To the Editor.
—I am writing regarding the article in the Jan 22/29 issue of JAMA by Weiss et al.1I enjoyed reading this thought-provoking article on the reversing of aging and sun-damaged skin; however, I found it to be lacking in several areas.
As the authors readily admit, this was not a double-blind study because of the irritation and erythema produced by the test compound. Second, it is difficult to understand how the grading of each parameter was determined. What is the difference between "mild," "moderate," "moderately severe," and "severe"?
The authors did not discuss how the pinkness affects their evaluation of the different types of wrinkling. It is conceivable that excessive erythema could mask fine wrinkling. Furthermore, I wonder how the authors were capable of evaluating clinical edema of the skin accurately. I suspect that minimal dermal edema of the skin would not be obvious even histopathologically.
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