The skincare market includes cosmetic products designed for the care and protection of the skin. This definition covers all types of creams and lotions for face, body, hand, and foot care as well as sunscreen and baby and child skincare products. The skincare industry is part of the beauty and personal care segment.

Compared to the make-up segment, skincare was resilient during the Covid-19 crisis. During this period, the market only suffered a change in its revenue of -6% change compared to the cosmetics sector where we observed a change in revenue of -20%. During the various lockdowns, consumers prioritized self-care over glam and invested more in their skincare routine than their makeup. The emphasis is now put on the inner self, authenticity, and wellness. Consumer habits shifted in terms of beauty and personal care and this new way of consuming beauty products is here to stay. The rise of hybrid make-up is further illustrating this new trend.

Globally, the skincare market generated 144 billion USD in 2022. And is forecasted to reach 186 billion USD in 2028. Among beauty and care revenues, skincare is the second most important segment after personal care. The segment represents 27% of the revenue within this category. Within the skincare sector, facial products generate the most revenue with 100 billion USD in revenue in 2022.

Worldwide, the biggest markets for the skin care industry in 2022, regarding total generated revenues, were the United States, Japan, China, India, and South Korea. The United States, China, and India are part of this ranking thanks to their substantial population. But also because of their population’s disposable income. The United States has higher income earners and China and India both have an ever-growing middle class.

What is Retin-A?

Retin-A, or tretinoin, is a form of vitamin A that was developed at the University of Pennsylvania in the 1960s. One of the most successful patents of all time, it revolutionized topical skin care and still has great utility today.

To understand how Retin-A works, it helps to understand the effects of aging on the skin. The most superficial cells – the keratinocytes of the epidermis – tend to become more adhesive and hang around longer. This leaves the skin looking dryer and rougher. The epidermal cells at the base also do not replicate as quickly, so the lifespan of these cells in the outer layer is much longer – and it shows. The pigmentation can become irregular and mottled because of this.

Retin-A is a topical medicine available by prescription only that is applied sparingly to the facial skin, sparing the eyelids and the corners of the nose and lips. It works at the cellular level and takes several months to see the full effect. In many ways, Retin-A can be thought of as reversing the outward signs of aging on the skin.

Retinol and retinoic acid belong to a family of compounds known as retinoids, and their history can be traced back to ancient Egypt, where the liver (which contains retinoids) was used to treat night blindness.

It was first isolated in the 1930s, but in a very unstable form that was easily broken down by sunlight and oxygen. To fix this, Retinoic Acid was developed and the first study using retinoids to treat acne was published in 1943.

Tretinoin, the retinoid most used today, was first used topically for skin conditions in 1958 and its use in anti-aging treatments was pioneered in the 1980s. These days retinol is essential in most anti-aging skincare routines because of its ability to increase cellular turnover, create new collagen proteins, fade pigmentation, and soften rough patches of skin.

Who invented Retin-A?

Dr. Kligman was born on March 17th, 1916, into a poor Russian immigrant family in Philadelphia. He graduated from the University of Pennsylvania School of Medicine in 1947 and completed his residency in dermatology in 1950. He subsequently became a professor of dermatology at the University of Pennsylvania.

Dr. Albert Kligman (M.D., Ph.D.) is considered to be a founder of the cosmeceuticals field. He was a prolific scientist who spent many years studying the anti-aging effects of Tretinoin and retinol.

In 1942, Dr. Kligman received his Ph.D. in botany, specializing in the study of fungi. He went on to continue his education at the University of Pennsylvania Medical School, where he chose dermatology as his specialty.

In this field, he was able to apply his knowledge of fungi to work on skin conditions such as athlete’s foot and dandruff.

However, he is most famous for his research on topical retinoids. Along with Dr. J.E. Fulton and Dr. G. Plewig, he developed the Tretinoin treatment for acne that is still in use in current-day dermatological practice.

The study was truly considered groundbreaking, as before Dr. Kligman’s research, the benefits of these active ingredients for skin were unknown. It was following such research that Dr. Kligman started to call skincare products with therapeutic benefits “cosmeceuticals”.

Retin-A, whose generic name is tretinoin, is a derivative of Vitamin A originally discovered by European researchers. However, their initial studies suggested that it did too much damage to the skin for widespread use. Working through the early 1960s, Kligman eventually found a formulation of the drug that could clear up acne without causing irritation, and he patented it in 1967. He and the university licensed it to Johnson & Johnson, which began selling it in 1971.

It remains the most effective treatment for acne.

The dark side of experiments

In his early career, Kligman had become an expert on fungi and, in 1951, officials at the nearby Holmesburg Prison called him to treat an outbreak of athlete’s foot, which is related to fungi. When he entered the prison for the first time, he later told a reporter,

All I saw before me were acres of skin. It was like a farmer seeing a fertile field for the first time.

He recruited prisoners to participate in the testing of drugs for the skin and other ailments, paying them $60 a month or more at a time when they were earning 15 cents an hour for manual labor. At the request of the Defense Department, he even tested psychoactive drugs.

At the time, testing drugs in prisons was a common occurrence. But the city of Holmesburg banned it in 1974 as Congress began an investigation of the practice. Eventually, severe restrictions were imposed nationwide. A group of inmates and former inmates attempted to sue Kligman, the University of Pennsylvania, and others, claiming debilitating health problems. The lawsuit was dismissed, however, because the statute of limitations had expired. Kligman denies that anyone was harmed.

I have always offered that, if anyone was ever injured in any way, come to us and we will take care of you. We are sorry if we did anything like that. And you know what? Not one person has ever come.

Backed by hundreds of thousands of dollars in grants, Kligman and the University of Pennsylvania began to test numerous chemicals on the bodies of incarcerated people at Holmesburg in the early 1950s.

In 1966, Kligman and Penn entered a $10,000 contract with Dow Chemical, a major chemical corporation, to test dioxin, a highly poisonous component of Agent Orange and other herbicides. Dow wanted to find the minimum amount of dioxin required to elicit a reaction in human subjects. In the tests, Dow instructed Kligman to apply small doses – between 0.2 and 16 micrograms – of dioxin to the foreheads and backs of the incarcerated men.

Shortly after the study began, Kligman reported back to Dow that he had outstanding new results. After seeing minimal change with Dow’s instructed dosage, Kligman decided to apply 7,500 micrograms of dioxin to the skin of many participants – 486 times the dosage instructed by Dow. Kligman left the men with excruciating and lasting lesions, blackheads, and blisters on their skin.

Dow was shocked. They had not approved this increase in dioxin application on human skin. Kligman had failed to answer their research question, proving only that the minimum dosage required to elicit a reaction was somewhere between 16 and 7,500 micrograms – a massive window. To make matters worse, because of Kligman’s incoherent record-keeping, no one could conduct follow-ups on the affected participants. Dow Chemical walked away with no answers and left 70 incarcerated men with chronic pain.

Kligman became the first researcher in the history of the Food and Drug Administration to be banned from testing drugs on human subjects. The FDA cited Kligman’s sloppy work and inconsistent records in their decision. Nonetheless, he was reinstated a month later.

In a 1980 hearing by the Environmental Protection Agency on the dioxin experiments, V. K. Rowe, the former director of Toxicological Affairs and Health and Environment Research at Dow, said that Kligman “was a professor of Dermatology at the University of Pennsylvania, and we had reasonable confidence that he would proceed in a manner consistent with our original protocol.”

Rowe was wrong.

Around the same time as the Dow Chemical experiments, 320 men at Holmesburg were turned “into human guinea pigs in secret chemical warfare experiments” through a $386,486 contract between Penn and the United States Army. In these experiments, Kligman and his associate Herbert W. Copelan, another physician at Penn, were tasked with finding the MED-50, or minimum effective dose necessary to mentally disable half of any given population, for several mind-altering drugs. Participants were paid $12 for medical screening and up to $25 for each set of experiments they participated in. After exposure to several chemicals, including elements of Agent Orange and psychoactive drugs, as well as chemicals Kligman hoped would “harden” the skin, participants experienced nausea, lightheadedness, delirium, hallucinations, and anxiety. Two-thirds of the participants in the study were Black men.

However, Kligman and Copelan claimed that “no subject suffered any toxic or harmful effect.” Like the Dow Chemical records, research documents omitted the names of these participants, ensuring no one could perform a follow–up study on the exposed.

The legacy still lives on

Kligman’s experiments left scars on these men both physically and mentally. For instance, one former inmate, Yusef Anthony, has publicly recounted his experiences in Holmesburg and how they continue to plague his health today. The family of one of the most prominent advocates for these men who was an experimental subject himself, Leodus Jones, has also detailed both the generational impact and contribution to medical mistrust specifically in the Black community from these unethical studies.

As more has been uncovered about Kligman’s experiments, it’s become clear that despite the innovative impact they made in the field of dermatology, they have still caused irrevocable harm. This harm has not gone unnoticed in the broader dermatologic community: groups such as the Society for Investigative Dermatology have removed their association with Kligman, eliminating his name from the awards and lectureships that were once labeled in his honor. Penn, however, has yet to do the same.

For decades, there have been repeated calls to action for Kligman’s legacy to be addressed by Penn., yet the University has yet to thoroughly address the issue. Currently, Kligman’s name remains across multiple arenas within the Perelman School of Medicine. Professorships, research labs, and a lectureship all bear his name. Displays in the atrium of the Hospital of the University of Pennsylvania and at the Perelman Center for Advanced Medicine highlight his contributions to Penn’s legacy, and specifically Retin-A. By proudly displaying his name without context and neglecting to formally apologize or publicly consider reparations, the University implies that they don’t see the trauma that Kligman inflicted as worthy of acknowledgment or compensation. This is unacceptable.

Countless people have called for the removal of Kligman’s name from laboratories on campus and prestigious awards. Additionally, many have demanded that the University teach students about the human cost of Kligman’s research.