The effect of age on skin color and color heterogeneity in four ethnic groups

Intradermal Treatment with a Hyaluronic Acid Complex Supplemented with Amino Acids and Antioxidant Vitamins Improves Cutaneous Hydration and Viscoelasticity in Healthy Subjects

Intradermal injection of bioactive compounds is used to reduce the effects of aging skin. The aim of this work is to study the response of facial injection of a hyaluronic acid complex supplemented with amino acids and antioxidant vitamins on skin rejuvenation. A total of 40 healthy adult subjects were recruited to whom this complex was injected into the facial skin, three consecutive times every two weeks. Together with assessing the degree of skin hydration, the level of skin microcirculation, wrinkles, skin color, and skin biomechanical parameters were evaluated. Using the GAIS scale, the degree of satisfaction of the participants was assessed. At 42 days (D42), there was an 11-12% increase in skin hydration and viscoelasticity, a 23% increase in skin density, a 27% increase in skin microcirculation, and a significant lightening and whitening of skin color, but without causing changes in skin wrinkles. A value between 1 and 3 on the GAIS scale was observed between 70 and 92% of the participants, and 87% of subjects found their skin more beautiful, 85% would recommend this treatment, and more than 50% found their face rejuvenated. In summary, the intradermal treatment tested suggests skin rejuvenation, with a good degree of safety.

Association between the three-dimensional facial shape and its color in a boundary group of young to middle-aged Asian women

Visual cues strongly influence an individual's self-esteem and have fundamental sociopsychological functions. The color and shape of the face are important information for visual cues and are hypothesized to be correlated with each other. However, few studies have examined these relationships. Thus, this study determined the association between color and shape of the face. For this purpose, we evaluated Chinese women in their 30s and 40s (n = 166). Three-dimensional (3D) image-capture devices that provide shape morphology along with standardized photographs (color information) were used to obtain 3D images of women. The coordinates and red‒green-blue color data on the 3D images were utilized to perform principal component (PC) analysis, and shape and color PCs were generated. A canonical variate analysis was then conducted to check for significant correlations between the shape and color PCs. As a result, 6 significant correlations were found (p < 0.05). In detail, in addition to the physical correlations (i.e., steric faces or faces with protrusion of the cheek showed greater shadows, retrognathism was related to a shadow under the lower lip and vice versa), biological correlations (fatty faces showed greater redness and remarkable marionette lines; faces with age-related sagging showed greater darkness, possibly related to cumulative ultraviolet radiation exposure of the skin; and robust mandibles and supraorbital ridges were related to thick eyebrows) were found. This insight can aid both medical and cosmetic practitioners in comprehending the intricate details conveyed by facial features, thereby facilitating more comprehensive diagnosis and treatment planning, including makeup.

The relevance and accuracy of an AI algorithm-based descriptor on 23 facial attributes in a diverse female US population

BACKGROUND

The response of AI in situations that mimic real life scenarios is poorly explored in populations of high diversity.

OBJECTIVE

To assess the accuracy and validate the relevance of an automated, algorithm-based analysis geared toward facial attributes devoted to the adornment routines of women.

METHODS

In a cross-sectional study, two diversified groups presenting similar distributions such as age, ancestry, skin phototype, and geographical location was created from the selfie images of 1041 female in a US population. 521 images were analyzed as part of a new training dataset aimed to improve the original algorithm and 520 were aimed to validate the performance of the AI. From a total 23 facial attributes (16 continuous and 7 categorical), all images were analyzed by 24 make-up experts and by the automated descriptor tool.

RESULTS

For all facial attributes, the new and the original automated tool both surpassed the grading of the experts on a diverse population of women. For the 16 continuous attributes, the gradings obtained by the new system strongly correlated with the assessment made by make-up experts (r ≥ 0.80; p < 0.0001) and supported by a low error rate. For the seven categorical attributes, the overall accuracy of the AI-facial descriptor was improved via enrichment of the training dataset. However, some weaker performance in spotting specific facial attributes were noted.

CONCLUSION

In conclusion, the AI-automatic facial descriptor tool was deemed accurate for analysis of facial attributes for diverse women although some skin complexion, eye color, and hair features required some further finetuning.

Diversity of Asian skin: A review on skin biophysical properties

Asian is home to dozens of different ethnic groups that are characterised by fascinating social and cultural variations. Unfortunately, existing literature on the skin properties of Asians tends to group this diverse population solely based on skin colour, perpetuating the misconception and stereotype that all Asian skin is the same. While Asia is one of the largest continents in the world, the difference in the geographical location and climate have long shaped the population into various ethnic groups with significant differences in the collective and diverse customs, traditions, cultures and living habits. The diverse ethnic groups in this region hint us that their skin biophysical characteristics can be very different from each other. This review features the profiling of the distinctive skin biophysical properties of Asians. We learn more about the different ethnic groups in Asia and acknowledge the unique skin biophysical properties even from the same country.

Predictors of female age, health and attractiveness perception from skin feature analysis of digital portraits in five ethnic groups

OBJECTIVE

Research indicates the impact of skin colour, tone evenness and surface topography on ratings of age, health and attractiveness in women. In addition to subjective assessments, these effects have been quantified with objective measures derived from skin image analysis. Signs of skin ageing may manifest differently across ethnic groups. However, comparisons have been limited to research with two ethnic groups, preventing conclusions about an ethnicity-specific ranking of skin ageing signs.

METHODS

We report results from a multi-ethnic and multi-centre study in which faces of women (n = 180; aged 20-69 years) from five ethnic groups were imaged. Facial images were rated for age, health and attractiveness by members of the same ethnic group (each n = 120). Digital image analysis was used to quantify skin colour, gloss, tone evenness and wrinkling/sagging. We assessed associations between face ratings and skin image measurements in the total sample (i.e. all ethnic groups) and separately by ethnicity.

RESULTS

Skin image analysis revealed differences between ethnic groups, including skin colour, gloss, tone evenness, wrinkling and sagging. Differences in the relative predictive utility of individual skin features in accounting for ratings of age, health and attractiveness also were observed between ethnic groups. Facial wrinkling and sagging were the best predictors of face ratings in each ethnic group, with some differences in the type (or predictive magnitude) of skin features.

CONCLUSION

The current findings corroborate previous reports of differences between ethnic groups in female facial skin and indicate differential effects of skin features on ratings of age, health and attractiveness, within and between ethnic groups. Facial wrinkling and sagging were the best predictors of age and attractiveness ratings, and skin tone evenness and gloss had an additional role in ratings of health.

Lip color measurement: A new hyperspectral imaging device

INTRODUCTION

The lips are of significant interest among the facial features for self-perception and social interactions. Such perceptions could rely in part upon the contrast in color between the lips and the surrounding skin. In contrast to skin color, lip color ethnic diversity measurement provides a challenge and is less documented in the literature, most likely due primarily to challenges in measurement based upon the lip characteristics of size and contour. Accurate measurement and reproduction of lip color are essential to build strong cross-sectional knowledge about lip color.

OBJECTIVE

This preliminary experiment of a large-scale project on lip and skin color was designed to assess accuracy in lip color measurement and recommend instruments and protocols for good measurement practice.

METHODS

The study involved 19 healthy French Caucasian women. Their inferior and superior natural lip color was measured twice with three devices in order to extract the standard colorimetric parameters of lightness (L*), chroma (C*), and hue (h): the VISIA-CR® (high-resolution digital camera, Canfield Scientific Inc.); the spectrophotometer VS3200 (45°:0° spectrophotometer, MetaVue™ VS3200, X-Rite Inc.); and the SpectraFace® (new hyperspectral imaging system, Newtone Technologies). The intercomparison and color distribution between the different instruments and the measurement repeatability of each one were assessed.

RESULTS

Our results showed a reliable and equivalent repeatability for the three tested instruments. Moreover, the three tools led to the same conclusion regarding lip color heterogeneity (lighter, redder, less yellow and more saturated inferior lip versus superior lip). Agreement between the SpectraFace® and the spectrophotometer measurements was higher, and the SpectraFace® allowed to identify three separated lip color typologies.

CONCLUSION

In conclusion, the combination of imaging technology and hyperspectral measurement makes the SpectraFace® a useful tool to investigate lip color characterization and establish a large-scale cross-sectional knowledge study about lip color.

Accuracy and clinical relevance of an automated, algorithm-based analysis of facial signs from selfie images of women in the United States of various ages, ancestries and phototypes: A cross-sectional observational study

BACKGROUND

Real-life validation is necessary to ensure our artificial intelligence (AI) skin diagnostic tool is inclusive across a diverse and representative US population of various ages, ancestries and skin phototypes.

OBJECTIVES

To explore the relevance and accuracy of an automated, algorithm-based analysis of facial signs in representative women of different ancestries, ages and phototypes, living in the same country.

METHODS

In a cross-sectional study of selfie images of 1041 US women, algorithm-based analyses of seven facial signs were automatically graded by an AI-based algorithm and by 50 US dermatologists of various profiles (age, gender, ancestry, geographical location). For automated analysis and dermatologist assessment, the same referential skin atlas was used to standardize the grading scales. The average values and their variability were compared with respect to age, ancestry and phototype.

RESULTS

For five signs, the grading obtained by the automated system were strongly correlated with dermatologists' assessments (r ≥ 0.75); cheek skin pores were moderately correlated (r = 0.63) and pigmentation signs, especially for the darkest skin tones, were weakly correlated (r = 0.40) to the dermatologist assessments. Age and ancestry had no effect on the correlations. In many cases, the automated system performed better than the dermatologist-assessed clinical grading due to 0.3-0.5 grading unit differences among the dermatologist panel that were not related to any individual characteristic (e.g. gender, age, ancestry, location). The use of phototypes, as discontinuous categorical variables, is likely a limiting factor in the assessments of grading, whether obtained by automated analysis or clinical assessment of the images.

CONCLUSIONS

The AI-based automatic procedure is accurate and clinically relevant for analysing facial signs in a diverse and inclusive population of US women, as confirmed by a diverse panel of dermatologists, although skin tone requires further improvement.

Epidemiological survey of the quantity and anatomical position of facial pigmented spots in relation to age in 454 Japanese women

Facial pigmented spots are one of the phenotypes of skin aging, but no quantitative analysis of spot features such as color intensity, size, anatomical position, and number on the cheek has yet been performed. In the current study, we conducted an epidemiological survey of 454 Japanese women in their 20s to 70s and analyzed age-related changes and site differences of facial pigmented spots. Using image analysis of high-resolution digital facial photographs, 4912 individual pigmented spots were quantified according to color, size, anatomical position, and total number on the cheek. As a result of color analysis, the color intensity of individual pigmented spots increased with aging, significantly so between ages 30s and 50s. The age-related increase in melanin index of facial spots was confirmed in all sites but did not significantly differ between facial subregions. Regarding the size of pigmented spots, the frequency of large spots increased with age, and large spots were detected in all facial sites. The total number of pigmented spots on the entire cheek increased with aging, significantly so between the 20s and 40s. The number of pigmented spots tended to increase from the region near the canthi to the lower cheeks. The number of spots was markedly increased in the buccal regions compared with the infraorbital and zygomatic regions. The data and methodology presented in the current study can link the state of facial pigmentation with the various factors involved in the histological development of pigmented spots, opening new possibilities in the fields of skin pharmacology and dermatology.

Quantification of perception towards facial skin ideal complexion in multiple ethnic populations from clinical imaging cues

OBJECTIVE

Ideal complexion is a perceptual skin quality that is strongly influenced by cultural and ethnic background. The objectives of this study are to quantitatively characterize skin ideal complexion based on clinical image cues and to compare the perceptions of ideal complexion among multiple ethnicities.

METHODS

Facial images of Indian, Chinese, Caucasian and Latino females collected using VISIA®-CR were presented to naïve panels of the same ethnicity following a two-alternative forced choice design and responses on skin "ideal complexion" were obtained from 336 panelists. Panel perception was transformed logistically (d') and projected onto a continuum (ω) following Bradley-Terry model. Image cues including skin color and unevenness, skin shine and surface smoothness, and pigmentary blotches and spots were computed using image analysis and their relationship with ω were evaluated through multiple regression analysis. A novel skin index namely ideal complexion score (ICS) was developed and correlated against age using linear regression. Finally, ICS was applied to evaluate treatment efficacy of a skin brightening kit on 35 female Caucasian subjects.

RESULTS

Panel perception d' showed statistically significant (p < 0.05) correlation with the contrast of image cues for all ethnic panels (R² = 0.74, 0.76, 0.62 and 0.46 for Indian, Chinese, Caucasian and Latino respectively) and strong correlations between perception ω and linear combinations of image cues were observed (R² > 0.88 for all). Main effects of facial image visual cues on ideal complexion were compared: contrast of skin redness and pigmented spots and visual smoothness were important in determining ICS for all ethnicities; skin color unevenness was more pronounced for Indian and Caucasian; skin lightness was important for Indian and Chinese; skin shine was critical for Chinese and Latino; and skin hue angle ranked higher for Caucasian. Correlations between ICS and age were observed for Indian and Caucasian (R² = 0.55) in which ICS decreased as age increased. Twenty-nine percent improvement on ICS was observed after 12 weeks' treatment using the brightening kit compared to the baseline.

CONCLUSION

Mathematical models were successfully established to describe subjective perception towards skin ideal complexion based on objectively measured image cues for multiple ethnicities.

Facial skin characteristics and concerns in Indonesia: A cross-sectional observational study

BACKGROUND

Facial skin characteristics and appearance vary according to ethnicity. While much of this knowledge is derived from the Caucasian population, lately there have been efforts to gain such understanding in various regions in Asia.  In this paper, we have built an understanding of such features in Indonesia. In Indonesia, a section of females wears a traditional veil (hijab) to cover the scalp and part of face. The influence of the hijab on facial skin attributes was also investigated.

METHODS

In a cross-sectional observational study design involving 419 female volunteers in Jakarta, Indonesia, facial skin attributes (colour, radiance, hydration, trans-epidermal water loss [TEWL], wrinkles, fine lines, pores, and sebum levels) and conditions (melasma, post-inflammatory hyperpigmentation (PIH), solar lentigines/ senile lentigines, seborrheic keratoses and acne) were assessed by trained operators and dermatologists using standard validated instruments and scales.

RESULTS

With age, facial skin colour showed darkening in cheek; forehead on the other hand showed slight lightening. The skin evenness and radiance decreased, substantially. Aging attributes measured in terms of lines, wrinkles, and under-eye dark circles showed deterioration with age; the decline was progressively faster than colour change. Facial image data analysis corroborated these findings. Skin hydration remained similar across the age groups even though the skin barrier function measured in terms of TEWL improved with age. Sebum levels in the skin were similar up to the age of 50 but declined in the next group of 50-60 year. Pore severity increased with age. Melasma, seborrheic keratosis and PIH showed a high prevalence (>∼50%) at the young age group (20-30 years), itself. Melasma prevalence attained 100% in the age group of 41-50 year and onwards, and its severity similarly showed a steady rise with age. PIH on the other hand showed a steady decline with age. Solar lentigines prevalence (∼30%) did not change much across age groups, and the severity scores were similar in age groups up to 50 year but increased substantially in 51-60-year age groups. Seborrheic keratosis was similar (∼47%) in age groups up 20-40 year but steadily increased in upper age groups. Its severity was similar in the age groups of 20-30 year and 31-40 year but showed a two-fold increase in subsequent age groups. Acne was 10% in the age group of 20-30 year and declined gradually to 0.7% in the 51-60-year age group. Hijab wearers showed slight protection in skin colour darkening and improvement of evenness and radiance but were similar on aging (fine lines and wrinkles on crow's feet, under eye and peri-oral areas) markers to non-wearers. In general, in majority of age-groups, hijab wearers showed a higher prevalence of melasma, solar/senile lentigines, seborrheic keratosis and PIH.

Repeatability and reproducibility of a hyperspectral imaging system for in vivo color evaluation

BACKGROUND

Color imaging is a tried and true method for the evaluation of cosmetic and dermatological effects, but it fails to capture all the information in a scene's spectral reflectance. For this reason, there has been in recent years increasing interest in the use of imaging spectrometers for clinical studies and product evaluation.

MATERIAL AND METHODS

We developed a novel HyperSpectral Imager (HSI) able to take in vivo full-face format images as a next generation instrument for skin color measurement and beyond. Here, we report part of the results of our first full-scale validation test of the HSI. We replicated a make-up foundation screening test by applying three products to a panel of 9 models and evaluated the product L^∗ , a^∗ , b^∗ , and ∆E effect immediately after application relative to the bare skin condition. We repeated this test twice in order to study the repeatability of the HSI as an evaluation instrument and during each test two different operators duplicated the data acquisition so we can assess the reproducibility of the measurements.

RESULTS

We find that the measurements from the HSI provide repeatability and reproducibility as good or better than those of our previous benchmark devices.

CONCLUSION

From these results, we conclude that not only is the HSI suitable for use in color evaluation studies, but also that it gives operational advantages over the previous generation of evaluation instruments, as it provides a spectral measurement combined with good spatial resolution. This allows for analysis of color over an area and post hoc selection of study regions and so opens new possibilities for studies of complex in vivo phenomena which neither non-imaging spectrometers nor conventional cameras can pursue. This study also raises points for future work concerning proper inclusion of instrument uncertainty in comparisons of results between instruments and handling of systematic uncertainties from analyses based on a single area.

Automated capillary flow segmentation and mapping for nailfold video capillaroscopy

OBJECTIVE

This study aimed to develop an automated image analysis method for segmentation and mapping of capillary flow dynamics captured using nailfold video capillaroscopy (NVC). Methods were applied to compare capillary flow structures and dynamics between young and middle-aged healthy controls.

METHODS

NVC images were obtained in a resting state, and a region of the vessel in the image was extracted using a conventional U-Net neural network. The approximate length, diameter, and radius of the curvature were calculated automatically. Flow speed and its fluctuation over time were mapped using the Radon transform and frequency spectrum analysis from the kymograph image created along the vessel's centerline.

RESULTS

The diameter of the curve segment (14.4 μm and 13.0 μm) and the interval of two straight segments (13.7 μm and 32.1 μm) of young and middle-aged subjects, respectively, were significantly different. Faster flow was observed in older subjects (0.48 mm/sec) than in younger subjects (0.26 mm/sec). The power spectral analysis revealed a significant correlation between the high-frequency power spectrum and the flow speed.

CONCLUSIONS

The present method allows a spatiotemporal characterization of capillary morphology and flow dynamics with NVC, allowing a wide application such as large-scale health assessment.

Biophysical properties of redness-prone skin in Korean women

BACKGROUND

Facial skin redness can have a negative impact on the quality of life. In this study, we investigated the skin biophysical parameters associated with facial skin redness as a function of aging.

METHODS

Our aims were as follows: (1) to understand the impact of non-pathological facial skin redness on the quality of life of Korean women through a survey; and (2) compare skin biophysical properties between women with and without facial skin redness.

RESULTS

Women aged between 20 and 39 years perceived their own facial skin redness at a higher rate than those aged ≥40 years. In addition, in redness-prone women, the intensity of skin redness and skin surface perfusion were higher, while skin hydration was lower regardless of age. In redness-prone women aged ≥40 years, the values for transepidermal water loss, elasticity, and skin thickness were lower, and the mean pore depth was greater. Facial redness intensity was higher, and the distribution was wider in redness-prone younger women, while only redness intensity increased in the older age group.

CONCLUSIONS

Overall, redness-prone women aged ≥40 years had weaker skin properties. Our study indicated the age-related biophysical characteristics of non-pathological facial skin redness. We believe that our findings will help improve its negative effects.

Modeling the associations between internal body orientation, body appreciation, and intuitive eating among early-adult and middle-adult men and women: A multigroup structural invariance analysis

This cross-sectional study investigated the associations among internal body orientation, body appreciation, intuitive eating, age, and BMI in men and women between 30 and 70 years old as delineated in the acceptance model of intuitive eating. Self-report measures were administered to a final sample of 522 individuals consisting of early-adult men (ages 30-44; n = 153), middle-adult men (ages 45-70; n = 108), early-adult women (ages 30-44; n = 135), and middle-adult women (ages 45-70; n = 126). Overall mean age was 45.03 (SD = 10.95). Structural equation modeling evidenced that, for both age groups of men and women, internal body orientation was positively associated with body appreciation and body appreciation was positively associated with intuitive eating. Internal body orientation was positively associated with intuitive eating in each group, except early-adult women. The associations among age and BMI with the aforementioned variables were inconsistent. Although evidencing measurement non-invariance among a number of parameters, multigroup structural invariance analyses showed that the associations among internal body orientation, body appreciation, intuitive eating, age, and BMI were invariant across each gender and age. These results further confirm components of the acceptance model of intuitive eating among men and women in early-adulthood and middle-adulthood.

Developing an Artificial Intelligence (A.I)-based descriptor of facial appearance that fits with the assessments of makeup experts

OBJECTIVE

To develop an A.I-based automatic descriptor that detects and grades, from selfie pictures, 23 facial signs, hairs included, as a help to making-up procedures.

MATERIAL AND METHODS

The selfie images taken in very different conditions by 3326 women and men were used to create (90% of dataset) and validate (10% of dataset) a new algorithm architecture to appraise and grade 23 different facial signs such as lips, nose, eye color, eyebrows, eyelashes, and hair color as defined by makeup artists. Each selfie image was annotated by 12 experts and defined references to train Artificial Intelligence (A.I)-based algorithm.

RESULTS

As some the 23 signs present a continuous or discontinuous feature, these were analyzed by two different statistical approaches. The results provided by the automatic descriptor system were not only in good agreement with the expert's assessments but were even found of a better precision and reproducibility. This automatic descriptor system has proven a good and robust accuracy despite the very variable conditions in the acquisition of selfie pictures.

CONCLUSION

Such automatic descriptor system seems providing a valuable help in making-up procedures and may extend to other activities such as Skincare or Haircare. As such it should allow large investigations to better evaluate the consumers' needs of esthetical improvements.

Statistical analysis of age-related skin parameters

BACKGROUND

Due to the increasing interest in human anti-aging, demand for a higher quality of life, and technological advancement, the development of anti-aging skincare has great market prospects. Most cosmetic companies develop products driven by the market or focus on the mechanism of action of substances and the behavior of skin; however, little research utilizes skin parameters and large data methodology to develop skincare products.

OBJECTIVE

To instruct consumers to purchase skincare products and to guide skincare research toward the development of customer-targeted products.

METHODS

A total of 815 Chinese subjects (83 male; 732 female) from five different cities were included. We measured 14 indices in each subject, including moisture, transepidermal water loss (TEWL), and sebum levels. We performed multiple regression analysis to understand the relationship between skin indices and aging; a novel approach is shown using the R software.

RESULTS

The exact age at which changes in each skin index occurred could be demonstrated by this method of analysis: 39, 38, 48, 46, and 56 years old with respect to the L value, Melanin, Rt, Rm, and Rz, respectively.

CONCLUSION

With the use of statistical analysis, consumers can be more efficiently targeted and choose suitable products considering particular skin parameter changing points; thus, skincare companies will not only meet customer requirements but also better control budgets.

The Skin Interactome: A Holistic "Genome-Microbiome-Exposome" Approach to Understand and Modulate Skin Health and Aging

Higher demands on skin care cosmetic products for strong performance drive intense research to understand the mechanisms of skin aging and design strategies to improve overall skin health. Today we know that our needs and influencers of skin health and skin aging change throughout our life journey due to both extrinsic factors, such as environmental factors and lifestyle factors, as well as our intrinsic factors. Furthermore, we need to consider our microflora, a collection of micro-organisms such as bacteria, viruses, and fungi, which is a living ecosystem in our gut and on our skin, that can have a major impact on our health. Here, we are viewing a holistic approach to understand the collective effect of the key influencers of skin health and skin aging both reviewing how each of them impact the skin, but more importantly to identify molecular conjunction pathways of these different factors in order to get a better understanding of the integrated “genome-microbiome-exposome” effect. For this purpose and in order to translate molecularly the impact of the key influencers of skin health and skin aging, we built a digital model based on system biology using different bioinformatics tools. This model is considering both the positive and negative impact of our genome (genes, age/gender), exposome: external (sun, pollution, climate) and lifestyle factors (sleep, stress, exercise, nutrition, skin care routine), as well as the role of our skin microbiome, and allowed us in a first application to evaluate the effect of the genome in the synthesis of collagen in the skin and the determination of a suitable target for boosting pro-collagen synthesis. In conclusion, we have, through our digital holistic approach, defined the skin interactome concept, as an advanced tool to better understand the molecular genesis of skin aging and further develop a strategy to balance the influence of the exposome and microbiome to protect, prevent, and delay the appearance of skin aging signs and preserve good skin health condition. In addition, this model will aid in identifying and optimizing skin treatment options based on external triggers, as well as helping to design optimal treatments modulating the intrinsic pathways.

The Interaction of Age and Anatomical Region Influenced Skin Biophysical Characteristics of Chinese Women

BACKGROUND

Ageing is an inevitable physiology process of humans, and skin biophysical parameters change owing to genetic and environmental factors in different ethnic populations.

AIM

To gain comprehensive data on the skin biophysical parameters of different anatomical regions and to explore the change trend of the skin characteristics associated with age for the indicated regions by generalized additive model.

METHODS

We measured various skin biophysical parameters on forehead, cheek, chin and inner forearm of 178 Chinese women aged between 20 and 64 years living in Beijing. These parameters comprised skin hydration, transepidermal water loss (TEWL), sebum content, erythema index (EI), melanin index (MI), L*a*b* values, individual typology angle (ITA) and pH, which were quantified by non-invasive instruments.

RESULTS

Comparing the skin parameters among the four test areas, we observed that the hydration, TEWL, EI and a* values were significantly higher for the face than for the forearm, but the L* and ITA values were just the opposite. The cheek was the lightest and brightest region with lowest sebum content, while the chin was much darker and the forehead was yellowish. Considering the change of the skin parameters with age, TEWL, sebum content and melanin and erythema indices had a linear relationship with age, whereas skin hydration, L, a, b, ITA and pH values exhibited a non-monotonic relationship. The turning points of these curves appeared almost at the thirties, showing the lightest and evenest skin color and more hydration, with lower pH values.

CONCLUSION

This study indicates that the skin biophysical characteristics of Chinese women were significantly affected by age and body regions.

Changes in the eye contour signs due to age among Mexican women: Comparison with women of other ethnic origins

OBJECTIVE

To evaluate the changes in certain ocular signs because of age, among Mexican women and to compare these with those previously obtained on women of other ethnicities.

MATERIAL AND METHODS

Photographs were taken of the faces of 203 Mexican women of different ages, under standardized conditions. These photographs allowed us to focus and define nine ocular signs, which were then graded by 15 experts and dermatologists, using standardized scales provided by a reference Skin Aging Atlas. Hence, the same protocol, previously used on 3240 women of four other ethnic origins (Caucasian: 600; Chinese: 990; Japanese: 1010; Indian: 300; African: 340), allowed us to compare the results obtained on Mexican women.

RESULTS

The severity of crow's feet wrinkles for Mexican women shows a more intense progression with age than those of women from other ancestries. The lower eyelid wrinkles of Mexican women, that show weak or erratic changes with time, were however found to have higher and significant severity at a young age. Pigmentation disorders of their ocular area were found less pronounced as compared to those of Asian or Indian women. Eye bags were observed with similar slight changes in all five ancestries.

CONCLUSION

The present work confirms that the clinical signs of age for the female eye area develop differently depending on the ethnic origins of the volunteer.

The effect of air pollution on the skin colour and tone of Chinese women: A multicentre cohort study

BACKGROUND

Overall facial skin colour is an important sign of perceived health and attractiveness, is predetermined by genetic factors, and is influenced by cultural and living habits, ultraviolet (UV) exposure, climate/seasons and ageing. The objective of this study was to determine the impact of pollution on the skin colour of Chinese women.

MATERIALS AND METHODS

A total of 203 Chinese women between 20 and 59 years of age participated in the study and were selected from two cities with different levels of air pollution. Skin colour (L*, a* and b* values), melanin and haemoglobin levels were measured at three sites: the cheek, eye and inner upper arm. Measurements of the inner upper arm were taken as this area of skin was exposed to air pollutants but had minimal exposure to UV light.

RESULTS

There were significant differences in skin chromophores between Chinese women living in two different cities with different levels of pollution. The b* value (yellowness) was higher in the eye and cheek region, and the a* value (redness) was lower in the cheek and arm region for women in the moderately polluted city. The melanin index was significantly higher, and the haemoglobin level was lower for the eye region for women living in the city with a higher level of air pollution.

CONCLUSION

This study has shown that air pollution may negatively affect the skin colour of Chinese women.

Objective measurement and comparison of human facial skin color in East Asian females

BACKGROUND

Skin color is an important physiological index of human skin that has essential significance in cosmetology and dermatological diagnoses and aesthetics, especially in East Asian culture, where the beauty standard is the whiter the skin, the more beautiful a person is. However, there has been a lack of objective comparisons of facial skin color in East Asian females.

MATERIALS AND METHODS

Skin color at the cheek site was measured in 445 healthy females, including 362 Chinese women in Beijing and 83 Japanese women in Tokyo, all aged 18-50 years. The parameters consisted of L^* , a^* , b^* , individual typology angle (ITA°), and hue angle and were determined using noninvasive skin measurement instruments.

RESULTS

The skin color categories in East Asians ranged from very light (I) to brown (V), and the dark (VI) category was not observed; the main categories were light (II), intermediate (III), and tan (IV). The facial skin color of Chinese individuals was brighter, more reddish, and less yellowish than that of Japanese individuals. With age, L* values decreased, and a* values and hue angle increased in East Asians with significant differences. Chinese women showed the same differences as Japanese women for all parameters in all age groups.

CONCLUSIONS

This study provides objective skin color measurements and examines significant differences with respect to geographic location and age.

Reconstructed Skin Models Revealed Unexpected Differences in Epidermal African and Caucasian Skin

Clinical observations of both normal and pathological skin have shown that there is a heterogeneity based on the skin origin type. Beside external factors, intrinsic differences in skin cells could be a central element to determine skin types. This study aimed to understand the in vitro behaviour of epidermal cells of African and Caucasian skin types in the context of 3D reconstructed skin. Full-thickness skin models were constructed with site matched human keratinocytes and papillary fibroblasts to investigate potential skin type related differences. We report that reconstructed skin epidermis exhibited remarkable differences regarding stratification and differentiation according to skin types, as demonstrated by histological appearance, gene expression analysed by DNA microarray and quantitative proteomic analysis. Signalling pathways and processes related to terminal differentiation and lipid/ceramide metabolism were up-regulated in epidermis constructed with keratinocytes from Caucasian skin type when compared to that of keratinocytes from African skin type. Specifically, the expression of proteins involved in the processing of filaggrins was found different between skin models. Overall, we show unexpected differences in epidermal morphogenesis and differentiation between keratinocytes of Caucasian and African skin types in in vitro reconstructed skin containing papillary fibroblasts that could explain the differences in ethnic related skin behaviour.

Ageing profiles of Caucasian and Chinese cohorts - focus on hands skin

OBJECTIVE

In spite of hand care being a dynamic segment of skin care, hands skin physiology has been receiving little attention in comparison to facial skin. In the present study, we aimed at gathering a comprehensive set of skin data from the dorsal part of the hand to study age related-changes in two ethnic groups (Caucasian and Chinese).

METHODS

Skin topographic, skin colour/colour heterogeneities, skin chromophores and skin biophysical measurements of 116 Caucasian and Chinese female volunteers aged 30-65 years old were collected in Ireland and in China as part of a cross-sectional study.

RESULTS

Topographic alterations happened at both micro and macro scales with a noticeable delay in the onset of 10 years for the Chinese cohort. Similar evolution of skin colour with ageing was observed between the two cohorts and strong dissimilarities were seen when it came to colour heterogeneities and melanin hyper concentration, with a 20-year delay in severity for the Chinese cohort. A similar sharp drop of skin hydration occurred when reaching the 60's regardless of the group and substantial differences were recorded for skin biomechanical properties of the skin.

CONCLUSION

These results provide additional insights about hand skin physiology in relation to ageing and ethnic differences, especially when put into perspective with what is currently known about facial ageing. This research yield additional material for hand cream product rationale and strategies for mitigating the appearance of ageing hands.

Effective melanin degradation by a synergistic laccase-peroxidase enzyme complex for skin whitening and other practical applications

Melanin is major cause of dark skin, which is regarded as social status in eastern Asia. As a result, researchers in cosmetic industries are developing skin whitening agents. Melanin can be decolorized by many oxidative enzymes. Laccase (CueO) from Escherichia coli and dye-decolorizing peroxidase (DyP) from Bacillus subtilis were merged with the dockerin domain of endoglucanase B from Clostridium cellulovorans. Scaffoldin has great potential to exert structural benefits that enable complementary enzyme effects. The carbohydrate binding module (CBM) in scaffoldin was replaced with the melanin binding peptide (MBP) to increase melanin binding and thereby enhance melanin degradation. The modified scaffoldin exhibits a nearly 64% increase in specific binding to melanin over that of the native scaffoldin. Laccase was used to degrade melanin via the production of hydrogen peroxide, which produced synergistic activity with peroxidase. The activity of the optimized complex was approximately 6.4-fold greater than that of laccase alone. This enzyme complex can also reduce the number of melanin granules in corneocytes. Based on these results, a recombinant enzyme complex is suitable for use in melanin degradation by next generation whitening agents in the skin cosmetics industry.

Appearance of aging signs in differently pigmented facial skin by a novel imaging system

Background

Facial wrinkles, pores, and uneven skin tone are major beauty concerns. There is differential manifestation of aging signs in different ethnic groups. In this regard, studies on Black Africans from the African continent are scarce.

Objective

To investigate facial wrinkles, pores, and skin tone in Black African women from Mauritius Island and elucidate the differences to Caucasian women from France.

Methods

Facial images were taken using the imaging system ColorFace^®. Wrinkles and pores were measured by their length, depth, surface, volume, and number; for skin tone, we measured L*a*b* and calculated ITA, IWA_Newtone, and color homogeneity.

Results

We found good correlations of wrinkle and pore scores with expert ranking done on ColorFace^® images for Caucasians (Spearman's rho = 0.78 and 0.72) and Black Africans (Spearman's rho = 0.86 and 0.65). Caucasians showed more advanced facial signs of aging than Black Africans. Exceptions were vertical lines on upper lip and the depth of pores which were greatest for the Black African subjects. Black Africans had higher heterogeneity scores indicative for uneven skin tone. Luminance (L*) was significantly higher in Caucasians but a* and b* values were significantly higher in the Black African subjects. ITA and IWA_Newtone were significantly higher for Caucasians.

Conclusions

The high correlation between expert ranking and wrinkle and pore measurements prove ColorFace^® a valid imaging system to study skin aging. Our results show that Africans from the African continent show delayed signs of aging compared to Caucasians. Some exceptions suggest that ethnic differences in facial aging are a complex phenomenon.

Characteristic features of neck skin aging in Chinese women

INTRODUCTION

Neck skin aging is of particular interest to skin scientists and dermatologists because of the increasing demand for neck wrinkle improvement. This study aimed to determine the neck aging features of Chinese women and to investigate the clinical alterations and mechanical, topographical, and biophysical properties of neck skin.

METHODS

A total of 450 Chinese women (age range: 16-66 years) were clinically examined and graded by the same dermatologist using standardized photographs. The skin properties were assessed by noninvasive skin measuring devices.

RESULTS

The results showed that different neck aging signs, including the horizontal neck fold, neck sagging, hollowing of emaciated neck, platysmal bands, and neck texture, appeared in different ages, and all of them worsened age-dependently since they manifested. The skin elasticity markedly changed before the onset of most of the aging signs and showed a negative correlation with both age and the severity of these signs. Transepidermal water loss (TEWL) was positively correlated with age, whereas hydration and pH were not significantly correlated with age. We also found that wrinkles (SEw) and average roughness (Ra) were significantly correlated with age. SEw, smoothness, the average depth of roughness (Rz), TEWL, and erythema index were significantly and positively correlated with the severity of the horizontal neck fold, neck sagging, hollowing of emaciated neck, and platysmal bands.

CONCLUSION

This is the first study to emphasize that age causes diverse changes in Chinese women's neck skin. The changes in skin elasticity may effectively predict neck aging before the onset of most of the neck aging signs.

An updated review of clinical methods in the assessment of ageing skin - New perspectives and evaluation for claims support

With the advancement of skin research, today's consumer has increased access to an informed understanding of ageing skin and its appendages, together with a plethora of targeted products to meet such needs. In recent years, increased legislative demands for quality evidential claims support have led not only to the development and validation of clinical methods to measure and quantify ageing skin, but also a clearer understanding of the skin ageing process-especially the impact of both its internal and external environments-as well as a tougher stance on clearly unjustifiable claims. Traditional testing methods used to research and evaluate anti-ageing products claim to employ sophisticated instruments. Today, however, since the term anti-ageing can be considered a misnomer, intelligent use of combined more advanced clinical methods has enabled the development of technologically improved consumer products providing enhanced efficacy and targeted performance. Non-invasive methods for the assessment and quantification of the causes of ageing skin provide tools to the clinical researcher as defined by key clinically observed ageing parameters. Where evidence requires additional support, a number of clinical procedures evaluating ageing skin and hair products are combined with invasive procedures, thus enabling an added value to product claims. As discussed herein, given the enhanced understanding of ageing, we provide an update to our previous reviews of clinical methods used in the assessment of skin ageing, to include the wider aspects of environmental exposure; skin pigmentation; microbiome disturbance; surface topography; colour, radiance, and pH; and structural integrity-all requiring a disciplined approach to their use in dermatological investigations and product claims evidence.

Personalized skincare: from molecular basis to clinical and commercial applications

Individual responses of human skin to the environmental stress are determined by differences in the anatomy and physiology that are closely linked to the genetic characteristics such as pigmentation. Ethnic skin phenotypes can be distinguished based on defined genotypic traits, structural organization and compartmentalized sensitivity to distinct extrinsic aging factors. These differences are not only responsible for the variation in skin performance after exposure to damaging conditions, but can also affect the mechanisms of drug absorption, sensitization and other longer term effects. The unique characteristics of the individual skin function and, particularly, of the ethnic skin type are currently considered to shape the future of clinical and pharmacologic interventions as a basis for personalized skincare. Individual approaches to skincare render a novel and actively growing area with a range of biomedical and commercial applications within cosmetics industry. In this review, we summarize the aspects of the molecular and clinical manifestations of the environmental stress on human skin and proposed protective mechanisms that are linked to ethnic differences and pathophysiology of extrinsic skin aging. We subsequently discuss the possible applications and translation of this knowledge into personalized skincare.

Visible-Near Infrared Spectroscopic Assessment of Urogenital Tissue in Premenopausal and Postmenopausal Women

BACKGROUND

A clinical study was conducted to evaluate the feasibility of using visible and near-infrared (NIR) spectroscopy as a potential noninvasive measure of genital skin health in premenopausal and postmenopausal women.

METHODS

A total of 45 female subjects (aged 21-70 years), all of whom gave fully informed consent to participate, were enrolled in the study and assigned to 1 of 3 groups: 15 premenopausal (Pre-M), 15 postmenopausal receiving hormone replacement therapy (Post-M HRT), and 15 postmenopausal receiving no form of hormone replacement therapy (Post-M non-HRT). Spectral measurements were taken at the vaginal mucosa, and spectral data were evaluated for the erythema index (EI), hemoglobin index (HI), bilirubin/β-carotene, and melanin. The color index (CI; calculated as the ratio of absorbance at 480 nm/540 nm) was also determined. Results were compared with previously published results on biomarkers and physical characteristic of genital tissue measured on the same groups of women.

RESULTS

Spectral measurements from the Post-M Non-HRT subjects indicated a significant reduction in HI compared with the Pre-M group (P = .0003) and to the Post-M HRT group (P < .0001). Similarly, EI was reduced in the Post-M Non-HRT (P < .0001 and P = .0041 for the Pre-M and Post-M HRT groups, respectively). In contrast, the Post-M Non-HRT subjects exhibited a significant increase in β-carotene compared with the Pre-M subjects (P = .0098). Bilirubin and melanin were not significantly affected. The Post-M Non-HRT group exhibited a significant increase in CI, indicating a shift away from the hemoglobin absorption region (510-620 nm wavelength) and toward the bilirubin/β-carotene absorption region (450-490 nm wavelength). This change was significant when compared with both the Pre-M group (P < .0001) and the Post-M HRT group (P = .0048). The changes in spectral measurements were consistent with previously reported changes in physical parameters (vaginal atrophy, increased pH, decreased skin temperature) and with decreased concentrations of the biomarkers histamine and histidine.

CONCLUSIONS

Hemodynamic spectral characteristics differ in postmenopausal vaginal tissue compared with tissue in premenopausal women, with decreased absorbance in the hemoglobin absorption region (510-620 nm wavelength) and an increased absorbance in the bilirubin/β-carotene absorption region (450-490 nm wavelength). A change in absorbance in the visible and NIR wavelengths is a promising, additional measure of genital skin health related to menopause and vulvovaginal atrophy.

Differences in Complexion between Cold- and Heat-Prescription Groups in Sasang Medicine

Sasang constitutional medicine (SCM) is a type of traditional Korean medicine (TKM) that classifies the human constitution into four types. The appearance of the complexion is one of the diagnostic factors of SCM but is rarely used in a quantitative and objective manner for diagnosis. In this study, an analysis using actual clinical data was conducted to assess the use of the complexion as a diagnostic element. A total of 528 Sasang medicine prescriptions from Korea Constitutional Multicenter Bank (KCMB) were classified into either a Cold-prescription group or a Heat-prescription group, and the complexion differences of the patients were analyzed using the L^⁎a^⁎b^⁎ color space. After adjusting for age, BMI, and systolic blood pressure, significant differences were observed among the Cold- and Heat-prescription groups within each Sasang constitution. However, when the Sasang constitution was ignored, no significant difference was observed for either sex. This study quantitatively analyzed the complexion of patients, which is used as a diagnostic element in clinical practice. It is hoped that the results will contribute to objective medical treatments in the future, such as determining an appropriate herbal prescription based on the patient's complexion.

Relationship between skin color and solar elastosis in aged Asian skin: A colorimetric-pathologic correlation

Aged skin is reported to be associated with unattractive skin color changes and solar elastosis. However, comparative studies have not documented the possible correlation between the two factors. This study investigated the plausible relationship between the facial skin color of elderly Asians and solar elastosis. A total of 22 skin specimens were collected from 22 Korean patients who underwent cheek skin biopsies. Skin color was quantitatively measured using colorimetric photography techniques to produce CIE L*a*b* values; the degree of solar elastosis was quantifiably assessed using a histologic grading scale. These values were used to investigate a correlation between the CIE L*a*b* coordinates and solar elastosis grade. The solar elastosis grade increased according to patient age (r = 0.67, p = .0006). However, the extent of solar elastosis was not statistically correlated with the CIE L*a*b* values, including L*, a*, and b* (r = 0.02, p = .95; r = 0.15, p = 0.50; r = -0.07, p = 0.76, respectively). The results showed that the solar elastosis grade increased, according to patient age, because of cumulative actinic damage. However, colorimetric skin color data did not correlate with the degree of solar elastosis. Therefore, cutaneous color changes and solar elastosis are separate, age-related phenomena. Physicians should be aware of the possible histologic changes in actinically damaged facial skin, regardless of the skin color.

Carbonylated proteins exposed to UVA and to blue light generate reactive oxygen species through a type I photosensitizing reaction

BACKGROUND

Carbonylated proteins (CPs) are generated by the reaction of basic amino acid residues in proteins with aldehyde compounds produced during lipid peroxidation. CPs in the stratum corneum (SC) impact skin conditions such as skin moisture functions including water content and transepidermal water loss (TEWL). In addition, CPs can be frequently seen in the SC from sun-exposed sites compared with sun-protected sites.

OBJECTIVE

The aim of this study was to reveal whether CPs could be a generation source of reactive oxygen species (ROS) in the SC following exposure to ultraviolet (UV) radiation and to identify the type of ROS and its generation mechanism.

METHODS

ROS generation was detected using a methyl cypridina luciferin analog (MCLA) chemiluminescence system and an ESR spin-trapping method. CPs in porcine SC, in a keratin film and in bovine serum albumin (BSA) were prepared by reaction with acrolein. Levels of protein carbonylation were quantified by detecting aldehyde residues.

RESULTS

CP levels in the SC were increased in a UVA energy-dependent manner. That result suggested that a source of ROS generation existed in the SC initiated and produced the carbonylation of SC proteins. Carbonylated BSA and carbonylated porcine SC sheets exhibited fluorescence spectra at an excitation wavelength of 430nm and an emission wavelength of 520nm. Irradiation of the SC with UVA increased protein carbonylation and the amount of autofluorescence in the SC. ROS generation in the SC caused by UVA and by short-wavelength visible light (blue light, 400-470nm) was detected by the MCLA chemiluminescence system. Artificially carbonylated porcine SCs and keratin films had increases of chemiluminescence intensity after exposure to both light sources as well. The addition of superoxide dismutase to the MCLA system completely abolished the incremental chemiluminescence intensity after both UVA and blue light exposure of the SC. In addition, acrolein-treated BSA gave ESR signals like hydroxyl radicals (OH) converted from superoxide anion radicals (O₂^-) during irradiation with a xenon arc lamp containing UVA and visible light. From the sum of these results, we consider that CPs are produced from O₂^- initially generated from exposure to UVA and blue light.

CONCLUSION

CPs are excited by absorbing sunlight, particularly UVA and blue light, and result in the generation of O₂^- through a CPs progress new protein carbonylation in stratum corneum through ROS generation. photosensitizing reaction. Further, the results suggest that the O₂^- produces CPs in the SC through lipid peroxidation in the sebum, and finally affects skin conditions including color and moisture functions.

Characterizing facial skin ageing in humans: disentangling extrinsic from intrinsic biological phenomena

Facial skin ageing is caused by intrinsic and extrinsic mechanisms. Intrinsic ageing is highly related to chronological age. Age related skin changes can be measured using clinical and biophysical methods. The aim of this study was to evaluate whether and how clinical characteristics and biophysical parameters are associated with each other with and without adjustment for chronological age. Twenty-four female subjects of three age groups were enrolled. Clinical assessments (global facial skin ageing, wrinkling, and sagging), and biophysical measurements (roughness, colour, skin elasticity, and barrier function) were conducted at both upper cheeks. Pearson's correlations and linear regression models adjusted for age were calculated. Most of the measured parameters were correlated with chronological age (e.g., association with wrinkle score, r = 0.901) and with each other (e.g., residual skin deformation and wrinkle score, r = 0.606). After statistical adjustment for age, only few associations remained (e.g., mean roughness (R z ) and luminance (L (*)),  β = -0.507, R (2) = 0.377). Chronological age as surrogate marker for intrinsic ageing has the most important influence on most facial skin ageing signs. Changes in skin elasticity, wrinkling, sagging, and yellowness seem to be caused by additional extrinsic ageing.

Periocular skin hyperpigmentation in children treated with prostaglandin analogues

PURPOSE

To report periocular skin hyperpigmentation related to prostaglandin analogue (PGA) use in children with glaucoma.

METHODS

This cross-sectional study examined children treated with PGA for at least 6 months between June 2013 and December 2013. The pigmentation scores of the upper eyelids, lower eyelids and cheek were recorded with a chromameter. Hyperpigmentation was defined as a positive difference in scores between the cheek and the upper/lower eyelid. The influence of age, baseline skin pigmentation, duration of PGA, type of PGA and mono- or multitherapy on hyperpigmentation were evaluated. Subjective grading of pigmentation on standardized face photographs and the parent's perception of hyperpigmentation were also recorded. A P value of <0.05 was considered significant.

RESULT

A total of 55 patients were included. Hyperpigmentation of the upper and lower eyelids occurred in all eyes. Subjectively, 26 (47%) eyes had mild and 14 (26%) moderate hyperpigmentation. The upper eyelid showed significantly greater hyperpigmentation than the lower eyelid (P = 0.00004). Chromameter measurements overlapped with pigmentation grading on photographs. The type of and duration of PGA use, PGA mono- or multidrug therapy or baseline skin pigmentation had no effect on the grade of hyperpigmentation.

CONCLUSIONS

PGA use for more than 6 months was associated with periocular skin hyperpigmentation that was greater in the upper eyelid versus lower eyelid. All variables examined failed to show a relationship with the grade of hyperpigmentation.

The relationship between skin aging and steady state ultraweak photon emission as an indicator of skin oxidative stress in vivo

BACKGROUND/PURPOSE

Ultraweak photon emission (UPE) is one potential method to evaluate the oxidative status of the skin in vivo. However, little is known about how the daily oxidative stress of the skin is related to skin aging-related alterations in vivo. We characterized the steady state UPE and performed a skin survey.

METHODS

We evaluated the skin oxidative status by UPE, skin elasticity, epidermal thickness and skin color on the inner upper arm, the outer forearm, and the buttock of 70 Japanese volunteers.

RESULTS

The steady state UPE at the three skin sites increased with age. Correlation analysis revealed that the steady state UPE only from the buttock was related to skin elasticity, which showed age-dependent changes. Moreover, analysis by age group indicated that b* values of the inner upper arm of subjects in their 20s were inversely correlated with UPE as occurred in buttock skin. In contrast, photoaged skin did not show a clear relationship with steady state UPE because the accumulation of sun-exposure might influence the sensitivity to oxidative stress.

CONCLUSION

These results suggest that steady state UPE reflects not only intrinsic skin aging and cutaneous color but also the current oxidative status independent of skin aging.