Skin Deep - Clinical & Cosmetic Dermatology Blog

Skin Deep is a blog for dermatologists and skin care professionals with focus on theoretical, cosmetic and aesthetic dermatology. This blog is associated with ‘Dermatologists Sans Borders’ one of the largest curated groups of skin care professionals on facebook. If you are looking for non-technical information, please visit


Animation of the structure of a section of DNA...
Animation of the structure of a section of DNA. The bases lie horizontally between the two spiraling strands. (Photo credit: Wikipedia)

How many times your psoriasis or vitiligo patients wanted to know the risk of their kids developing the disease? I am sure you have also noticed the horror on the face of the adolescent staring  at his father’s shiny bald scalp or the young girl seeing the undeniable stain of melasma spreading on her mother’s face. All these conditions are neither life threatening nor debilitating, but the psychological morbidity is enormous. We have also prayed in silence before starting Imuran for the CAD patients in distress hoping that they were not unlucky enough to be in the 0.3% with faulty TPMT.

We have been trying to reduce their anxiety by giving the general risk of inheritance till now, but we will soon be empowered to give the specific risk of the individual based on his/her genetic makeup. The technology has been there for sometime to screen specific areas of an individual’s genome (DNA) to identify SNPs (snips) that could make your risk prediction more accurate, but it was beyond the reach of most people especially in countries like India.

Ms. Anuradha Acharya, the young biotech entrepreneur who leveraged  Indian bioinformatics expertise with Ocimum bio solutions is doing it again with mapmygenome, a ‘personal genomics’ initiative to take this technology to the masses. It is still in early stages and it covers only Lupus, Melanoma and Psoriasis from a dermatologist’s list of potential interest, but more specific test series will be available soon. All you need to provide is a saliva sample with a swab.

The potential benefits go beyond risk prediction and prognostic applications. Once enough data is available, the depersonalised population statistics would be an invaluable research tool for Indian population geneticists. More information about this, including how to order the test is available from the website .

Special thanks to Ms. Acharya for finding time to brief me on this.

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The stem cell Line

Stem cells
Stem cells (Photo credit: BWJones)

What are the challenges in stem cell therapy? No, I am not talking about the Apple stem cell cream your beauty therapist gave you that is supposed to wipe away the wrinkles on your face like a magic wand and you actually believed, for the umpteenth time, that maybe you are going to become young again. Here I am talking about your own ‘real’ stem cells!

You need to identify a source, isolate and selectively amplify the correct type, ensure differentiation into the correct terminal cell type and find a way to actually put them in the correct place. Not something as simple as eating an apple. So if you want to treat a non-healing ulcer with keratinocyte stem cells, how do you get them without making another breach in the epidermis?

Dr Nair and Dr Krishnan from  Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India found that 4% of peripheral blood mononuclear cell in the blood are keratinocyte progenitor cells (KPCs) with the specific KPC marker p63 that can be harvested easily.[1]  They have designed a biomimetic niche that can amplify it up to 70%. Within 12 days of culture, the cells coexpressed p63, CK5, and CK14 ensuring a keratinocyte lineage. Differentiation progressed during subculture and expressed involucrin and filaggrin indicating terminal keratinocyte differentiation. Since desmosomal connections are absent these cells can be easily transferred to a fibrin/fibroblast sheet ideal for transplantation as a skin substitute.

The two other stem cells of dermatological importance are melanocyte and hair progenitors. The former is difficult to amplify while the latter is difficult to find. Hope with the breathtaking developments in stem cell research, we would find a way soon!


1. Nair, RP. "Identification of p63+ keratinocyte progenitor cells in circulation and ..." 2013. <>

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Opposite Poles

Have you ever had this dream? Patients sitting outside your office waiting for their monthly infusion of stem cells. The polygel electrode of your next-gen skin rejuvenator not only replenishes the skin stem cell reserve but also removes any degraded cell fragments. Well, sit tight. This ‘fountain of youth’ technology may be just around the corner!

Like tiny crawling compass needles, whole living cells and cell fragments orient and move in response to electric fields - but in opposite directions, scientists at the University of California, Davis, have found.[1] This technology could open up new ways to safely and effectively deliver stem cells and remove unwanted cell fragments.
Cell Biology
Cell Biology (Photo credit: ex_magician)

Another study explores the usefulness of human in vitro models to understand the mechanisms of skin ageing.[2] They have successfully used UVA-irradiated dermal fibroblasts to investigate the anti-ageing effects of sargachromanol E isolated from a marine brown alga, Sargassum horneri.


1. "Opposites attract: How cells and cell fragments move in electric fields." 2013. 7 May. 2013 <>

2. Kim, JA. "The chromene sargachromanol E inhibits ultraviolet A-induced ..." 2012. <>

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Hurting the fly

Have you been hurting your patients with lasers, derma rollers or mesotherapy to initiate a wound healing response that promotes collagen synthesis and anti-ageing? I have blogged about a new laser technology from Philips before. But soon you may be able to initiate the same response without causing any injury at all. No, I am not going back to peptides again.

A syncytium forms after wounding the Drosophil...
A syncytium forms after wounding the Drosophila epithelium. (Photo credit: Wikipedia)
Many of the breakthroughs in clinical medicine is inspired by basic research and cosmetic dermatology is no exception. Scientists from University of California have recently published their findings on wound repair in Drosophila or the ubiquitous fruit fly and found some new genes involved in the process.[1] More than the list of new genes they have unearthed, the novel methodology they have employed in their study is of relevance in cosmetic dermatology in spite of the huge difference between the fruit fly and human fly.

The researchers have found that the serine protease trypsin is sufficient to induce a striking global epidermal wound response without inflicting cell death or compromising the integrity of the epithelial barrier and this could be applicable to humans as well. This "woundless wound healing cascade" could have many applications in cosmetic dermatology. Another curious finding was the absence of wound site melanization in trypsin wounded embryos while melanisation was common after puncture wounds. Though the primary focus of the paper was not melanisation and the authors have not discussed it much, this could well realise our dream of ‘controlled injury without the risk of post inflammatory hyperpigmentation’!


1. Patterson, Rachel A et al. "Serine Proteolytic Pathway Activation Reveals an Expanded Ensemble of Wound Response Genes in Drosophila." PLOS ONE 8.4 (2013): e61773.

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About Me

As a Dermatologist and Informatician my research mainly involves application of bioinformatics techniques and tools in dermatological conditions. However my research interests are varied and I have publications in areas ranging from artificial intelligence, sequence analysis, systems biology, ontology development, microarray analysis, immunology, computational biology and clinical dermatology. I am also interested in eHealth, Health Informatics and Health Policy.


Bell Raj Eapen
Hamilton, ON