Wrinkles

Definition

Wrinkles refer to changes in the texture of the skin that appear as lines, creases or folds. It is a normal change in the skin that occurs with aging. Medically, wrinkles are known as rhytides.

Description

Wrinkles in the skin generally begin as fine lines and then deepen. They occur mostly on the face, neck, backs of the hands and the forearms. Although wrinkles are not physically harmful in any way they can influence a person's self-perception, especially in women and lead to lack of confidence.

Wrinkles occur due to changes in the skin that occur with aging. The skin is composed of two layers; the outer epidermis which lies on top of the second layer called the dermis. With age the outer layer of the skin, the epidermis, slows its rate of cellular reproduction and becomes thinner. The under layer of the skin or dermis also becomes thinner and the two layers tend to separate some. This separation decreases the circulation to the upper dermis and the epidermis which decreases the supply of nutrients to cells located there. Other changes that occur in the skin include the decrease of large structural molecules including collagen, elastin and glycosaminoglycans. All of these changes collectively lead to decreases in elasticity, firmness and structure of the skin that result in fine lines and wrinkles.

Fine expression lines that occur from talking, laughing and frowning can begin to occur as early in a person's twenties. These lines are generally seen in areas used in facial expressions such as the forehead, eyes and around the corners of the mouth. These fine lines eventually deepen into wrinkles and folds that affect deeper layers of the skin. Wrinkling of the skin that may be caused by sun exposure can show up in the thirties. In the forties dry skin can begin and the expression lines that may have begun in the twenties

deepen. These effects progress through the fifties. Developing a basic skin care routine that includes wearing sunscreen and moisturizer early in life can minimize the effects such that they pay off when a person reaches age 60.

Demographics

Skin changes that result in wrinkles can start as early in life as the mid-20s. These changes are part of the natural aging process but there can also be a genetic predisposition to early wrinkling. People with overexposure to the sun, particularly those with outdoor jobs or who routinely tan are at a higher risk for developing wrinkles early. Those exposed to environmental pollution as well as smokers are also more at risk. Fair skinned people are also more prone to wrinkles. There is no evidence that stress increases the risk of wrinkles, none the less, we often hear people say they have ‘earned’ their wrinkles.

Causes and symptoms

Normal changes in the skin that occur with age cause wrinkles. These changes include thinning of the skin, loss of moisture and decreased barrier function of the skin. This process of aging skin is accelerated by exposure to excess sunlight, environmental pollutants and cigarette smoke. There are also internal factors that are associated with aging skin. These include decreases in estrogen levels that occur with menopause and decreases in metabolic activity of the skin cells. Structural proteins in the skin also decrease.

Diagnosis

Diagnosis of wrinkles is made by visual examination of the skin.

Treatment

Wrinkles do not require treatment as they are not considered a medical illness. Wrinkles are a normal natural process for which there is no real cure. However, there are treatments or procedures that can decrease the appearance of wrinkles. Procedures that can be done at home include the use of products that contain alpha hydroxy acids or beta hydroxy acids. These products remove the very outer layer of cells from the skin, which allow it to maintain moisture better and removes superficial lines and wrinkles. Care should be taken with these products because too high of a concentration can cause damage to the skin. Using a good moisturizer on the skin to help maintain water in the skin can also help mask lines. The most important ingredient in a moisturizer or cream is a high quality oil to help prevent loss of moisture from the skin.

There is of course extensive research done each year to investigate possible ingredients for skin creams that can help in the treatment and prevention of wrinkles. Although many ingredients end up being marketing hype, there are a few ingredients that have potential to help decrease the appearance of wrinkles. The trouble is that some of the anti-aging creams are able to garner large price tags and it has to be questioned whether it is worth the price without solid data to back up the claims.

• KTTKS or palmitoyl pentapeptide-3 which goes by the brand name of Matrixyl is a bioactive peptide that can increase the production of collagen and other structural proteins in the skin thus decreasing the appearance of wrinkles.
• Tretinoin is a derivative of vitamin A that works by irritating the skin causing the cells to divide more rapidly. This gives the skin a younger appearance. It is also used to treat acne.
• Alpha-hydroxy acids are fruit acids that penetrate the skin to remove the very outer layer of dead cells. This removed some fine lines and helps to moisturize the skin.
• Vitamin C and other antioxidants including alpha lipoic acid may help the skin's appearance. These vitamins and antioxidants can be both applied to the skin as well as ingested in the form of fruits and vegetables.

Besides over the counter treatments for wrinkles there are also medical procedures used to remove lines. These include chemical peels, resurfacing, fillers and botulinum neurotoxin or Botox. Chemical peels involve the use of phenol, trichloroacetic acid, alpha-hydroxy acids or beta hydroxyl acids. These peels remove some of the outer skin and can be either light peels, medium peels or deep peels. Peels can help remove wrinkles, uneven pigmentation and scars. This treatment lasts a few weeks. There are side effects associated with peels so a physician or other qualified professional should be consulted.

Fillers are substances that are injected directly under the skin to smooth out wrinkles by increasing tissue volume. There is a wide assortment of fillers used including collagen, hyaluronic acid and synthetic polymers. Botox is a brand name for botulinum toxin which is a neurotoxin secreted by a bacteria. This neurotoxin causes paralysis of muscle. When injected into the muscles between the eyebrows it diminishes what is called motion wrinkles which are caused from contraction of facial muscles. Botox treatment lasts three to six months. Dermabrasion is a surgical procedure where the skin is sanded away to expose lower layers of the skin. Dermabrasion can remove wrinkles, scars and age spots. A related procedure is laser resurfacing which uses a laser to vaporize the outer layer of skin.

Contour threads are often referred to as a non-surgical face lift . This is a relatively new procedure so there is not a lot known about it yet although it is being heavily advertised both on TV and in magazines. In this procedure a surgical thread containing tiny hooks or barbs are injected into the skin to pull up sagging areas. Finally, the most invasive procedure for treating wrinkles of course is the face lift. In this surgical procedure incisions are made in the hair area near the temple to the front of the ear and behind the ear. The sagging tissue is pulled and lifted to remove wrinkles. The skin is then closed with stitches or clips.

Nutrition/Dietetic concerns

The best way for the skin to receive nutrients is through the diet . Increased consumption of foods high in antioxidants found in fruits and vegetables are most important for skin health. Vitamin C is necessary for the production of collagen in the skin and so important in delaying wrinkling. Ingestion of fats, especially essential fatty acids are important in holding moisture in the skin and providing it with its barrier function. Drinking plenty of water is important in keeping the skin moisturized. Using topical moisturizers does not help unless there is plenty of moisture inside the body. Nutrition can also be delivered to the surface of the skin to a certain extent. Many anti-wrinkle creams will contain essential fatty acids, vitamin C, retinoids as well as other antioxidants. These nutrients are important in the diet as well as topically.

Therapy

The influence of societal standards of beauty is often the incentive for wrinkle treatment. Because of this it may be good to really consider the risks and benefits of cosmetic surgeries. Since nothing can remove all of a persons imperfections, looking at other ways to improve self confidence and self-esteem might be a good idea. One's attitude towards aging is most important when determining the effect wrinkles have on quality of life.

Prognosis

Wrinkles will tend to get worse with age. Since wrinkles are not a medical condition, treatment is not necessary. However, one's physical appearance can have an effect on self-image and thus on quality of life. Using a good moisturizer can always diminish the appearance of wrinkles though.

Prevention

Preventing or slowing the progression of wrinkles is something that begins years before wrinkles appear. Establishing a good skin care routine early in life will pay off. The most important points in preventing or delaying wrinkling include keeping the skin well moisturized, wearing a sunscreen with SPF 15 or a hat to prevent sun damage to the face, and not smoking or binging on alcohol, which causes dehydration . Daily exercise helps to increase circulation to the skin and deliver nutrients. It is generally accepted that antioxidants can slow the progression of wrinkles, both topically and in the diet. There are many new products on the market touting their ability to prevent wrinkles. Although there is not much evidence to support claims as of yet, some of the promising ingredients for anti-aging creams include alpha hydroxyl acids, vitamin C, retinoids, lycopene, green tea, oat beta-glucan, niacinamide, coenzyme Q10, alpha lipoic acid and DMAE (dimethylaminoethanol).

Caregiver concerns

Care givers should be aware of what affect signs of aging such as wrinkles have on the patient's quality of life.

Resources

OTHER

British Medical Journal, Wrinkles http://clinicalevidence.bmj.com/ceweb/conditions/skd/1711/1711_background.jsp

Proctor & Gamble The Science of Beauty, Biology of fine lines, wrinkles & texture http://www.pgbeautyscience.com/biology-of-fine-lines-wrinkles-texture1.html

Smart Skin Care.com http://www.smartskincare.com/

Cindy L.A. Jones Ph.D.