Understanding the biology of adipocytes is important to the progress of lipolysis techniques and the possible usage of adipocytes as stem cells. In addition, various methods for fat removal are being investigated, including drugs or chemicals that can stimulate lipoly- sis (e.g., phosphatedylcholine, isopro- terenal, theophylline, aminophylline, caffeine, carnitine, carbon dioxide, and herbal extracts) and device-assisted liposuction such as ultrasound (to burst fat cells) or 1064 nm Nd:YAG laser (to melt the fat cell). These new methods need to be evaluated for safety and efficacy.
SUMMARY
Adipocytes and subcutaneous tissue are important subjects to which the
BOX 3-2 Hexsel Classification of Cellulitea
• At Stage 0, the skin’s surface is not altered. • At Stage I, skin is smooth when the indi-
vidual is standing or lying down, but some cellulite appears if the skin is pinched. • At Stage II, skin appears dimpled without
any pinching or manipulation. • At Stage III, skin appears both dimpled
and raised in some areas.
aPersonal communication with Doris Hexsel,
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cosmetic dermatologist should pay attention. There are cosmetic concerns related to both excess and loss of fat for which the patient will seek cos- metic intervention. Advances in this field will be centered on more directed therapies of fat removal or disruption in heavy patients and on stem cell purification and injection in thinner patients. It is the role of the cosmetic dermatologist to remain abreast of these changes. Furthermore, cosmetic dermatologists and surgeons should take an active role in counseling patients on proper nutrition and weight management from both extremes (too thin or too heavy).
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T AND THE
SUBCUT
ANEOUS
LA
YER
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C H A P T E R 4
Immunology of
the Skin
H. Ray Jalian, MD
Jenny Kim, MD, PhD
response, on the other hand, occurs slowly and activation of adaptive immune cells, such as B and T cells, requires that receptors undergo gene rearrangements. The adaptive immune system can mount either humoral immunity (B cells, which make antibod- ies) or cell-mediated immunity (T cells). Furthermore, the adaptive immune sys- tem is also responsible for immune memory, which confers long-term pro- tection to the host. Although the two systems appear distinct, they are not separate, and in fact can act synergisti- cally, insofar as the innate immune sys- tem instructs the adaptive immune response and the adaptive immune sys- tem influences the innate system.
In the epidermis, the two main innate cells are the keratinocytes and Langerhans cells. In addition, neutrophils, macro- phages, and dendritic cells present within the dermis also play a role in innate immunity. When a foreign substance is encountered, activation of innate cells occurs through PRRs, including the Toll- like receptors (TLRs), which are reviewed below. Upon activation, the innate cells become capable of inducing a direct antimicrobial response by producing fac- tors that can help protect the host from external insults. These factors include reactive oxygen and nitrogen intermedi- ates (also known as “free radicals”) and antimicrobial peptides. In addition, acti-
vated innate cells produce cytokines and other inflammatory mediators that can instruct adaptive immunity. Paradoxically, the same innate immune response can induce proinflammatory cytokine pro- duction that can lead to inflammation and tissue injury, thereby facilitating dis- ease pathology.