Effects of Age, Gender, BMI, and Anatomical Site on Skin Thickness in Children and Adults with Diabetes
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OBJECTIVE: We aimed to assess the effects of age, sex, body mass index (BMI), and anatomical site on skin thickness in children and adults with diabetes. METHODS: We studied 103 otherwise healthy children and adolescents with type 1 diabetes aged 5-19 years, and 140 adults with type 1 and type 2 diabetes aged 20-85 years. The thicknesses of both the dermis and subcutis were assessed using ultrasound with a linear array transducer, on abdominal and thigh skin. RESULTS: There was an age-related thickening of both dermis (p<0.0001) and subcutis (p = 0.013) in children and adolescents. Girls displayed a substantial pubertal increase in subcutis of the thigh (+54%; p = 0.048) and abdomen (+68%; p = 0.009). Adults showed an age-related decrease in dermal (p = 0.021) and subcutis (p = 0.009) thicknesses. Pubertal girls had a thicker subcutis than pubertal boys in both thigh (16.7 vs 7.5 mm; p<0.0001) and abdomen (16.7 vs 8.8 mm; p<0.0001). Men had greater thigh dermal thickness than women (1.89 vs 1.65 mm; p = 0.003), while the subcutis was thicker in women in thigh (21.3 vs 17.9 mm; p = 0.012) and abdomen (17.7 vs 9.8 mm; p<0.0001). In boys, men, and women, both dermis and subcutis were thicker on the abdomen compared to thigh; in girls this was only so for dermal thickness. In both children and adults, the skin (dermis and subcutis) became steadily thicker with increasing BMI (p<0.0001). CONCLUSIONS: Skin thickness is affected by age, pubertal status, gender, BMI, and anatomical site. Such differences may be important when considering appropriate sites for dermal/subcutaneous injections and other transdermal delivery systems.
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Age-related changes, such as decreased vascular compliance, increased arterial stiffness, and thinning of the epidermis, reduce the pulsatility and clarity of the PPG waveform.
“Age-related changes, such as decreased vascular compliance, increased arterial stiffness [18], and thinning of the epidermis [19], reduce the pulsatility and clarity of the PPG waveform.”
From PPG-Based Heart Rate Accuracy in Hispanic Adults with Fitzpatrick III–V Skin Tones: An Evaluation of Body Composition and Skin-Tone Effects (2026) · cites this paper as [19]
The Results (Effects of age, puberty, and gender; page unavailable) report that dermal thickness decreases with age in adults. The Methods say the dermal measurement includes a small contribution from the epidermis, but the paper does not establish that the epidermis itself thins or that thinning reduces PPG waveform pulsatility or clarity. The vascular changes are attached to a different citation. (LLM, conf=0.86)
Experimental — accuracy not yet measuredDermal thickness varies with BMI, ranging from 1.0 mm to over 2.5 mm.
“Dermal thickness variations with BMI is shown to range from 1.0 mm to over 2.5 mm thickness58.”
From Synthetic photoplethysmography (PPG) of the radial artery through parallelized Monte Carlo and its correlation to body mass index (BMI) (2021) · cites this paper as [58]
The thickness of human epidermis is approximately 0.10 mm.
“The thickness of human epidermis is approximately 0.10 mm58,59.”
From Synthetic photoplethysmography (PPG) of the radial artery through parallelized Monte Carlo and its correlation to body mass index (BMI) (2021) · cites this paper as [58]
Skin thickness is directly correlated to BMI and can dampen PPG signal amplitude.
“Perhaps most detrimental to the PPG waveform is skin thickness, as it is directly correlated to BMI and can dampen PPG signal amplitude [56,70].”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [70]
Once adolescence is reached, skin is known to thin as age increases.
“Once adolescence is reached, skin is known to thin as age increases [70,80,81,82].”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [70]
Skin thickness decreases as age increases.
“| Skin thickness | Decrease | Derraik et al., 2014 Van Mulder et al., 2017 Farage et al., 2013 | [70,80,93] |”
From Sources of inaccuracy in photoplethysmography for continuous cardiovascular monitoring (2021) · cites this paper as [70]
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Cites
Body mass index reference curves for the UK, 1990.
Cole, T. J., Freeman, J. V., & Preece, M. A. (1995) · Archives of Disease in Childhood · doi:10.1136/adc.73.1.25 · Cited by 2,063 · see citing works
Sandby-Møller, J., Poulsen, T., & Wulf, H. C. (2003) · Acta Dermato-Venereologica · doi:10.1080/00015550310015419 · Cited by 737 · see citing works
The influence of age and sex on skin thickness, skin collagen and density
SHUSTER, S., BLACK, M. M., & McVITIE, E. (1975) · British Journal of Dermatology · doi:10.1111/j.1365-2133.1975.tb05113.x · Cited by 640 · see citing works
Skin thickness of Korean adults
Lee, Y., & Hwang, K. (2002) · Surgical and Radiologic Anatomy · doi:10.1007/s00276-002-0034-5 · Cited by 475 · see citing works
Mathematical models of skin permeability: An overview
Mitragotri, S., Anissimov, Y. G., Bunge, A. L., Frasch, H. F., Guy, R. H., Hadgraft, J., Kasting, G. B., Lane, M. E., & Roberts, M. S. (2011) · International Journal of Pharmaceutics · doi:10.1016/j.ijpharm.2011.02.023 · Cited by 370 · see citing works
Skin thickness measurement by pulsed ultrasound: its reproducibility, validation and variability
Tan, C. Y., Statham, B. N., Marks, R., & Payne, P. A. (1982) · British Journal of Dermatology · doi:10.1111/j.1365-2133.1982.tb14702.x · Cited by 346 · see citing works
Gibney, M. A., Arce, C. H., Byron, K. J., & Hirsch, L. J. (2010) · Current Medical Research and Opinion · doi:10.1185/03007995.2010.481203 · Cited by 283 · see citing works
Skin Thickness Changes in Normal Aging Skin
Branchet, M., Boisnic, S., Francès, C., & Robert, A. M. (2009) · Gerontology · doi:10.1159/000213172 · Cited by 255 · see citing works
Laurent, A., Mistretta, F., Bottigioli, D., Dahel, K., Goujon, C., Nicolas, J. F., Hennino, A., & Laurent, P. E. (2007) · Vaccine · doi:10.1016/j.vaccine.2007.05.046 · Cited by 235 · see citing works
Effect of dermal thickness, tissue composition, and body site on skin biomechanical properties
Smalls, L. K., Wickett, R. R., & Visscher, M. O. (2006) · Skin Research and Technology · doi:10.1111/j.0909-725x.2006.00135.x · Cited by 192 · see citing works
Cellularity in different regions of adipose tissue in young men and women
Sjöström, L., Smith, U., Krotkiewski, M., & Björntorp, P. A. (1972) · Metabolism · doi:10.1016/0026-0495(72)90109-6 · Cited by 159 · see citing works
Influences of age and sex on abdominal muscle and subcutaneous fat thickness
Kanehisa, H., Miyatani, M., Azuma, K., Kuno, S., & Fukunaga, T. (2004) · European Journal of Applied Physiology · doi:10.1007/s00421-003-1034-9 · Cited by 124 · see citing works
Thickness and Echogenicity of the Skin in Children as Assessed by 20-MHz Ultrasound
Seidenari, S., Giusti, G., Bertoni, L., Magnoni, C., & Pellacani, G. (2000) · Dermatology · doi:10.1159/000018491 · Cited by 114 · see citing works
Skin manifestations of diabetes
van Hattem, S., Bootsma, A. H., & Thio, H. B. (2008) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.75.11.772 · Cited by 113 · see citing works
Wilkinson, S. C., Maas, W., Nielsen, J. B., Greaves, L. C., van de Sandt, J. J. M., & Williams, F. M. (2006) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-005-0056-5 · Cited by 105 · see citing works
Olsen, L. O., Takiwaki, H., & Serup, J. (1995) · Skin Research and Technology · doi:10.1111/j.1600-0846.1995.tb00021.x · Cited by 96 · see citing works
Presti, D. L., Ingegnosi, C., & Strauss, K. W. (2012) · Pediatric Diabetes · doi:10.1111/j.1399-5448.2012.00865.x · Cited by 83 · see citing works
Short needles (8 mm) reduce the risk of intramuscular injections in children with type 1 diabetes.
Tubiana‐Rufi, N., Belarbi, N., Pasquier-Fediaevsky, L. D., Polak, M., Kakou, B., Leridon, L., Hassan, M., & Czernichow, P. (1999) · Diabetes Care · doi:10.2337/diacare.22.10.1621 · Cited by 66 · see citing works
Defining the Ideal Injection Techniques When Using 5-mm Needles in Children and Adults
Hofman, P. L., Derraik, J. G. B., Pinto, T. E., Tregurtha, S., Faherty, A. M., Peart, J. M., Drury, P., Robinson, E., Tehranchi, R., Donsmark, M., et al. (2010) · Diabetes Care · doi:10.2337/dc10-0871 · Cited by 63 · see citing works
Self-citationSkin Heat Dissipation: The Influence of Diabetes, Skin Thickness, and Subcutaneous Fat Thickness
PETROFSKY, J. S., McLellan, K. C. P., Bains, G. S., Prowse, M., Ethiraju, G., Lee, S., Gunda, S., Lohman, E., & Schwab, E. (2008) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2008.0009 · Cited by 60 · see citing works
Distributed Diffusion–Clearance Model for Transient Drug Distribution within the Skin
Kretsos, K., Nitsche, J. M., & Kasting, G. B. (2004) · Journal of Pharmaceutical Sciences · doi:10.1002/jps.20187 · Cited by 58 · see citing works
Burbridge, B. (2007) · PubMed · Cited by 57 · see citing works
Echographic assessment of age‐dependent variations of skin thickness
Lasagni, C., & Seidenari, S. (1995) · Skin Research and Technology · doi:10.1111/j.1600-0846.1995.tb00022.x · Cited by 57 · see citing works
Hofman, P. L., Lawton, S., Peart, J. M., Holt, J., Jefferies, C., Robinson, E. M., & Cutfield, W. S. (2007) · Diabetic Medicine · doi:10.1111/j.1464-5491.2007.02272.x · Cited by 55 · see citing works
Self-citationNauck, M. A., Weber, I., Bach, I., Richter, S., Ørskov, C., Holst, J. J., & Schmiegel, W. (1998) · Diabetic Medicine · doi:10.1002/(sici)1096-9136(1998110)15:11 · Cited by 53 · see citing works
Kivitz, A., & Segurado, O. G. (2007) · Expert Review of Medical Devices · doi:10.1586/17434440.4.2.109 · Cited by 53 · see citing works
Levakov, A., Vučković, N., Djolai, M., Mocko-Kacanski, M., & Bozanic, S. (2012) · Medicinski pregled · doi:10.2298/mpns1206191l · Cited by 43 · see citing works
Subcutaneous or intramuscular insulin injections.
Smith, C. P., Sargent, M. A., Wilson, B. P., et al. (1991) · Archives of Disease in Childhood · doi:10.1136/adc.66.7.879 · Cited by 40 · see citing works
PETROFSKY, J. S., & Lohman, E. (2008) · Cited by 35 · see citing works
Winter, M. D., Londoño, L. A., Berry, C. R., et al. (2013) · Journal of Feline Medicine and Surgery · doi:10.1177/1098612x13499013 · Cited by 33 · see citing works
Ploin, D., Schwarzenbach, F., Dubray, C., Nicolas, J., Goujon, C., Trong, M. D., & Laurent, P. E. (2011) · Vaccine · doi:10.1016/j.vaccine.2011.07.111 · Cited by 28 · see citing works
Roentgenographic Measurement of Skin Thickness in Normal Individuals
Bliznak, J., & Staple, T. W. (1975) · Radiology · doi:10.1148/116.1.55 · Cited by 27 · see citing works
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Fine, J., Branan, K. L., Rodriguez, A. J., Boonya-ananta, T., Ajmal, Ramella-Roman, J. C., McShane, M. J., & Coté, G. L. (2021) · Biosensors · doi:10.3390/bios11040126 · Cited by 348 · see citing works
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Van Mulder, T. J. S., de Koeijer, M., Theeten, H., Willems, D., Van Damme, P., Demolder, M., De Meyer, G., Beyers, K. C. L., & Vankerckhoven, V. (2017) · Vaccine · doi:10.1016/j.vaccine.2016.07.039 · Cited by 89 · see citing works
Ajmal, Boonya-Ananta, T., Rodriguez, A. J., Du Le, V. N., & Ramella-Roman, J. C. (2021) · Biomedical Optics Express · doi:10.1364/boe.439893 · Cited by 79 · see citing works
Boonya-ananta, T., Rodriguez, A. J., Ajmal, A., Du Le, V. N., Hansen, A. K., Hutcheson, J. D., & Ramella-Roman, J. C. (2021) · Scientific Reports · doi:10.1038/s41598-021-82124-4 · Cited by 70 · see citing works
Faggionato, E., Schiavon, M., & Dalla Man, C. (2021) · Metabolites · doi:10.3390/metabo11040235 · Cited by 15 · see citing works
Kostrna, J., Oparina, E., Palacios, C., Rodriguez, A. J., Pei, J., Ajmal, A., & Ramella-Roman, J. C. (2026) · Sensors · doi:10.3390/s26102922 · Cited by 2 · see citing works
- Authors
- Derraik, J. G. B., Rademaker, M., Cutfield, W. S., Pinto, T. E., Tregurtha, S., Faherty, A., Peart, J. M., Drury, P. L., & Hofman, P. L.
- Affiliations
- University of Auckland (NZ)
- Waikato Hospital (NZ)
- Auckland District Health Board (NZ)
- Corresponding author
- Derraik, José G. B.
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-01-21
- Volume
- 9
- Issue
- 1
- Pages
- e86637
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3897752
- OpenAlex
- W2091447598
- Cited by
- 129
- References
- 32
- Citations by year
- 2026: 9 · 2025: 18 · 2024: 19 · 2023: 11 · 2022: 14 · 2021: 14 · 2020: 15 · 2019: 6 · 2018: 5 · 2017: 9 · 2016: 4 · 2015: 3 · 2014: 2
- FWCI
- 6.56
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Funders
- Auckland District Health Board
- Novo Nordisk
- Topics
- Health Sciences › Medicine › Dermatology › Skin Diseases and Diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- skin thickness, dermis, subcutaneous tissue, type 1 diabetes, type 2 diabetes, children and adolescents, age-related changes, puberty, sex differences, body mass index, anatomical site, abdominal skin, thigh skin, injection site selection, transdermal drug delivery
- MeSH terms
- Abdomen, Adolescent, Adult, Aged, Aged, 80 and over, Child, Diabetes Mellitus, Type 1, Female, Humans, Male, Middle Aged, Sex Factors, Thigh, Body Mass Index, Dermis, Subcutaneous Fat, Young Adult
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