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November 2017
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What causes fine lines or wrinkles as one ages? Dr. Emily Altman, Dermatologist NJ

Wrinkles and fine lines can be caused by dehydration or allergies in faces of any age. Young children with allergies, asthma or eczema (atopy) can have creases and folds under the eyes, called Dennie-Morgan lines.

These lines and wrinkles are caused by chronic rubbing and scratching of the eczema/atopic dermatitis around the eyes.  They will resolve with proper treatment of the dermatitis.

Wrinkles and folds due to atopic dermatits (eczema) of the eyelid

Wrinkles and folds due to atopic dermatits (eczema) of the eyelid

Other factors like dehydration, pollution, nutrition, genetics, smoking, and certain medications contribute to the formation of wrinkles. However the majority of wrinkles and fine lines are related to photodamage from ultraviolet light.

Damage from ultraviolet (UV) light exposure is responsible for almost 80% of the skin changes commonly attributed to the aging process. The biggest sources of UV light are the sun and indoor tanning beds.

Ultraviolet light damage causes both a breakdown of collagen and elastin (molecules in the dermis that give strength and elasticity to the skin) by activating enzymes called matrix metalloproteinases (MMP) but also by decreasing the deposition of new collagen by dermal fibroblasts. When exposed to ultraviolet light, fibroblasts undergo aging or senescence.

Illustration showing components of the skin

Illustration showing components of the skin

Wrinkles and lines first appear in the lines of facial expression. Dynamic wrinkles are the ones that appear when a facial expression, such as a smile or frown, is made and go away when the face is relaxed. Eventually, these dynamic wrinkles become permanent or static as the facial expressions etch them into the skin that has lost some amount of strength and elasticity.

One system of classifying photoaging is the Glogau Classification:
I Mild
No wrinkles
Early Photoaging: mild pigment changes, no keratosis, minimal wrinkles, minimal or no makeup

II Moderate
Wrinkles in motion
Early to Moderate Photoaging: Early brown spots visible, keratosis, palpable but not visible, parallel smile lines begin to appear, wears some foundation

III Advanced
Wrinkles at rest
AdvancedPhotoaging: Obvious discolorations, visible capillaries
(telangiectasias), visible keratosis, wears heavier foundation always

IV Severe
Only wrinkles
Severe Photoaging: Yellow-gray skin color, prior skin malignancies, wrinkles throughout – no normal skin, cannot wear makeup because it cakes and cracks

Glogau photoaging classification:  Comparing Type I and Type IV

Glogau photoaging classification: Comparing Type I and Type IV

In addition to the thinning of the skin, there is also loss of volume in the soft tissues (subcutaneous fat) and even the bony structures of the face, which decreases the scaffolding the skin is draped over. That decrease of underlying volume also contributes to the formation of wrinkles, creases and folds. The famous “parentheses” or nasolabial folds are really formed by the loss of volume of the midface (cheeks) and temples.


For more information on skin aging: http://www.advancedskinwisdom.co…

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