"Stretching the Skin Surface: Skin Elasticity"

DRAFT
R. Randall Wickett, Ph.D.
University of Cincinnati
College of Pharmacy

Cosmetics and Toiletries 116(3)47-54 (2001)

Introduction
This contribution to the series "From Test to Claims" deals with the
instrumental measurement of skin elasticity, discussing measuring
conditions, relevant parameters to record, its analysis and the type of
claims that could be derived from such measurements. In particular, this
paper will review the use of the Dermal Torque Meter ® (DTM; Dia-stron
Ltd., Andover, Hampshire, UK) and the Cutometer® (Courage & Khazaka,
Cologne, Germany) to measure the elasticity of the stratum corneum. The
two instruments will be compared and contrasted and measurement protocols
will be discussed.

Since the pioneering work of Blank (1952) identifying water as the

primary plasticizer of the stratum corneum, cosmetic scientists have
realized the importance of water to stratum corneum function. Those of us
who have worked with isolated stratum corneum realize that dry stratum
corneum is stiff and brittle while a well-hydrated horny layer is
extremely flexible. The inflexibility of dry stratum corneum has long
been assumed to be an important contributing factor to problems
associated with dry skin. Reiger (Reiger and Deem, 1974a) (Reiger and
Deem, 1974b) and Middleton (Middleton, 1974) were among those who
reported the use of in-vitro measurements of treatment effects on stratum
corneum elasticity to study moisturizing ingredients. An example of the
extreme effect of hydration on skin elasticity in-vitro is found in the
work of Van Duzee (1978). He reported that the extensibility of the horny
layer with a water content of 40% was more than 100 times more extensible
than dry stratum corneum. While water is clearly a highly efficient
plasticizer of stratum corneum, Van Duzee also reported that urea
increased the extensibility of stratum corneum independently compared to
untreated samples at the same water content. Along these lines Takahshi
et al.(1985) reported that lactic acid had more effect on stratum corneum
elasticity in-vitro than sodium lactate, even though sodium lactate
increased the skin’s water content and lactic acid did not. I reviewed
the literature on both in-vitro and in-vivo studies of stratum corneum
elasticity and postulated that small molecules such as urea and lactic
acid may increase stratum corneum elasticity by directly plasticizing
keratins while humectants like glycerin primarily effect elasticity by
increasing water content (Wickett, 1987). Recently Wiechers and Barlow
(Wiechers and Barlow, 1999) reported further evidence that elasticity and
moisturization may arise from at least two different mechanisms.

While in-vitro measurements of stratum corneum elasticity may provide

some information about interactions of actives such as urea or lactic
acid with the stratum corneum, they are not particularly relevant to the
in-vivo situation. In-vivo, the horny layer is exposed to air on one side
and the viable epidermis on the other. The water gradient (Warner and
Lilly, 1994) across the stratum corneum in-vivo is not easy to simulate
in-vitro, so in-vitro measurements of stratum corneum elasticity will
always be questionable.

There was a conference in Miami Beach in 1976 that eventually led to the
formation of the International Society for Bioengineering and the Skin.
One of my clearest memories from that conference is a discussion with
Professor Ronald Marks on the importance of measuring the mechanical
properties of the stratum corneum in-vivo and the great inherent
difficulty in making and interpreting such measurements. The main
difficulty arises because of the intimate connection between the stratum
corneum and the epidermis, which is, in turn, firmly attached to the
dermis. While the horny layer is the main moisture barrier of the skin,
it is, after all, only about 20 microns thick, while the dermis, composed
of its tough layers of collagen fibers and elastin, is much thicker.

As bioengineering methods progressed, it became possible to attempt to

study the effects of moisturizers on stratum corneum elasticity in-vivo.
In 1985 Cooper et al. (Cooper et al., 1985) used the gas-bearing
electrodynamometer (Christensen et al., 1977) to study the effect of
glycerol on stratum corneum elasticity in-vivo. Aubert et al.(1985)
described the use of a torque method to investigate the effects of
cosmetic ingredients on stratum corneum in-vivo. The torque device
described by Aubert et al. became commercially available as the Dermal
Torque Meter® (DTM; Dia-Stron, Andover, Hampshire, UK). When using the
DTM, torque is applied to the skin through an 18mm diameter disk that is
fixed to the skin surface with double-sided tape. A guard ring is also
taped to the skin surface to restrict the range of the deformation. The
DTM probe with and without the guard ring in place is shown in figure 1a
and 1b, respectively. The DTM has been described in detail in the
Handbook of Non-Invasive Methods and the Skin (Agache, 1995).

Figure 1 a: The DTM probe without the guard ring attached

Figure 1 B the DTM probe with the guard ring in place

Figure 1 C: The DTM probe on the author’s arm.

Two other commercially available instruments for measuring skin
elasticity in-vivo are the Dermaflex A® (Cortex Technology, Hadsund,
Denmark) (Gniadecka and Serup, 1995) and the Cutometer® SEM 474, now
replaced by the Cutometer® SEM 575 (Courage & Khazaka, Cologne, Germany)
(Barel et al., 1995). These instruments rely on a vacuum to pull the skin
vertically into the opening of the probe. The probe of a Cutometer® 575
is shown in Figure 2. Barel et al. have recently reviewed the use of
suction devices for measuring skin elasticity in detail (Barel et al.,
1998).

Figure 2: the Cutometer Probe

Straining the skin with any of these instruments results in deformation
of the entire skin, not just the stratum corneum. Thus it is difficult,
or impossible, to determine how much of the resistance to deformation
came from the horny layer. The general approach to dealing with this
complication is to try to use very small deformations in the hope that
the contribution of the stratum corneum will dominate. With the
Cutometer® this is accomplished by using the smallest diameter probe (2
mm) and a vacuum level below the maximum. With the DTM the smallest ring
gap of 1 mm is used and the torque is kept below 15 mN/m2. Even under
these conditions there will be some deformation of the viable epidermis
and the dermis. In fact, Diridollou and co-workers (Diridollou et al.,
1998a) (Diridollou et al., 1998b) used a clever combination of ultrasound
and suction measurements to show that not only the dermis, but also the
subcutaneous fat is deformed under 50 mbar of negative pressure with a 3
mm opening. We can only hope that enough of the resistance to deformation
comes from the horny layer, such that relative changes in stratum corneum
elasticity after treatment can be seen. Attempts to validate this
approach will be discussed below.

Form of the Data

The general form of Cutometer® and the DTM data curves of deformation
versus time is shown in Figure 3. This is the only form for the DTM and
is mode 1 for the Cutometer, one of the 4 possible Cutometer ® modes.
Use of the Cutometer® in the stress/strain mode has been reviewed (Barel
et al., 1995; Barel et al., 1998).

Figure 3 General form of Cutometer (mode 1) and DTM curves.

The curve is characterized by the following parameters:
 UE is the elastic deformation of the skin due to the application of
stress (vacuum or torque) by the instrument;
 UV is the viscoelastic creep occurring after the elastic
deformation;
 UF is the total extensibility of the skin;
 UR is the elastic deformation recovery due to stress removal;
 UA is the total deformation recovery at the end of the stress-off
period;
 R is the amount of deformation not recovered by the end of the
stress-off period;
 UA/UF is the overall elasticity of the skin including creep and
creep recovery;
 UR/UE is the pure elasticity ignoring viscoelastic creep;
 UV/UE is the ratio of viscoelastic to elastic extension called the
viscoelastic ratio;
 UR/UF is the ratio of elastic recovery to total deformation.

If the DTM and the Cutometer® are adequately reporting changes in the
elasticity of the stratum corneum, we should expect to see that either
removing the stratum corneum or increasing its water content should
effect the measurements. Removing the horny layer by tape stripping has
been reported to cause a small decrease in U R/UF and a large increase in
UV/UE (Barel et al., 1998). Our group has found that removing the stratum
corneum with a CO2 Laser (single pass) caused profound changes in
Cutometer® parameters (Kitzmiller et al., 1999,2000). In agreement with
Barel et al., we found that UV/UE increased dramatically and that UR/UF
decreased.

Treatment with humectants such as urea or glycerol presumably increases

stratum corneum water content and Lévêque (Leveque, 1984) reported that
both of these actives increased UE compared to vehicle in a 4-weeks
study. While we assume that this effect is from changes in elasticity in
the stratum corneum, it is possible that it may arise from another skin
layer. To check this, we have investigated the effect of direct hydration
of the skin with liquid water using both the Cutometer® (Murray and
Wicket, 1996) and the DTM (He et al., 1999). In both cases, the skin was
hydrated for 10 minutes with a wet paper towel and then blotted dry. We
would not expect this short water treatment to significantly affect the
lower layers of the skin. Measurements were made as quickly as possible.
These studies are difficult to execute because the skin is drying rapidly
during the course of the measurements. However, we did see various
effects on the stress-strain parameters measured with both instruments.
With the Cutometer UR seemed to be the most sensitive parameter to direct
hydration. With the DTM UE, UR and UF increased significantly and UV
decreased slightly. Thus, we feel that it is safe to conclude that the
measured changes in elastic parameters after moisturizer treatment are
caused by changes in the elasticity of the stratum corneum rather than
originating from deeper levels in the skin.

We have compared the Cutometer® to the Dermal Torque® meter for their
ability to detect moisturizer-induced changes in leg skin elasticity
using a small panel {Murray & Wickett 1997 ID: 94}. The protocol was as
follows: Subjects used no moisturizer on their outer-calf region and
washed daily with a standard soap for 1 week. After baseline measurements
were taken, the subjects were given an effective moisturizer to use twice
a day for two weeks. A vacuum of 500 mbar and the 2-mm diameter probe
were used for the Cutometer®. Ten mN/m2 torque and a 1-mm ring gap width
were used for the DTM. Both torque-on and torque-off were 10 seconds and
torque-off 10 seconds for each instrument.

The purpose of the study was to compare two very similar moisturizers,
both containing 12% glycerin. Each subject used one product on either the
right or the left leg and the other product on the other leg. After two
weeks of treatment, there was no difference in the effect of the
moisturizers on any of the mechanical parameters or on electrical
measurements taken with the NOVA™ Dermal Phase Meter DPM 9003 (NOVA™
Technology Corp., Gloucester, MA, USA). The data were therefore pooled
for the purpose of comparing the instruments. Figure 4 shows the average
change from pre-treatment baseline after two weeks of treatment for each
of the parameters. We also performed a sensitivity analysis and concluded
that the DTM was more sensitive to moisturizer treatment under the
conditions of this test.

Figure 4: Relative sensitivities of Cutometer and DTM

parameters to moisturizer treatment.
The data in Figure 4 were obtained using a vacuum level of 500 mbar
(Murray and Wickett, 1997). This level was chosen because the results
obtained in our previous study of short-term hydration effects did not
indicate that lower levels of vacuum gave better sensitivity to
hydration. However, long-term moisturization may be different from short-
term water treatment in its effects on stratum corneum elasticity. It is
possible that lower vacuum levels might give better sensitivity in a
long-term test. We tested this hypothesis with a panel of 9 subjects.
After a 1-week dry-out as described above, baseline measurements were
taken on the lower legs. We found that a minimum vacuum level of 200 mbar
was required with the 2-mm diameter probe to be sure of getting a reading
at baseline on dry leg skin. Baseline measurements were taken with the
Cutometer® at 200 and 500 mbar and with the NOVA ™ DPM. Measurements were
repeated 1 hour after treatment with a moisturizer containing 5%
glycerin. At the 1-hour time point, only the DPM showed a significant
hydration effect of moisturizer treatment. The subjects then applied a
moisturizer to one leg four times a day for 1 week and measurements were
repeated 16 hours after the last application of treatment. The results
for the treated legs are shown in Table 1. The p-values were calculated
using a paired t-test against the baseline values for the individual
sites. None of the parameters changed significantly on the untreated
legs.

Table 1. Evaluation of moisturizer effects using the Cutometer at 2

vacuum levels and the NOVA DPM.

Parameter Pre- Post – p-value

Treatment Treatment
DPM 98.8 116.2 0.001

UE (200 mbar) 0.036 0.048 0.02

UE (500 mbar) 0.068 0.079 0.46

UV (200mb) 0.015 0.024 0.07

UV (500mb) 0.025 0.029 0.60

UR (200mb) 0.026 0.039 0.03

UR(500mb) 0.050 0.061 0.26

The 200-mbar vacuum level did indeed lead to more sensitivity in the
test. UE and UR increased significantly even with this small base size and
UV just missed significance. From these data we conclude that using a
lower vacuum level may improve sensitivity to moisturizer-induced changes
in elasticity. In this study UE and UR appeared to be more sensitive to
the moisturizer effect than UV.
Practical considerations for measuring stratum corneum
elasticity
The first consideration in performing in-vivo trials with human subjects
is to ensure that the panelists are comfortable and equilibrated to the
room conditions. We usually control temperature between 20-22 ºC and RH
between 35-45% and allow at least 20 minutes for panelists to equilibrate
while sitting comfortably in a reclining chair. If we are also making
electrical and/or TEWL measurements, as we nearly always are, we take
these measurements before doing mechanical assessments. This is
especially important with the DTM because the DTM probe is affixed to the
skin with double-sided tape.

With the Cutometer we usually take 3 measurements at each treatment site

at baseline and at each measurement period during the study, using 5
seconds on and 5 seconds off time. With the DTM we take only one
measurement because the tape-stripping that occurs with the measurement
leads to small but consistent systematic changes in the values.

As a research tool we believe that the DTM has some advantages over the
Cutometer. It may be more sensitive to moisturization effects (Murray and
Wickett, 1997) and the data can be more easily exported for more detailed
mathematical analysis (He et al., 1999). However, the Cutometer is much
easier to use especially in clinical studies with large numbers of
subjects and does reflect changes in elasticity that occur with
moisturization.

The data in Table 1 above indicate that lower Cutometer vacuum settings
may give more sensitivity to moisturizer effects. In our experience, 200
mbar of negative pressure is a lower practical limit for dry leg studies
because even lower levels may not give any deformation on severely dry-
legs, leading to no measurement. On the forearms or face it may be
practical to use even lower settings to get even more sensitivity to the
stratum corneum. When looking for effects on stratum corneum, we always
use the 2mm diameter probe but when we are looking for effects in the
dermis, for example in evaluating laser surgery, we use the 6mm probe.

Contact pressure is an important variable with virtually all biophysical

measurements that are made with skin contact. With the Cutometer it is
easy to verify that increased contact pressure leads to lower readings
for UE. The spring used in the Cutometer allows fairly good control of
contact pressure but practice is required. It is also important that the
person performing the measurements be blind to the treatment so that they
do not unconsciously influence the measurement through contact pressure.
Whenever possible, the same operator should perform all measurements in
any given study.

Claims from DTM and Cutometer studies:

This paper has focused on the use of the DTM and Cutometer to evaluate
the increase in elasticity that occurs on skin moisturization. Increased
water content in the stratum corneum should make the skin more extensible
and increase UE in particular. This is observed after treatment with
effective moisturizing product over a period of time. Since both the
instruments are deforming the whole stratum corneum, it seems clear that
the elasticity changes measured are occurring throughout the stratum
corneum and represent ‘deep’ moisturization. The observed differences
between ‘moisturization’ and elasticity increases in some cases (Wiechers
and Barlow 1999, Wickett and Murray 1996) may result from the relative
depth sensitivity of the mechanical and electrical measurements. Our
experience is that the electrical measurements may be more sensitive to
surface water and may not always correlation well to elasticity changes
for this reason.
Increases in UR indicate that the skin is storing the energy of the
deformation and using it to return the skin to its initial state. It is
thus more resilient as well as more elastic. In summary, both DTM and
Cutometer measurements can be used to evaluate the effects of
moisturizing products on skin elasticity. The DTM may give more precision
but the Cutometer is definitely easier to use, especially in large
clinical studies.

Appendix

We are often interested in comparing effects of treatments on U E, UV or

UA. However, the Cutometer does not report any of these directly.
Instead, a series of “R” values are reported from the Cutometer curves.
The Cutometer manual states that in mode 2 the parameters as calculated
internally by the software are:

UE = e(0.1)

UF = e(a)

UV = e(a) – e(0.1)

UR = e(a) – e(a+0.1)

UA = e(a) – e(a+b)

R = e(a+b)

Where e(0.1) is the deflection at 0.1 seconds after application of the

vacuum, e(a) is the deflection and the end of the on-time and e(a+b) is
the deflection at the end of the first cycle.

According to the manual the values reported by Cutometer “calculate

results” option are related to the “U” parameters above as follows:

r0 = e(a) = UF

r1 = e(a+b) = R

r2 = UA/UF

r5 = UR/UE

r6 = UV/UE

r7 = UR/UF = UR/r0
To get the “U” parameters from what is reported requires algebra.

r7 = UR/r0 so UR =r7r0

UE = UR/r5 = r7r0/r5

UV = UF – UE = r0 – r7r0/r5

or UV = r6UE = r6r7r0/r5

UA = r2UF = r2r0 or UA = r0 – r1
 Reference List

Agache, P.G. (1995) Twistometry measurement of skin elasticity. In: J.

Serup and G.B.E. Jemec (Eds.), Handbook of Non-invasive Methods and
the Skin. CRC Press, Ann Arbor, p. 319.

Aubert, L., Anthoine, P., de Rigal, J. and Leveque, J.L. (1985) An in

vivo assessment of the biomechanical properties of human skin
modifications under the influence of cosmetic products.
Int.J.Cosmet.Sci 7, 51.

Barel, A.O., Courage, W. and Clarys, P. (1995) Suction method for

measurement of skin mechanical properties: The Cutometer. In: J.
Serup and G.B.E. Jemec (Eds.), Handbook of Non-invasive methods and
the Skin. CRC Press, Ann Arbor, p. 335.

Barel, A.O., Lambrecht, R. and Clarys, P. (1998) Mechanical Function of

the Skin:State of the Art. In: P. Elsner, A.O. Barel, E.
Berardesca, B. Gabard and J. Serup (Eds.), Skin Bioengineering
Techniques and Applications in Dermatology and Cosmetology. Karger,
Basel, p. 69.

Blank, I.H. (1952) Factors which influence the water content of the
stratum corneum. J.Invest.Dermatol. 18, 433.

Christensen, M.S., Hargens, C.W., Nacht, S. and Gans, E.H. (1977)

Viscoelastic properties of intact human skin: instrumentation,
hydration effects, and the contribution of the stratum corneum. J
Invest Dermatol 69, 282.

Cooper, E.R., Missel, P.J., Hannon, D.P. and Albright, G.B. (1985)
Mechanical Properties of dry, normal and glycerol-treated skin as
measured by the gas-bearing electrodynamometer. J.Soc.Cosmet.Chem.
36, 335.

Diridollou, S., Berson, M., Black, D., Gregoire, J.M., Patat, F. and
Gall, Y. (1998a) Subcutaneous fat involvement in skin deformation
following suction. 12th International Society for Bioengineering
and the Skin, Boston MA. (Abstract)

Diridollou, S., Berson, M., Vabre, V., Black, D., Karlsson, B., Auriol,
F., Gregoire, J.M., Yvon, C., Vaillant, L., Gall, Y. and Papat, F.
(1998b) An in vivo method for measuring the mechanical properties
of the skin using ultrasound. Ultrasound in Med & Biol 24, 215.

Gniadecka, M. and Serup, J. (1995) Suction Chamber Method for Measurement

of Skin Mechanical Properties: The Dermaflex. In: J. Serup and G.B.
Jemec (Eds.), Handbook of Non-invasive methods and the Skin. CRC
Press, Ann Arbor, p. 329.
He, M.M., Minematsu, Y., Sakr, A. and Wickett, R.R. (2000) Two-
exponential rheological models that describe skin's response to the
Dermal Torque Meter. Skin Research and Technology Submitted for
publication,

Kitzmiller, W.J., Singer, L., Page, D., Visscher, M. and Wickett, R.R.
(1999) Use of noninvasive biophysical techniques to compare effects
of laser resurfacing and dermabrasion on perioral skin. Skin
Research and Technology 5, 112.(Abstract)

Kitzmiller W, Singer L, Page D, Wickett R, Visscher M. Controlled

evaluation of dermabrasion vs. CO2 resurfacing for the treatment of
perioral wrinkles. Plastic and Reconstructive Surgery, (2000) In
press(November 2000 issue).

Lévêque, J.L. (1984) Physical Methods to measure the efficacy of

cosmetics in humans. Cosmetics and Toiletries 99, 43.

Middleton, J.D. (1974) Development of a skin cream designed to reduce dry

and flaky skin. J.Soc.Cosmet.Chem. 25, 519.

Murray, B.C. and Wickett, R.R. (1996) Sensitivity of cutometer data to

stratum corneum hydration level. Skin Research and Technology 2,
167.

Murray, B.C. and Wickett, R.R. (1997) Correlations between Dermal Torque
Meter, Cutometer and Dermal Phase Meter measurements of human skin.
Skin Research and Technology 3, 101.

Reiger, M.M. and Deem, D.E. (1974a) Skin Moisturizers. I. Methods for
measuring water regain, mechanical properties, and transepidermal
moisture loss of stratum corneum. J.Soc.Cosmet.Chem. 25, 239.

Reiger, M.M. and Deem, D.E. (1974b) Skin Moisturizers. II. The effects of
cosmetic ingredients on human stratum corneum. J.Soc.Cosmet.Chem.
25, 253.

Takahashi, M., Machida, Y. and Tsuda, Y. (1985) The influence of hydroxy

acids on the rheological properties of stratum corneum.
J.Soc.Cosmet.Chem. 36, 177.

Van Duzee, B.F. (1978) The influence of water content, chemical treatment
and temperature on the rheological properties of stratum corneum.
J.Invest.Dermatol. 71, 140.

Warner, R. and Lilly, N. (1994) Correlation of water content with

ultrastructure in the stratum corneum. In: P. Elsner, E. Berardesca
and H.I. Maibach (Eds.), Bioengineering of the Skin: Water and the
Stratum Corneum. CRC Press, Boca Raton, p. 3.

Wickett, R.R. (1987) A review of stratum corneum plasticization

mechanisms. Bioeng.Skin 3, 383.
Wiechers, J.W. and Barlow, T. (1999) Skin moisturization and elasticity
orginate from at least two different mechanisms. Int.J.Cosmet.Sci
21, 425.