What Causes Wrinkles?

Aging Process
As a person ages, skin cells divide more slowly, and the inner skin, or dermis, starts to thin. Fat cells beneath the dermis begin to atrophy, and the underlying network of elastin and collagen fibers, which provides scaffolding for the surface layers, loosens and unravels. Skin loses its elasticity; when pressed, it no longer springs back to its initial position but instead sags and forms furrows. The skin's ability to retain moisture diminishes; the sweat- and oil-secreting glands atrophy, depriving the skin of their
protective water-lipid emulsions. As a consequence, the skin becomes dry and scaly. In addition, the ability of the skin to repair itself diminishes with age, so wounds are slower to heal. Frown lines (those between the eyebrows) and crow's feet (lines that radiate from the corners of the eyes) appear to develop because of permanent small muscle contractions. Habitual facial expressions also form characteristic lines, and gravity exacerbates the situation, contributing to the formation of jowls and drooping eyelids. (Eyebrows, surprisingly, move up as a person ages, possibly because of forehead wrinkles.)

Sun Damage (Photoaging)
The skin can also age prematurely as a result of prolonged exposure to ultraviolet (UV) radiation emanating from the sun (called intrinsic or photoaging). The role of the sun cannot be overestimated as the most important cause of aging skin and skin cancers. Overall, exposure to ultraviolet (referred to as UVA or UVB) radiation from sunlight accounts for about 90% of the symptoms of premature skin aging, and most of these effects occur by age 20. UVB is the primary agent in sun burning and primarily affects the outer skin layers. UVA penetrates more deeply and efficiently, however. Both UVA and UVB rays cause damage leading to wrinkles, lower immunity against infection, aging skin disorders, and cancer. Even small amounts of UV radiation damage collagen fibers (the major structural protein in the skin) and cause accumulation of abnormal elastin (the protein that causes tissue to stretch). During the process, large amounts of enzymes called metalloproteinases are produced. The normal function of these enzymes is to remodel the sun-injured tissue by synthesizing and reforming collagen. This is an imperfect process, however, and to achieve it, some of these enzymes actually degrade collagen. The result is an uneven formation (matrix) of disorganized collagen fibers called solar scars. If this process of imperfect skin rebuilding occurs over and over, wrinkles result. One study indicated that when people with light to moderate skin color are exposed to sunlight for just five to 15 minutes, metalloproteinases remain elevated for about a week. It should be noted, however, that some studies indicate that metalloproteinases may also have factors that protect against melanoma. Researchers have identified a molecule called urocanic acid that reacts to UV radiation by suppressing certain immune factors in the skin that are important for protection against skins cancers, including basal cell carcinoma and melanoma. In the process it also triggers oxygen-free radicals. These are unstable particles that, in excess, can damage cells, and in skin, contribute to photoaging.

Other Factors Other environmental factors, including cigarette smoke and pollution, particularly ozone, may hasten chronologic aging by producing oxygen-free radicals. These are particles produced by many of the body's normal chemical processes; in excessive amounts they can damage cell membranes and interact with genetic material, possibly contributing to the development of a number of skin disorders, including wrinkles and, more importantly, cancer. Rapid weight

loss can also cause wrinkles by reducing the volume of fat cells that cushion the face. This not only makes a person look gaunt, but can cause the skin to sag

Can Wrinkles Be Prevented?

Avoiding Intense Overexposure to Sunlight
Staying out of the Sun. The best way to prevent skin damage in any case is to avoid episodes of excessive sun exposure, particularly during the hours of 10 AM to 4 PM when sunlight pours down 80% of its daily UV dose. Reflective surfaces, such as water, sand, concrete, and white-painted areas should be avoided. Clouds and haze are not protective, and in some cases may intensify UVB rays. Ultraviolet intensity depends on the angle of the sun, not heat or brightness. For example, UV intensity in April (two months before summer starts) is equal to that in August (two months after summer begins). The US Weather service provides a UV index, which ranges from 1 to 10+; the higher the index number the greater the exposure to UV rays. This index is valid for about a 30-mile radius around the city from which the broadcast originates. Currently, the computation of the UV Index does not include the effects of variable surface reflection (eg, sand, water, or snow), atmospheric pollutants, or haze. Higher altitudes appear to reduce the time it takes to burn. (One study suggested, for example, that an average complexion burns at six minutes at 11,000 feet at noon compared to 25 minutes at sea level in a temperate climate.) Sun lamps and tanning beds provide mostly UVA rays, and some experts believe that 15 to 30 minutes at a tanning salon are as dangerous as a day spent in the sun.

Sunscreens and Sunblocks. Sunscreens are classified generally as organic or inorganic. Organic types are those commonly referred to as sunscreens (which contain chemicals) and inorganic as sunblocks (which contain zinc or titanium oxide). When used generously, they help reduce the severity of many aging skin disorders, including squamous cell cancers. Studies are conflicted, however, over whether sunscreens provide protection against other skin cancers; some have even have found a higher

association with sunscreen use and melanoma and some basal cell cancers. A number of studies now indicate that people who wear sunscreens are lulled into believing that they are safe from the sun because they don't burn; therefore, they stay out longer than is safe, thereby actually increasing their risk for skin cancer. Some experts argue that people do not apply enough sunscreen. In fact, some evidence indicates most people apply about one quarter of the amount used in determining specific sun protection factors (SPF) [ see Box below ]. Others believe, however, that heavy application would only encourage people to stay in the sun longer. It should be noted that SPF ratings do not yet describe the sunscreen's level of protection against UVA, which are the deeply penetrating rays. Changes in the FDA's labeling requirements are scheduled to include both UVA and UVB protection by 2002.

The inorganic sunscreens, called sunblocks, prevent nearly all UVA and UVB rays from reaching the skin and contain zinc oxide or titanium dioxide. They lie on top of the skin and are not absorbed. Standard sunblocks are white, pasty, and unattractive, but a more recent form called microfine zinc oxide (Z-Cote) is transparent and nearly as protective as the older types. Zinc oxide, in any case, may be more beneficial than titanium oxide. The bottom line is not that people should avoid sunscreens or sunblocks but that they should always use them in combination with other sun-protective measures. Any organic chemical sunscreen should contain a wide spectrum of UVA-blocking ingredients, which include butyl methoxydibenzoyl-methane (also called avobenzone or Parsol 1789), dioxybenzone, oxybenzone, sulisobenzone, methyl anthranilate, octocrylene, and octyl methoxycinnamate or ethylhexyl p-methoxycinnamate. Assuming the same ingredients are used, inexpensive products work as well as expensive ones. Sunscreen-containing shampoos, conditioners, and hair sprays are now available. Waterproof formulas last for about 40 minutes in the water, whereas water-resistant formulas last half as long.

Daily Preventive Skin Care
People are encouraged to wash their face with a mild soap that contains moisturizers. Alkaline soaps, especially with deodorant, should be avoided. The skin should be patted dry and immediately lubricated with a water–based moisturizer to prevent further dehydration. Hundreds of creams and lotions are available for wrinkle-protection, although very few have been proven to be very effective. Gentle scrubbing with a mildly abrasive material and a soap that contains salicylic acid can help remove old skin so that new skin can grow. Organic loofahs, sea sponges, and washcloths may harbor bacteria; nonorganic textured sponges do not carry this risk. Some cleansing grains contain pulverized walnut shells and apricot seeds, which can lacerate skin on a microscopic level. Cleansing grains with microbeads don't have sharp edges and remove skin without cutting it. It is very important to rub gently. The rubbing, which should be perpendicular to the wrinkle, mechanically removes the outer layer of dead skin cells and is particularly effective against tiny wrinkles that form around the mouth and eyes. Overall, the skin appears smoother and fresher. Exfoliation using scrubs, however, can worsen certain conditions, such as acne, sensitive skin, or broken blood vessels. No matter what product people put on their skin, it is important to include sunscreen with the daily skin regimen, even if someone is going outdoors only for a short time.

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