A wrinkle, also known as a rhytide, is a fold, ridge, or crease in the skin or on fabric. Skin wrinkles typically appear as a result of aging processes such as glycation, habitual sleeping positions, loss of body mass, or temporarily, as the result of prolonged immersion in water. 

Causes of aging 

The development of facial wrinkles is a kind of fibrosis of the skin. Misrepair-accumulation aging theory suggests that wrinkles develop from incorrect repairs of injured elastic fibers and collagen fibers. Repeated extensions and compressions of the skin cause repeated injuries of extracellular fibers in the derma. During the repairing process, some of the broken elastic fibers and collagen fibers are not regenerated and restored but replaced by altered fibers. When an elastic fiber is broken in an extended state, it may be replaced by a “long” collagen fiber. Accumulation of “long” collagen fibers makes part of the skin looser and stiffer, and as a consequence, a big fold of skin appears. When “long” collagen is broken in a compressed state, it may be replaced by a “short” collagen fiber. The “shorter” collagen fibers will restrict the extension of “longer” fibers, and make the “long” fibers in a folding state permanently. A small fold, namely a permanent wrinkle, then appears. 

Sleep wrinkles 

Sleep wrinkles are created and reinforced when the face is compressed against a pillow or bed surface inside or stomach sleeping positions during sleep. They appear in predictable locations due to the underlying superficial musculoaponeurotic system and are usually distinct from wrinkles of facial expression. As with wrinkles of facial expression, sleep wrinkles can deepen and become permanent over time, unless the habitual sleeping positions that cause the wrinkles are altered. 

Water immersion wrinkles 

The wrinkles that occur in the skin after prolonged exposure to water are sometimes referred to as pruney fingers or water aging. This is a temporary skin condition where the skin on the palms of the hand or feet becomes wrinkled. The common explanation was based on water absorption in the keratin-laden epithelial skin when immersed in water, causing the skin to expand and resulting in a larger surface area, forcing it to wrinkle. Usually, the tips of the fingers and toes are the first to wrinkle because of a thicker layer of keratin and an absence of hairs that secrete sebum. Water probably initiates the wrinkling process by altering the balance of electrolytes in the skin as it diffuses into the hands and soles via their many sweat ducts. This could alter the stability of the membranes of the many neurons that synapse on the many blood vessels underneath the skin, causing them to trigger more rapidly. Increased neuronal triggering causes blood vessels to constrict, decreasing the amount of fluid underneath the skin. This decrease in the fluid would cause a decrease in tension, causing the skin to become wrinkled. In 1935, Lewis and Pickering suggested that the nervous system also plays an essential role in wrinkling, so the phenomenon could not be entirely explained simply by water absorption. Recent research shows that wrinkling is related to vasoconstriction. 

Wrinkling is often scored with the immersion of the hands for 30 minutes in water or EMLA cream (see box) with measurements steps of 5 minutes and counting the number of visible wrinkles in time. Not all healthy persons have finger wrinkling after immersion, so it would be safe to say that sympathetic function is preserved if finger wrinkling after water immersion is observed, but if the fingers emerge smooth, it cannot be assumed that there is a lesion to the autonomic supply or the peripheral nerves of the hand.

Wrinkle Treatment 

Some products are marketed with claims that they will make people look younger. But are these products cosmetics? It depends. 

Products intended to make people more attractive are generally cosmetics. For example, moisturizing is a cosmetic claim. So, if a product is intended to make lines and wrinkles less noticeable, simply by moisturizing the skin, it’s a cosmetic. Similarly, makeup or “primers” intended to make the signs of aging less noticeable just by hiding them are also cosmetics.  Anti-aging creams are predominantly moisturizer-based cosmeceutical skincare products marketed with the promise of making the consumer look younger by reducing, masking, or preventing signs of skin aging. These signs are laxity (sagging), rhytids (wrinkles), and photoaging, which includes erythema (redness), dyspigmentation (brown discolorations), solar elastosis (yellowing), keratoses (abnormal growths), and poor texture. 

But, products intended to affect the structure or function of the body, such as the skin, are drugs, or sometimes medical devices, even if they affect the appearance. So, if a product is intended, for example, to remove wrinkles or increase the skin’s production of collagen, it’s a drug or a medical device. For example, tretinoin decreases the cohesiveness of follicular epithelial cells, although the exact mode of action is unknown. Topical glycosaminoglycans supplements can help to provide temporary restoration of enzyme balance to slow or prevent matrix breakdown and consequent onset of wrinkle formation. Glycosaminoglycans (GAGs) are produced by the body to maintain structural integrity in tissues and to maintain fluid balance. Hyaluronic acid is a type of GAG that promotes collagen synthesis, repair, and hydration. GAGs serve as a natural moisturizer and lubricant between epidermal cells to inhibit the production of matrix metalloproteinases. 

Dermal fillers are injectable products frequently used to correct wrinkles and other depressions in the skin. They are often a kind of soft tissue designed to enable injection into the skin for purposes of improving appearance. The most common products are based on hyaluronic acid and calcium hydroxylapatite. Botox is a specific form of botulinum toxin manufactured by Allergan. Botox injections are the best known of a group of medications that use various forms of botulinum toxin to temporarily paralyze muscle activity. Botox injections are noted primarily for the ability to reduce the appearance of some facial wrinkles. 

The botulinum toxin is sold commercially under the names:

  • Botox, Vistabel, Botox cosmetic (Onabotulinumtoxin A or botulinum toxin type A)
  • Dysport (Abobotulinumtoxin A or botulinum toxin type A)
  • Bocouture, Xeomin (Incobotulinumtoxin A or botulinum toxin type A)
  • Myobloc (Rimabotulinumtoxin B or botulinum toxin type B). 

Botulinum toxin treats wrinkles by immobilizing the muscles which cause wrinkles. It is not appropriate for the treatment of all wrinkles; it is indicated for the treatment of glabellar lines (between the eyebrows) in adults. Any other usage is not approved by the FDA and is considered off-label use.

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