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rhytides%20(wrinkles)
RHYTIDES (WRINKLES)
Treatment Guideline Chart
Rhytides or wrinkles are visible creases or folds in the skin.
Fine wrinkles is <1 mm in width while coarse wrinkles is >1 mm in width.
The decision to treat wrinkles depends on the degree that they bother the patient, the nature and severity of the wrinkles, and the patient's willingness to accept the risks and costs of treatment.
The patient should understand that protection from the sun at any age will reduce the risk of photoaging (including wrinkles), actinic keratoses and squamous cell cancer.

Rhytides%20(wrinkles) Management

Prevention

Sunscreens

  • Sunscreens that block UVB radiation are readily available
  • Sun protection factor (SPF) corresponds to the ratio of doses of UV radiation (predominantly UVB radiation) that result in erythema (sunburn) with protection to the doses that result in erythema without protection
  • Sunscreen that is broad spectrum with minimum SPF of 30 is important in any skin care regimen to prevent photoaging as well as skin cancers
  • Physical/inorganic sunscreen agents physically block UV radiation skin penetration by reflecting or scattering light
    • Most common agents are titanium dioxide and zinc oxide
    • Blocks both ultraviolet A (UVA) and UVB radiation
    • Well-tolerated on the skin with low risk of irritation
  • Chemical/organic sunscreen agents absorb the harmful UV rays and transform them to longer-wave radiation that is harmless
  • Adequate application of 2 mg/cm2 (approximately ½-1 tsp) of sunscreen is imperative for sunscreen to be effective
    • Less than recommended application consequently results in lowered SPF
SUNSCREEN COMPONENTS1
COMPONENT REMARKS 
 UVA Absorbers
 Avobensone (Parsol 1789) ((Butylmethoxydibenzoylmethane)  Absorbs throughout UVA I spectrum
 Controversy regarding potential to degrade other sunscreen ingredients and photostability 
 UVB Absorbers
 Aminobenzoic acid (Para-aminobenzoic acid) (PABA)  Not frequently used because of photocontact dermatitis and staining of clothes
 Ensulizole  Stabilize photolabile agents
 Ethylhexyl-methoxycinnamate (Octyl methoxycinnamate)  Non-staining, poor water resistance
 Padimate O, Padimate A (Para-aminobenzoic acid)  Esters of PABA but less dermatitis and staining
 May cause stinging
 Salicylates  Non-sensitizing, stable, water insoluble
 Have the ability to stabilize other agents that can prevent photodegradation
 UVA and UVB Blockers
 Octocrylene  Filters both UVB and UVA
 Stabilize photolabile agents
 Oxybenzone  Absorbs both UVB and UVA
 Titanium dioxide  No photoallergic or contact properties
 Titanium dioxide (micronized)  No photoallergic or contact properties
 Zinc oxide  No photoallergic or contact properties
1This list is not an all encompassing list of sunscreen components. These and other effective agents are found in various sunscreen preparations throughout different countries. Please see the latest MIMS for specific formulations.
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