Wrinkles (synonym: skin folds; ICD-10-GM L98.9: disease of the skin and subcutaneous tissue, unspecified) are the result of biological, natural aging of the skin. Frequency peak: biological skin aging (synonyms: photoaging; skin folds; light aging; photoaging) begins between the ages of 25 and 30 in women and 35 in men. Around the age of 40, the first age-related skin changes become visible. Course and prognosis: Skin aging per se cannot be stopped, but it can be slowed down by an appropriate lifestyle (healthy diet, limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day), nicotine restriction (refraining from tobacco consumption), plenty of fresh air and adequate sun protection.
Symptoms – Complaints
Typical signs of skin aging are:
- Wrinkles
- Sagging
- Atrophy (shrinkage, or reduction in cell mass).
- Yellowish discoloration
- Lipid deficiency (lack of fats)
- Irregular pigmentation
Pathogenesis (disease development) – etiology (causes)
The causes of the development of wrinkles are diverse and complex. First, it is necessary to distinguish between the so-called intrinsic and extrinsic skin aging. Intrinsic skin aging or endogenous aging refers to the physiological, chronological aging of the skin.Factors of intrinsic skin aging are:
- Genetic predisposition
- Hormonal balance (hormonal changes with age: menopause (menopause in women), andropause (menopause in men) and somatopause).
- Accumulation of replication errors during cell division.
Areas of skin that are marked only by this aging process are, for example, areas on the inside of the arms or in the gluteal region (buttock region). This time-aged skin usually has very fine wrinkles due to loss of water and elasticity. Extrinsic skin aging or exogenous aging is determined by the environmental factors to which the skin is exposed. It represents an acceleration of intrinsic skin aging due to various factors.Factors of extrinsic skin aging are:
- UV light (photoaging)
- Tobacco consumption (smoking)
- Alcohol consumption
- Exposure to heat and cold
- Diet
- Professional activities
- Stress
- Medications (e.g., corticoids, which age skin – by decreasing the thickness of the skin – faster, ie, the skin becomes parchment-like).
Also externally distinguish skin changes that are endogenous or exogenous cause. The wrinkles of exogenous skin aging are very deep, because the loss of elasticity is immense. In addition, the skin looks leathery and has irregular pigmentation. Especially sun-exposed skin areas, such as the face or hands, age prematurely. At the molecular level, there are different processes that contribute to the development of wrinkles:
- Reactive Oxygen Species (ROS) – These so-called reactive oxygen species are also known as free radicals and are culprits in the main aging process. ROS are produced by the exogenous factors mentioned above and cause the oxidation of proteins (albumen), phospholipids (cell membrane components) and DNA (genetic material). In order to permanently prevent damage, the organism has antioxidant protective mechanisms. If these mechanisms are overloaded, damage to the cells and the DNA will occur in spite of everything. For more information, see “Oxidative stress – free radicals”.
- Matrix metalloproteinases – UV light induces the formation of these enzymes (substance that accelerates chemical reactions), which contribute increasingly to the degradation of elastic fibers and collagen. This leads to loss of elasticity and the formation of wrinkles, the formation of which is particularly promoted, for example, by the constant use of facial mimic muscles.
- Reduction of water binding capacity – Aged skin dries out faster and promotes the formation of wrinkles.
- Change in hormonal balance
- Estrogens induce collagen synthesis and stimulate the formation of hyaluronic acid, which is an important water-binding component of the skin. With age, the hormone concentration decreases as well as the collagen content.
- Progesterone inhibits collagenases and thus collagen degradation.
- Testosterone leads to crossing over (cross-shaped collagen strands).This leads to the fact that the connective and fatty tissue gets its hold (anti-cellulite factor) – furthermore, testosterone also leads to the inhibition of collagenases (= inhibition of collagen degradation).
Therapy
Nowadays, there are numerous ways to prevent wrinkles at a young age. External factors such as strong or frequent sun exposure, lead to premature aging of the skin and can be prevented by ensuring adequate sun protection. Regular skin care and cleansing also contribute to the preservation of beautiful skin. Exogenous skin aging in particular can be significantly influenced by lifestyle. Here, for example, a balanced diet rich in vital substances (macro- and micronutrients) is useful. Once the wrinkles are there, effective methods can be used to help:
- Botox injections – In this procedure, small amounts of botulinum toxin are injected into the mimic muscles. The nerve toxin paralyzes the muscles and leads to the smoothing of wrinkles.
- Dermabrasion – The procedure of dermabrasion is a surgical method of aesthetic medicine. It is a mechanical grinding of the epidermis (top layer of skin) to correct wrinkles and scars.
- (Fruit acid) peeling – A peeling can be applied once or twice a week after cleansing. This removes the dead skin scales of the top layer of skin (epidermis).
- Wrinkle injection – This method is nowadays possible with various means, such as AlloDerm, Cymetra, autologous fat, hyaluronic acid, NASHA gel or collagen.
- Laser Skin Resurfacing – Laser treatment using CO2 laser or Erbium Yag laser gently and painlessly removes the aged epidermis. Deep, younger layers of skin are thereby stimulated to a natural renewal process, that is, the formation of collagen and moisture retention.
- Lifting – As part of a surgical procedure, the skin is tightened and unsightly wrinkles are corrected. For this purpose, various surgical methods of aesthetic medicine are available: Facelift (face lift), forehead lift (brow lift), neck lift (neck lift).
Other measures that are used complementary in the treatment of wrinkles are: hormone cosmetics and micronutrient therapy (vital substances). All these procedures are successfully used – depending on the location and type of wrinkles – to treat troublesome wrinkles.