The stomach-churning truth about your pricey anti-ageing skin creams: How pioneering doctor dubbed Father of Modern Dermatology performed sick human experiments in a prison dubbed ‘the Terrordome’

Prized for their anti–ageing powers and promises of so–called ‘glass skin’, demand for potent vitamin-A skincare products known as retinoids has surged in recent years.

But one of the most powerful of these treatments – tretinoin – is linked to a deeply troubling chapter in medical history.

The prescription cream, widely hailed today as the gold standard for acne and anti-ageing treatments, was developed by American dermatologist Dr Albert Kligman.

Yet many of the experiments that helped build his reputation have since been condemned as among the most unethical in modern medicine.

Historical records show that Dr Kligman conducted experiments on prisoners and vulnerable patients in the United States during the mid-20th century, exposing them to harsh chemicals, infectious agents and toxic compounds.

Some studies reportedly involved deliberately infecting children with learning disabilities with fungal conditions such as ringworm.

Later trials at Holmesburg Prison in Philadelphia, a faciloity so mired in violence it was known as ‘the Terrordome’ exposed inmates – many of them poor or African American men – to substances including adhesives, radioactive compounds, mind-altering drugs and industrial chemicals.

In a notorious 1966 interview, Dr Kligman described his reaction when he first entered the prison: ‘All I saw before me were acres of skin. I was like a farmer seeing a fertile field for the first time.’

Tretinoin itself was developed through conventional dermatology research. However, disturbing revelations about the work of its inventor, have continued to raise difficult questions about the ethical context in which some of the era’s most influential skin research took place.

Before his work at Holmesburg Prison expanded into a vast programme of human experimentation, Kligman had already built his early career studying infectious skin diseases in institutional settings.

In the 1950s he conducted dermatology research at the Pennhurst State School and Hospital, a large facility housing children and adults with intellectual disabilities.

According to historian Allen Hornblum in Acres of Skin: Human Experiments at Holmesburg Prison and later medical ethics analyses, some of these studies involved deliberately infecting children with dermatophyte fungi – the organisms that cause ringworm.

Researchers induced the infections, they said, so they could observe how the disease developed and test potential antifungal treatments.

At the time, ringworm outbreaks were common in crowded institutions, schools and military barracks, and scientists argued that inducing infections under controlled conditions would help them better understand how the disease spread and how it could be treated.

However, critics say the research raised serious ethical concerns because the children involved were highly vulnerable and could not meaningfully consent to participate. Historians argue that institutionalised patients were often used in studies precisely because they were easily accessible to researchers and had little power to refuse.

These early experiments helped establish Kligman’s reputation as a dermatologist specialising in fungal infections – research that soon expanded dramatically when he began conducting trials on prisoners at Holmesburg Prison in Philadelphia.

According to medical ethics analyses and historical investigations, what began as a small dermatology project expanded into one of the largest programmes of human experimentation ever conducted in a US prison.

For more than two decades – from the early 1950s until the mid–1970s – inmates were used in hundreds of studies testing pharmaceuticals, cosmetics, industrial chemicals and even substances linked to military research. 

Many of the projects were funded by private corporations or government agencies.

One of Dr Albert Kligman’s earliest research projects involved deliberately infecting prisoners with fungal diseases such as ringworm and athlete’s foot, just as he had the disabled children.

According to evidence examined by historian Allen Hornblum in his book Acres of Skin: Human Experiments at Holmesburg Prison, large quantities of fungal organisms were applied to prisoners’ skin. Their feet were then wrapped or enclosed in boots or bandages to encourage infection before researchers tested different antifungal treatments.

The infections could cause severe itching, rashes and cracked skin.

Kligman also ran studies in which inmates were infected with viruses affecting the skin, including herpes simplex. Researchers monitored how the infections developed and used the outbreaks to test experimental treatments.

Participants sometimes developed painful lesions and open sores during these experiments.

Perhaps the most notorious trials involved dioxin (TCDD) – an extremely toxic chemical later associated with the herbicide Agent Orange used during the Vietnam War.

Between 1965 and 1966 Kligman conducted studies funded by the chemical company Dow to examine how the compound affected human skin.

Prisoners had the chemical applied directly to their backs in patches or injected beneath the skin. Some developed chloracne, an agonising and disfiguring skin eruption caused by dioxin exposure.

Later investigations found that some inmates had been given far higher doses than originally planned.

Kligman’s laboratory also ran hundreds of tests for commercial companies evaluating everyday products.

Prisoners had substances repeatedly applied to their skin to see whether they caused irritation, burns or allergic reactions. The substances included skin creams, shampoos and hair dyes, detergents, deodorants and experimental pharmaceutical drugs.

Companies paid the prison and the research teams to carry out these trials.

Another set of experiments involved the use of radioactive tracers to study how human skin renews itself.

Scientists applied or injected radioactive isotopes into small areas of skin and then tracked how labelled cells moved through layers of the epidermis – work that contributed to dermatologists’ understanding of skin cell turnover.

Some research carried out at Holmesburg was also funded by the US military. In these studies inmates were exposed to chemicals designed to irritate or blister the skin so scientists could observe the effects.

Participants sometimes reported severe rashes and burns following exposure.

Historical analyses suggest that thousands of prisoners took part in experiments at Holmesburg between the 1950s and early 1970s. Inmates were typically paid small sums of money – sometimes only a few dollars – to participate.

Critics say the payments exploited prisoners who had very few other ways to earn money while incarcerated.

Kligman and other researchers defended the work as legitimate medical science. 

Writing in the journal JAMA Dermatology in 2020, Dr Luke Adamson and bioethicist Dr Ezekiel Emanuel said that Kligman ‘saw prisoners as objects for experimentation’. 

Kligman himself was quoted as saying, of his time at Holmesburg: ‘It was years before the authorities knew that I was conducting various studies on prisoner volunteers. 

‘Things were simpler then. Informed consent was unheard of. No one asked me what I was doing. It was a wonderful time.’

He argued that deliberately inducing fungal infections or viral outbreaks was necessary to understand how these diseases spread and responded to treatment.

Chemical exposure studies were presented as a way to determine whether industrial compounds were safe for human use.

Trials involving cosmetics, household products and drugs were described as routine safety testing needed before products could be released to the public.

Research using radioactive tracers, meanwhile, was intended to improve scientific understanding of how skin grows and regenerates – knowledge that later helped shape treatments for acne and ageing.

Despite these explanations, the Holmesburg programme has since become one of the most heavily criticised episodes in modern dermatology.

Dr Adamson and Dr Emanuel damned the research, stating that it ‘exploited a vulnerable population who could not freely refuse participation’.

They noted that the prisoners used in the experiments were often poor, disproportionately black and under significant financial pressure to take part.

Historian Allen Hornblum, whose investigation remains the most detailed account of the programme, described the studies as ‘a classic example of how vulnerable populations can be exploited in the name of science’.

Ethicists frequently compare Holmesburg with the Tuskegee syphilis study, another notorious US medical scandal in which hundreds of Black men with syphilis were deliberately left untreated by government researchers for decades so scientists could observe the disease’s progression. 

While an unarguably shameful episode in medical history, these controversies helped spur sweeping reforms in how medical research was conducted.

In the years that followed, US congress passed the National Research Act, which created the modern system of ethical oversight for research involving human participants.

Stricter rules were introduced requiring researchers to obtain fully informed consent from participants, limiting the use of prisoners and other vulnerable groups in experiments, and mandating independent oversight by institutional review boards to assess whether studies are ethical before they begin.

Today the Holmesburg experiments are widely cited in bioethics literature as a warning of what can happen when scientific ambition outpaces ethical safeguards.

Even the University of Pennsylvania, where Kligman spent much of his career, has acknowledged the episode as a painful chapter in its history and has funded research and community initiatives examining the lasting impact of the studies.

For many historians and ethicists, the legacy of Holmesburg is a reminder that medical breakthroughs can sometimes emerge from deeply troubling circumstances – and that protecting the rights and dignity of research participants must remain at the centre of scientific progress.