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Skin Is Not the Largest Organ

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Skin Is Not the Largest Organ View metadata, citation and similar papers at core.ac.uk brought to you by CORE providedRD by Elsevier Sontheimer - Publisher Connector Skin is Not the Largest Organ 3 content. CHS, JNB, and MAS were involved in Paris, France; Division of Genetics and susceptibility to psoriasis vulgaris. J Invest study supervision. Molecular Medicine, St John’s Institute of Dermatol 134:271–3 Dermatology, Guy’s Hospital, London, UK; Martin MA, Klein TE, Dong BJ et al. (2012) Clinical 1,8 4 Alexander A. Navarini , Guy’s and St Thomas’ NHS Foundation pharmacogenetics implementation consortium Trust, Skin Therapy Research Unit, St John’s Laurence Valeyrie-Allanore2,8, guidelines for HLA-B genotype and abacavir 1 Institute of Dermatology, St Thomas’ Hospital, dosing. Clin Pharmacol Ther 91:734–8 Niovi Setta-Kaffetzi , London, UK; 5King’s College Hospital, London, Jonathan N. Barker1,3,4, UK; 6University Medical Center Freiburg, Navarini AA, Valeyrie-Allanore L, Setta-Kaffetzi N et al. (2013) Rare variations in IL36RN in 1 5 Institute of Medical Biometry and Medical Francesca Capon , Daniel Creamer , severe adverse drug reactions manifesting as 2 6 Informatics, Freiburg, Germany and Jean-Claude Roujeau , Peggy Sekula , 7 acute generalized exanthematous pustulosis. 1 Department of Dermatology, J Invest Dermatol 133:1904–7 Michael A. Simpson , Dokumentationszentrum Schwerer 1 Richard C. Trembath , Hautreaktionen (dZh), Universita¨ts-Hautklinik, Setta-Kaffetzi N, Navarini AA, Patel VM et al. (2013) Maja Mockenhaupt7,8 and Freiburg, Germany Rare pathogenic variants in IL36RN underlie a spectrum of psoriasis-associated 1,3,4,8 8 Catherine H. Smith These authors contributed equally to this work. pustular phenotypes. J Invest Dermatol 133: 1Division of Genetics and Molecular Medicine, E-mail: [email protected] 1366–9 Guy’s Hospital, King’s College, London, UK; Sugiura K, Takemoto A, Yamaguchi M et al. (2013) 2 Department of Dermatology, Referral Center The majority of generalized pustular psoriasis for Toxic and Auto-Immune Blistering Diseases, REFERENCES without psoriasis vulgaris is caused by defi- Henri Mondor Hospital, Assistance Publique Berki D, Mahil SK, David Burden A et al. (2014) ciency of interleukin-36 receptor antagonist. Hoˆpitaux de Paris, Universite´ Paris-Est Cre´teil, Loss of IL36RN function does not confer J Invest Dermatol 133:2514–21 Skin Is Not the Largest Organ Journal of Investigative Dermatology (2014) 134, 581–582; doi:10.1038/jid.2013.335; published online 12 September 2013 TO THE EDITOR text of the abstracts accompanying the body’s weight (Reynolds, 1977). In When scanning the newly published first 20 of those citations revealed that in addition, it has been reported that an literature cited on PubMed/Medline, it 16 (80%) it was specifically stated that average adult male is made up of 42% is almost a weekly occurrence that I the skin is the largest human organ. of skeletal muscle and an average adult see something go by stating that the However, published data simply do female is made up of 36% (as a skin is the largest organ in the human not support the ‘‘common knowledge’’ percentage of body mass; Marieb and body. The problem is that there is no proposition that the skin is the largest Hoehn, 2007). factual basis for this ubiquitous dog- organ in the human body. If one included the subcutaneous fat, matic statement. An earlier analysis of this question by the skin by mass would be a stronger As an example, the editor’s introduc- Goldsmith (1990) eloquently and humo- contender for being the largest organ in tion to the timely and informative rously concluded that the human skin is the human body. However, as its name Review Series on Dermatology that not the largest organ in the human body. implies ‘‘subcutaneous’’ fat is not an appeared in the 1 February 2012 issue By weight, the skin may be considered to official part of the skin. Wikipedia also (volume 122, issue 2) of the Journal of be the largest of the ‘‘medium-sized’’ states that human skin is the largest Clinical Investigation began with the organs such as the liver and brain. How- organ. However, Wikipedia, that fount following sentence ‘‘Though the body’s ever, the skin is no match in weight for the of conventional wisdom, also states that largest organ, the skin may be occasion- much larger organs of the musculoskeletal the skin is composed of the epidermis ally forgotten as a site of clinically system. In such comparisons, clearly the and dermis. It specifies that the hypo- important disease.’’ Similar statements musculoskeletal system must be consi- dermis (subcutaneous tissue) under- have been made in earlier Journal of dered as a human organ system. liestheskinbutisnotpartoftheskin Investigative Dermatology publications Goldsmith’s (1990) assumptions and (http://en.wikipedia.org/wiki/Skin#Hypo authored by prominent dermatology/ calculations resulted in a determination dermis/, accessed 31 May 2013). skin biology investigators (Setoguchi that the human skin (epidermis plus Nor can the skin be considered to be et al., 1994; Bickers and Athar, 2006; dermis) weighs 3.86 kg, or 5.5% of the the largest human organ with respect to Clark et al., 2007). total body weight of the proverbial functional surface area. The human On 31 May 2013, a PubMed search 70 kg man. skin surface area is identical to body using the phrase, ‘‘skin largest organ’’ It has been reported that the skeleton surface area. The body surface area returned 194 citations. A review of the accounts for B14% of the human of the proverbial 70 kg man is 1.7 m2 (Goldsmith, 1990). By comparison, the Accepted article preview online 7 August 2013; published online 12 September 2013 gas exchanging surface of the lung’s www.jidonline.org 581 LA Goldsmith Reply to Sontheimer 2 airways has been estimated to be 70 m CONFLICT OF INTEREST Goldsmith LA (1990) My organ is bigger than your (Notter, 2000), which is approx- The author states no conflict of interest. organ. Arch Dermatol 126:301–2 imately half the size of a tennis court. Richard D. Sontheimer1 Marieb EN, Hoehn K (2007) Human Anatomy & The mucosal surface of the human 1 Physiology. 7th ed. Pearson Benjamin Department of Dermatology, University of Cummings: San Francisco, p317 gastrointestinal tract has been esti- Utah School of Medicine, Salt Lake City, Notter RH (2000) Lung Surfactants: Basic Science mated to be the size of a football field. Utah, USA E-mail: [email protected] and Clinical Applications. Marcel Dekker: Thus, with apologies to all those New York, p120 dermatologists who for so long Reynolds WJ (1977) Skeleton weight allometry in have felt emboldened by the thought REFERENCES acquatic and terrestrial vertebrates. Hydrobio- that theirs is the largest organ, in Bickers DR, Athar M (2006) Oxidative stress in logia 56:35–7 the pathogenesis of skin disease. J Invest neither weight nor functional sur- Setoguchi Y, Jaffe HA, Danel C et al. (1994) Dermatol 126:2565–75 Ex vivo and in vivo gene transfer to the face area can the human skin be con- Clark RA, Ghosh K, Tonnesen MG (2007) Tissue skin using replication-deficient recombinant sidered to be human body’s largest engineering for cutaneous wounds. J Invest adenovirus vectors. J Invest Dermatol 102: organ. Dermatol 127:1018–29 415–21 Reply to Sontheimer Journal of Investigative Dermatology (2014) 134, 582; doi:10.1038/jid.2013.336; published online 12 September 2013 TO THE EDITOR To argue that skin has more sweat To stimulate others to study an organ The following is my response to the glands than any other organ, more that is more than a covering for the letter by Dr Sontheimer (2013) objec- Langerhans cells, more Merkel cells, innards, and to remind the world that ting to the common statement that skin more sebaceous glands, and more hair only scientific advances will solve the is the largest organ in the body. follicles—and is therefore the most daunting problems of those with dis- Short answer: Dr Sontheimer is correct. important organ in the body. eased skin. Long answer: Write a letter to the editor. Write a letter to the editor. To capture attention, make a point, CONFLICT OF INTEREST cop a plea, praise the past, impugn To argue against quoting nonfacts as The author states no conflict of interest. the present, predict the future, posit facts, mistaking rhetoric for science, hypotheses, neatly knit raveled skeins. expecting that public-relations state- 1 Lowell A. Goldsmith Write a letter to the editor. ments morph into research grants, 1 substituting dreams for hard work. Editor Emeritus, Professor Emeritus, Department of Dermatology, University of To lead others to care that Antarctica is Write a letter to the editor. North Carolina at Chapel Hill, Chapel Hill, the second largest land mass and has North Carolina, USA the lowest population density, zero, To express the joy of being quoted E-mail: [email protected] that Macau has the highest population after a quarter century, to praise Dr density, that Manhattan has the highest Sontheimer for bringing the ‘‘biggest REFERENCES density of dermatologists. organ’’ debate to front stage. Sontheimer RD (2014) Skin is not the largest organ. Write a letter to the editor. Write a letter to the editor. J Invest Dermatol 134:581–2 Accepted article preview online 7 August 2013; published online 12 September 2013 582 Journal of Investigative Dermatology (2014), Volume 134.
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