November 12, 1973

Smokers' Wrinkles

Author Affiliations

USN Naval Hospital Philadelphia

JAMA. 1973;226(7):788. doi:10.1001/jama.1973.03230070048018

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To the Editor.—  With reference to Dr. Weiss' comments, our use of "control," we hope, is confusing only to him. We dealt with four major variables: (1) crow's feet (wrinkles), (2) cigarette smoking, (3) actinic exposure, and (4) race.These variables were applied to our patients and were then studied systematically. We submit that in comparing black skin to white skin, regarding ultraviolet light effects, we have a near perfect experimental model. (White unexposed skin affords a control similar to black skin.) Black patients had no crow's feet regardless of how much they smoked or how much actinic exposure they had. This fact cannot be denied. White unexposed skin also showed no wrinkling.Armed with these observations and the knowledge that black skin differs from white only in number, size, and distribution of melanosomes, Dr. Boston notwithstanding, we next sought to understand why respected clinicians could be misled into believing