The skin of primates. 38. The skin of the red uacari (Cacajao rubicundus)

The skin of the red uacari (Cacajao rubicundus) is characterized by distinctive traits. Pigmentation of both the epidermis and dermis in juvenile animals resembles a similar condition recorded in adult Callithricidae. Extensive capillary sinuses pervade the upper dermis of the face, ears, forehead, and frontal scalp. Hederiform nerve endings are common in the face and scalp, as are papillary nerve endorgans in the volar friction surfaces; both are reactive for specific and pseudocholinesterase. A general diminution in size of hair follicles and a retarded generative cycle contribute to the phenomenon of “baldness” in the forehead and scalp of mature animals. Apocrine glands are quantitatively diminished over the dorsum. Eccrine sweat glands, confined to the palmar and plantar friction surfaces, are poorly differentiated; all secretory cells contain glycogen.     

The skin of primates. XXXVII. The skin of the pig-tail macaque (Macaca nemestrina)

The skin of the pig-tail macaque is basically similar to that of the rhesus monkey and the stump-tail macaque. The epidermis is thin and contains occasional basal melanocytes. The dermis, rich in elastic fibers, is practically free of pigment-containing cells. The upper dermis is highly vascular in the perianal region and sex skin. Cholinesterase-reactive nerve endings are plentiful beneath the friction surfaces of the pes and manus, mucous membranes, and junction of the hairy gluteus and glabrous ischial callosity. Hederiform-like endings are present in the eyelid, pinna, and frontal scalp. Apocrine and eccrine sweat glands occur throughout the hairy skin in a 2–3: 1 ratio. Both types are invested by nerves reactive for acetyl- and butyrylcholinesterase.     

The skin of primates. XXXVI. The skin of the pigmy marmoset--Callithrix (Cebuella) pygmae

The pigmy marmoset — Callithrix (= Cebuella) pygmaea Spix — is the second detailed study of the members of the family Callithricidae. It is closely allied to the red-mantled tamarin — Saguinus (=Tamarinus) fuscicollis illigeri Spix — and shares some of its characteristics with both Prosimii and Anthropoidea. The epidermis and dermis contain moderate numbers of concurrent, melanotic melanocytes. The dermis is rich in elastin. Hair follicles grow in groups of three or four over the general body surface, and one apocrine gland is associated with each grouping. Arrectores pilorum muscles are well developed. On the ventral ulnar wrist are sinus hairs associated with apocrine glands. Most hair follicles have nerve end-organs around them that are reactive for acetylcholinesterase and alkaline phosphatase. There is a large aggregation of sebaceous glands in the suprapubic region. The large sebaceous glands in the eyelid, face, and external genitalia are surrounded by cholinesterasereactive nerves. Apocrine glands are found over most of the hairy skin except the brow, scalp and back; a large grouping of them is present in the sternal region. Only the secretory coils of apocrine glands in the external genitalia are invested with butyrylcholinesterase-rich nerves. Eccrine glands are confined to the volar surfaces of the pes and manus. They have dark cells with abundant glycogen and clear cells with neither glycogen nor PAS-reactive material. The nerves around the eccrine secretory coil are reactive only for acetylcholinesterase.     

Island scalp flap for superior forehead reconstruction

An island scalp fasciocutaneous flap, based on the posterior superficial temporal vessels, is described for single-stage reconstruction of full-thickness forehead and scalp defects. The hairline can be precisely determined and tailored to restore symmetry. By removing the hair-bearing dermis of the forehead portion of the flap and placing a full-thickness skin graft, aesthetic reconstitution of the forehead skin is achieved. This flap is especially useful when exposed calvarium limits other techniques.     

Beards, baldness, and sweat secretion

The hypothesis according to which male common baldness has developed in the human species as a compensation for the growth of a beard in order to achieve heat loss has been tested. In 100 clean-shaven men direct measurement of the area of glabrous skin on the forehead and calvaria was found to be proportional to that of the hairy skin on the lips, cheeks, chin and neck. During light hyperthermia the evaporation rate on the bald scalp was 2 to 3 times higher than on the hairy scalp. Conversely the evaporation rate was practically equal on the foreheads and chins of women and unbearded young men, while in adult clean-shaven bearded men it was 40% less on the chin than the forehead. These results support the hypothesis that male baldness is a thermoregulatory compensation for the growth of a beard in adults.     

The skin of primates. XLIII. Further observations on the Philippine tarsier (Tarsius syrichta)

Underneath the volar friction surfaces is a highly developed, anastomosing system of alkaline phosphatase-reactive capillaries; numerous cholinesterase-positive hederiform nerve end-organs are present in the scalp, forehead, lower abdomen, back, and perianal region; sinus hair follicles occur on the flexor surface of the antebrachium; and a dense field of gigantic sebaceous and admixed apocrine glands constitutes the epigastric gland.     

Regional variations of cutaneous propionibacteria.

Propionibacterium acnes, P. avidum, and P. granulosum were quantitatively measured in 50 young adults. The scalp, forehead, external auditory canal, alae nasi, anterior nares, groin, rectum, and antecubital and popliteal fossa were sampled. These represent various cutaneous microenvironments, differing in moisture, density of sweat, sebaceous glands, and extent of anaerobiosis. These studies show that the propionibacteria are ubiquitous on the skin, with P. acnes predominant in both prevalence and population, especially in areas rich in sebum. P. granulosum recovery paralled that of P. acnes, but the density was significantly lower. P. avidum was found mainly in moist areas and the retum, suggesting an intestinal reservoir.     

Regional variations of cutaneous propionibacteria

Propionibacterium acnes, P. avidum, and P. granulosum were quantitatively measured in 50 young adults. The scalp, forehead, external auditory canal, alae nasi, anterior nares, groin, rectum, and antecubital and popliteal fossa were sampled. These represent various cutaneous microenvironments, differing in moisture, density of sweat, sebaceous glands, and extent of anaerobiosis. These studies show that the propionibacteria are ubiquitous on the skin, with P. acnes predominant in both prevalence and population, especially in areas rich in sebum. P. granulosum recovery paralled that of P. acnes, but the density was significantly lower. P. avidum was found mainly in moist areas and the retum, suggesting an intestinal reservoir.     

Characteristics of a new hairless mutation (bald) in rats

Hereditarily hairless rats have been maintained by sibmatings since 1973. These animals were termed "bald rats", and examined for their characteristics on genetics, physiological, hematological and clinical chemistry values and histology. The bald rats began to lose their hair at approximately three weeks of age. At five weeks of age, the skin was devoid of all general body hair except for the vibrissae, and the skin became wrinkled at two months of age. Histologically, follicular cysts were observed in a large number, from three months of age onward. The bald condition was a simple recessive character (ba); homozygous animals lost hair and heterozygous ones did not. The bald females attained sexual maturity around eight weeks of age and littered normally, but failed to nurse their young. The incapability of supplying sufficient milk supposedly resulted from the mammary glands that involuted after delivery. The bald animals consumed more food but showed lower values for body weights, plasma triglyceride, and epididymal adipose tissue amount than the haired animals. In addition, the bald males had brown adipose tissue in the interscapulum which was histologically activated as in newborn animals. Aged bald animals showed spontaneous tumors of the thymus, pituitary, testis, uterus, mammary gland, and skin. The incidence of skin tumors was much higher than those of tumors of other origins.     

The "Nordstrom suture" to enhance scalp reductions

The authors compared the results of 10 scalp reductions using the "Nordstrom suture" with the earlier published results of scalp reductions without a device to prevent stretch-back and of reductions with extenders. At 1 month postoperatively, the Nordstrom suture eliminated the stretch-back of 8.3 mm seen in earlier studies and, in fact, it shrank the bald area. The average shrinking achieved with the Nordstrom suture was 16.9 mm (i.e., 143 percent improvement over scalp reductions alone). Scalp extenders shrank the bald area, but the Nordstrom suture shrank the area about three times more than extenders at 1 month postoperatively.     

Repair of wide coup de sabre without cutaneous excision by means of pericranial-galeal padding flap

A case of double linear scleroderma of the forehead (coup de sabre) is described. The histopathology of this rare lesion is now well known with a normal epidermis and a sclerotic dermis. The correction was done with an original two-stage procedure: the lesion with alopecia was first treated by excision-suture and a transfer of the involved subcutaneous tissue along the right inner canthus; 1 year later, by a hemicoronal incision, we transferred a galeal-pericranial flap beneath the wider forehead lesion. We think that the use of a filling flap to correct wide coup de sabre lesions without cutaneous excision can be a simple alternative to the classic treatment by complete excision and flap reconstruction. The subcutaneous fascial system of the scalp can provide a good donor site with minimal morbidity.     

Tactile and thermal detection thresholds of the scalp skin

The tactile and thermal sensitivity of diverse regions of the human body have been documented extensively, with one exception being the scalp. Additionally, sensory changes may accompany the hair loss from the scalp in androgen-related alopecia (ARA), but formal quantitative sensory testing (QST) has not been reported in respect of this. Therefore, light touch detection thresholds were obtained at nine scalp sites and one forehead site, using Semmes–Weinstein filaments (Von Frey hairs), and for warming and cooling from skin baseline temperature, using 28 and 256?mm² thermodes. Affective, thermal, and nociceptive sensations experienced at thermal detection threshold were quantified. Thirty-two male participants were recruited, 10 of whom had normal hair coverage, 12 of whom had shaved scalp but with potentially normal hair coverage, and 10 of whom exhibited ARA to some extent. The scalp was relatively insensitive to tactile and thermal stimulation at all tested sites, especially so along the midline and near the apex of the skull. Threshold level warm stimuli were rated less pleasant, the less sensitive the test site. After correction for age-related changes in sensitivity, bald scalp sites were found more sensitive to cooling than the same sites when shaved, consistent with prior informal reports of increased sensitivity for some scalp sensations in ARA. QST on hair-covered sites was subject to methodological issues that render such testing non-ideal, such as bias in measurement of resting skin temperatures, and the near impossibility of delivering filament stimuli to the scalp skin without disturbing neighboring hairs.     

Tactile and thermal detection thresholds of the scalp skin

The tactile and thermal sensitivity of diverse regions of the human body have been documented extensively, with one exception being the scalp. Additionally, sensory changes may accompany the hair loss from the scalp in androgen-related alopecia (ARA), but formal quantitative sensory testing (QST) has not been reported in respect of this. Therefore, light touch detection thresholds were obtained at nine scalp sites and one forehead site, using Semmes-Weinstein filaments (Von Frey hairs), and for warming and cooling from skin baseline temperature, using 28 and 256 mm(2) thermodes. Affective, thermal, and nociceptive sensations experienced at thermal detection threshold were quantified. Thirty-two male participants were recruited, 10 of whom had normal hair coverage, 12 of whom had shaved scalp but with potentially normal hair coverage, and 10 of whom exhibited ARA to some extent. The scalp was relatively insensitive to tactile and thermal stimulation at all tested sites, especially so along the midline and near the apex of the skull. Threshold level warm stimuli were rated less pleasant, the less sensitive the test site. After correction for age-related changes in sensitivity, bald scalp sites were found more sensitive to cooling than the same sites when shaved, consistent with prior informal reports of increased sensitivity for some scalp sensations in ARA. QST on hair-covered sites was subject to methodological issues that render such testing non-ideal, such as bias in measurement of resting skin temperatures, and the near impossibility of delivering filament stimuli to the scalp skin without disturbing neighboring hairs.     

Physiopathological role of bald-scalp cytosolic proteins

The physiopathological role of androgen binding proteins in male pattern baldness (MPB) has been studied by using tritiated dihydrotestosterone (DHT) and methyltrienolone (R 1881) as ligands. DHT binding in bald scalp from subjects suffering from MPB is high (53 +/- 12 fmol/mg protein) in cytosol obtained from bald areas, being undetectable in hairy areas from the same subject. Since methyltrienolone does not bind in bald scalp cytosol, there must be no specific DHT receptor in this material. Several kinetic and molecular parameters of DHT binding in bald scalp cytosol and serum were similar in both samples. Only the association rate constant (k+1) was significantly higher in serum (8.8 X 10(6) M-1 min-1) than in cytosol (3.08 X 10(6) M-1 min-1). DHT binding in serum as well as the evaluation of plasma contamination in the skin samples (by nephelometric analysis) strongly suggests that DHT binding in skin cytosol is merely due to the presence of contaminating SHBG but it does not explain the lack of DHT binding in non bald areas. Thus, the possibility arises of there being a specific mechanism for the uptake of the plasmatic testosterone SHBG-complex taking place only in the hypertrophic sebaceous gland as well as the existence of active T metabolites other than DHT, probably 3 beta-androstanediol.     

Histology and cytochemistry of human skin. XI. The distribution of beta-glucuronidase

1. Various amounts of beta-glucuronidase activity may be found in all of the cutaneous appendages. 2. In the epidermis, the basal layer and the Malpighian layer contain a moderate amount of it, but a band of cells, including the stratum granulosum and the cells immediately above it, is rich in beta-glucuronidase. 3. The cells of the duct of eccrine sweat glands have moderately strong enzyme activity, but those in the secretory coil are strongly reactive; small and large reactive granules are crowded in the reactive cytoplasm. 4. The cells of the secretory coil of the apocrine glands contain more beta-glucuronidase than any other cutaneous appendage. 5. In the sebaceous glands, a very strong concentration of enzyme activity is found in the undifferentiated peripheral cells, a smaller amount of it is found in the differentiating cells. 6. In active hair follicles, the largest amount of beta-glucuronidase is found in the outer root sheath and in the bulb. In the outer sheath, the strongest concentration is found around the level of the keratogenous zone of the cortex. The dermal papilla is strongly reactive. In quiescent hair follicles, the outer root sheath has a moderate amount of enzyme concentration, but the dermal papilla is unreactive. 7. In the dermis, the fibroblasts in the papillary layer, the smooth muscle cells of the arrectores pilorum and the tunica media of arteries, and the fat cells all exhibit enzyme activity. Mast cells show a great concentration of beta-glucuronidase.     

The role of tissue expansion in the management of large congenital pigmented nevi of the forehead in the pediatric patient

The authors present a cohort of 21 consecutive patients who had congenital pigmented nevi covering 15 to 65 percent of the forehead and adjacent scalp and who were treated at their institution within the last 12 years. All patients were treated with an expansion of the adjacent texture- and color-matched skin as the primary modality of treatment. The median age at presentation was approximately 1 year; mean postoperative follow-up was 4 years. Nevi were classified according to the predominant anatomic areas they occupied (temporal, hemiforehead, and midforehead/central); some of the lesions involved more than one aesthetic subunit.The authors propose the following guidelines: (1) Midforehead nevi are best treated using an expansion of bilateral normal forehead segments and advancement of the flaps medially, with scars placed along the brow and at or posterior to the hairline. (2) Hemiforehead nevi often require serial expansion of the uninvolved half of the forehead to minimize the need for a back-cut to release the advancing flap. (3) Nevi of the supraorbital and temporal forehead are preferentially treated with a transposition of a portion of the expanded normal skin medial to the nevus. (4) When the temporal scalp is minimally involved with nevus, the parietal scalp can be expanded and advanced to create the new hairline. When the temporoparietal scalp is also involved with nevus, a transposition flap (actually a combined advancement and transposition flap because the base of the pedicle moves forward as well) provides the optimal hair direction for the temporal hairline and allows significantly greater movement of the expanded flap, thereby minimizing the need for serial expansion. (5) Once the brow is significantly elevated on either the ipsilateral or contralateral side from the reconstruction, it can only be returned to the preoperative position with the interposition of additional, non-hair-bearing forehead skin. Expansion of the deficient area alone will not reliably lower the brow once a skin deficiency exists. (6) In general, one should always use the largest expander possible beneath the uninvolved forehead skin, occasionally even carrying the expander under the lesion. Expanders are often overexpanded.     

The skin of primates. XLI. The skin of the silver marmoset—Callithrix (= Mico) Argentata

The skin of the silver marmoset, Callithrix (= Mico) argentata Linnaeus, has many outstanding characteristics. The unusually thin epidermis and dermis are generally devoid of melanotic melanocytes. The surface of the interramal gular region is peppered with small, elevated papillae; that of the corpus penis is characterized by keratinized, proximally directed hollow spines in whose cavities are organized nerve end-organs and capillary loops. Cholinesterase-reactive papillary nerve end-organs and Meissner corpuscles populate all volar friction surfaces. A highly vascular dermis and subcutaneous fat pad partially contribute to the characteristic rubicund color of the face, external ears, and anogenital region. Many body surface hairs are accompanied by the classic Haarscheibe of Pinkus. Sinus hairs are plentiful; a circumscribed vibrissa-bearing eminence is located on the ventral ulnar aspect of each wrist. Alkaline phosphatase-positive, stellate-shaped cells are found on the outer root sheath and epithelial sac of active and quiescent hairs in all cephalic regions; such cells are not argyrophilic, aurophilic, or osmiophilic. Hairs grow in linear perfect sets of 3 to 5 follicles; they do not grow singly on the cheek. Large sebaceous glands contain alkaline phosphatase in their peripheral acini; extensive fields of gigantic multilobular sebaceous glands contribute to the distinct, opaque-white color of the scrotal skin. Numbers of apocrine sweat glands are diminished in cephalic regions but one gland occurs with each hair follicle in the axilla, scrotum, suprapubic region, and ulnar eminence. Relatively avascular eccrine sweat glands are confined to the volar friction surfaces. Their secretory coils contain sporadically distributed glycogen and phosphorylase and surrounding nerves are much more reactive for acetyl- than butyrylcholinesterase.     

Seasonal changes in the skin glands of Roe deer (Capreolus capreolus)

Seasonal changes in the specialized skin glands of the forehead, metatarsal gland and interdigital regions of Roebucks are described and compared with glands of the general body surface. In both the forehead region and dorsal skin the sebaceous and apocrine glands enlarge as the testes enlarge and regress after the rut, but the glands of the forehead region are at least three times larger than those of the general body surface. The apocrine glands of the forehead region discharge by exocytosis except at the time of maximum secretion, which precedes total cell breakdown. In the metatarsal and interdigital regions the skin glands are enlarged throughout the year.     

The extended V-Y flap.

The extended V-Y flap is a modification of the V-Y advancement flap, which is very useful in closing defects following excision of facial lesions. The modification involves the addition of an extension limb onto the advancing edge of the standard flap. This limb is located adjacent to the area requiring reconstruction and is hinged down as a transposition flap on the end of the V-Y advancement flap to close the most distal portion of the defect. The extended V-Y flap has been found to be very effective in closing large defects in areas that typically have inadequate subcutaneous tissue to allow extensive mobilization of the standard V-Y advancement flap. It has been used effectively with excellent cosmetic results in the temporal, scalp, forehead, and nasal areas, providing a well-contoured and aesthetically pleasing reconstruction.     

Geometric considerations in the design of rotation flaps in the scalp and forehead region

The classical transposition and rotation flaps are well known. Cosmetic considerations in the scalp and forehead region limit the use of a flap design that requires a skin graft for a donor defect. On sound geometric principles, the classical flap designs are suitably modified here to have a somewhat equal proportion of transposition and rotation. This "modified rotation flap" design works to a maximum advantage in the inextensible region of the scalp and forehead by providing single-stage primary closure of moderate to large defects. No backcuts are ever necessary with this flap design. Use of this principle to modify the rotation flap design for closure of an extended midline forehead defect following rhinoplasty allows a still wider (up to 6.5 cm) midline forehead flap to be available for rhinoplasty with primary closure of the donor defect.