography. Methods: Assessments of acne with the Cunliffe scale were made of 32 subjects. Retrospective evaluations of standard and perpendicular polarized light photographs were made in a blinded fashion by a panel of evaluators. Results: Visualization of inflammatory acne lesions was enhanced with perpendicular polarized light photography, with clear delineation of erythematous borders. Acne assessments with the use of a Cunliffe scale were significantly higher ( p = 0.001) from perpendicular polarized light photographs than for clinical evaluations. Conclusion: Polarized light photography enhances visualization of inflammatory acne lesions in a manner not possible with conventional flash photographs, permitting accurate evaluation of the extent of disease and the effectiveness of therapy. (J Am Acad Dermatol 1997;37:948-52.)

Treatment-related changes in hyperpigmentation are difficult to quantify with visible light photography, especially when the changes are subtle.Our purpose was to determine the utility and reliability of fluorescence photography to measure changes in mottled and diffuse hyperpigmentation.Thirty-two subjects, with mildly to moderately photodamaged skin, completed a 36-week, double-blind, vehicle-controlled study of tretinoin cream 0.025%. Clinical evaluation of hyperpigmentation as well as standard flash photographs and fluorescence photographs were obtained at baseline and week 36.The fluorescence photographs were evaluated blindly and yielded macule counts that decreased significantly from baseline in tretinoin-treated subjects compared with vehicle-treated subjects (31% vs 11% decrease; p = 0.02). Diffuse hyperpigmentation, as evaluated from the fluorescence photographs, decreased 16% from baseline for tretinoin-treated subjects and increased 5% for vehicle-treated subjects (p0.01). No significant differences in mottled or diffuse hyperpigmentation were observed between groups through clinical evaluation.Fluorescence photography is a noninvasive method that is sensitive in the evaluation and quantification of distribution and changes of mottled and diffuse hyperpigmentation.

To quantify the dose-response relation of Irritant- induced erythema, we examined inflammation in human skin after application of an Irritant, using perpendicular polarized photography and diffuse reflectance spectroscopy as compared to clinical visual scoring. The ventral forearms of 11 healthy subjects were patch-tested for 24 h under occlusion in finn chambers with five concentrations of the irritant sodium lauryl sulfate. The tested sites and three control sites were evaluated clinically for erythenia at 24, 48, and 72 h after occlusion, photographed using standard and perpendicular polarized photography, and measured by diffuse reflectance spectroscopy. All photographs were evaluated for erythema by three investigators. Diffuse reflectance spectra were analyzed, and changes in apparent oxyhemoglobin and deoxyhemoglobin concentrations were estimated. Clinical and photographic assessments of erythema yielded similar linear dose-response relations, A linear dose-response relation, with no minimum thresh- old, also was obtained for changes in the apparent oxyhemoglobin concentration with increasing Irritant dose, whereas the apparent deoxyhemoglobin concentrations were unchanged with increasing dose. These results show that diffuse reflectance spectroscopy permits the characterization of irritant-induced inflammation in terms of a single parameter, the apparent concentration of oxyhemoglobin, and that irritant-Induced inflammation primarily involves the capillaries and the superficial arterial plexus.

Chronic exposure to a weak irritant leads to inflammatory changes which may be followed by pigmentary changes and accommodation. The inflammatory responses to acute exposure to an irritant have been extensively studied. This study investigated quantitatively the inflammatory reactions produced in photodamaged skin with chronic application of a weak chemical irritant (tretinoin cream 0.025%) over a period of 9 months (36 weeks). Forty-eight subjects with moderately to severely photodamaged skin were enrolled in a 36-week, double-blind placebo-controlled study. Tretinoin cream was applied nightly on the distal two thirds of one dorsal forearm and placebo on the other. The proximal third of each dorsal forearm received no treatment and served as control. Clinical assessments and diffuse reflectance measurements were made at 7 time points during treatment. Apparent concentrations of oxyhemoglobin (HbO2), deoxyhemoglo-bin (Hb) and melanin were estimated by analysis of the diffuse reflectance spectra. No changes were observed in the apparent H bO2or the Hb concentration of the placebo-treated or control sites, thus establishing a reliable baseline. The apparent HbO2 concentration of the tretinoin-treated sites increased significantly from baseline to a maximum at 12-18 weeks of treatment, then returned to baseline with continued applications. The changes in HbO2 concentration agreed closely with clinical assessments of erythema. The apparent melanin concentration, corresponding to diffuse hyperpigmentation, showed a large seasonal decrease in both the control and the treated sites, with an additional decrease in the treated sites between 12 and 18 weeks. Erythema appeared after repeated applications and eventually resolved under continuous treatment. The maximum decrease in hyperpigmentation occurred simultaneously with the maximum increase in erythema.

Background: Quantification of acne remains a challenge. It may be difficult to identify lesions by standard flash photography. Previous studies have shown that foci of light in fluorescence photographs correspond to high protoporphyrin IX production by Propionibacterium acnes in open comedones, follicles, and inflammatory lesions. Objective: Our purpose was to study the utility of fluorescence photography for evaluation of acne. Methods: Forty subjects with mild to moderate acne vulgaris were randomly selected to apply either clindamycin 1% topical solution or vehicle twice daily. Counts of acne lesions and flash and fluorescence photographs were obtained at baseline, and at 4, 8, and 12 weeks. Results: At 12 weeks, the treatment group had a larger percentage change in open comedones, less fluorescence in all areas assessed, and a larger percent decrease in fluorescence than the vehicle group. Conclusion: Fluorescence photography appears to be a useful tool to chart the course of acne treatment.

Background: The clinical characteristics of photodamaged skin, such as coarse and fine wrinkling, sallowness, hyperpigmentation, tactile roughness, laxity, and erytherma, are not accurately evaluable from photographic records. Objective: The purpose of this study was to develop accurate and reproducible photographic techniques that generate an evaluable record of the characteristics of photodamaged skin. Methods: The method used involved illumination and photography through polarizing filters (polarized light photography). Results: Polarized light photography generates images that selectively enhance either the surface features or the subsurface features of the skin, providing an accurate and evaluable record for evaluation of photodamaged skin. Conclusion: Polarized light photography, when coupled with precise framing and mapping, yields an accurate and evaluable record of photodamaged skin.

We have isolated and characterized cDNAs representing the rat thyrotropin-beta-subunit. The cDNAs were prepared from poly(A)+ RNA obtained from rat pituitary glands and encode the precursor of the rat thyrotropin-beta-subunit which contains a leader or signal peptide of 20 amino acids, and an apoprotein of 118 amino acids. Blot hybridization analysis of total rat liver DNA digested with several restriction enzymes indicates the likelihood of a single gene encoding the rat thyrotropin-beta-subunit. In addition, analyses of pituitary RNA from normal and thyroidectomized rats indicate that the mRNA encoding the rat thyrotropin-beta-subunit is approximately 700 bases in length and its level increases 8--10-fold after thyroid gland ablation.