A wrinkle , also known as a rhytid , is a fold, ridge or crease in an otherwise smooth surface, such as on skin or fabric . Skin wrinkles typically appear as a result of ageing processes such as glycation , habitual sleeping positions, loss of body mass, sun damage, or temporarily, as the result of prolonged immersion in water . Age wrinkling in the skin is promoted by habitual facial expressions, aging, sun damage, smoking, poor hydration, and various other factors. In humans, it can also be prevented to some degree by avoiding excessive solar exposure and through diet (in particular through consumption of carotenoids , tocopherols and flavonoids , vitamins (A, C, D and E), essential omega-3-fatty acids, certain proteins and lactobacilli).
39-480: 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 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
78-429: A 1988 clinical trial. The origin of the name tretinoin is uncertain, although several sources agree (one with probability, < one with asserted certainty ) that it probably comes from trans - + retinoic [acid] + -in , which is plausible given that tretinoin is the all-trans isomer of retinoic acid . The name isotretinoin is the same root tretinoin plus the prefix iso - . Regarding pronunciation,
117-416: A better grasp of wet objects. These results were called into question by a 2014 study that failed to reproduce any improvement of handling wet objects with wrinkled fingertips. However, a 2020 study of gripping efficiency found that wrinkles decreased the force required to grip wet objects by 20%, supporting the traction hypothesis. Prior to a 1935 study, the common explanation was based on water absorption in
156-469: Is a thin yet tough unitary tissue plane of the face formed by facial fasciae, subcutis connective tissue, and facial muscles. Its composition varies, containing muscle fibres in some areas, and fibrous or fibroaponeurotic tissue in others. It connects to the dermis via vertical septa. It does not attach to bone. In most areas, a distinct plane can be defined deep to the SMAS (continuous with that formed between
195-536: Is also useful as maintenance therapy for people who have responded well to their initial treatment, reducing the prolonged use of antibiotics for acne. Photoaging is premature skin aging resulting from prolonged and repeated exposure to solar radiation. Features of photoaging include fine and coarse wrinkles, change in skin pigmentation, and loss of elasticity. In human skin, topical retinoids increase collagen production, induce epidermal hyperplasia, and decrease keratinocyte and melanocyte atypia. Topical tretinoin
234-804: Is applied to the skin as a cream, gel or ointment. For acute promyelocytic leukemia, it is effective only when the RARA-PML fusion mutation is present and is taken by mouth for up to three months. Topical tretinoin is also the most extensively investigated retinoid therapy for photoaging . Common side effects when used as a cream are limited to the skin and include skin redness, peeling, and sun sensitivity. When taken by mouth, side effects include hypertriglyceridemia , hypercholesterolemia , shortness of breath , headache, numbness, depression, skin dryness, itchiness, hair loss, vomiting, muscle pains, and vision changes. Other severe side effects include high white blood cell counts and blood clots . Use during pregnancy
273-401: 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 a "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
312-567: Is contraindicated due to the risk of birth defects. It is in the retinoid family of medications. Tretinoin was patented in 1957, and approved for medical use in 1962. It is on the World Health Organization's List of Essential Medicines . Tretinoin is available as a generic medication . In 2021, it was the 206th most commonly prescribed medication in the United States, with more than 2 million prescriptions. Tretinoin
351-421: Is first cleaved by beta-carotene 15-15'-monooxygenase to retinol which is subsequently oxidized by RDH and ALDH enzymes to produce all-trans retinoic acid (see retinoic acid ). Tretinoin is produced synthetically using standard industrial practices. Tretinoin was co-developed for its use in acne by James Fulton and Albert Kligman when they were at University of Pennsylvania in the 1960s. Phase I trials,
390-408: Is most commonly used to treat acne , both inflammatory and noninflammatory. Multiple studies support the efficacy of topical retinoids in the treatment of acne vulgaris. It is sometimes used in conjunction with other topical acne medications to enhance their penetration. In addition to treating active acne, retinoids accelerate the resolution of acne-induced postinflammatory hyperpigmentation . It
429-427: Is often seen can be gently exfoliated with a washcloth. A non-comedogenic facial moisturizer can also be applied if needed. Delaying application of the retinoid for at least 20 minutes after washing and drying the face may also be helpful. Topical retinoids are not true photosensitizing drugs, but people using topical retinoids have described symptoms of increased sun sensitivity. This is thought to be due to thinning of
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#1732884245489468-571: Is preserved if finger wrinkling after immersion in water is observed, but if the fingers emerge smooth it cannot be assumed that there is a lesion to the autonomic supply or to the peripheral nerves of the hand. Examples of wrinkles can be found in various animal species that grow loose, excess skin, particularly when they are young. Several breeds of dog , such as the Pug and the Shar Pei , have been bred to exaggerate this trait. In dogs bred for fighting , this
507-487: Is the most extensively investigated retinoid therapy for photoaging. Topical tretinoin can be used for mild to severe photoaging in people of all skin types. Several weeks or months of use are typically required before improvement is appreciated. Although it has only been studied for a duration of two years, it may be continued indefinitely. A long-term maintenance regimen with a lower concentration or less frequent application may be an alternative to continued use. Tretinoin
546-612: Is the result of selection for loose skin, which confers a protective advantage. Current evidence suggests that tretinoin decreases cohesiveness of follicular epithelial cells, although the exact mode of action is unknown. Additionally, tretinoin stimulates mitotic activity and increased turnover of follicular epithelial cells. Tretinoin is better known by the brand name Retin-A. 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
585-569: Is used in the treatment of other conditions including migraine headache and cervical dystonia (spasmodic torticollis ) (a neuromuscular disorder involving the head and neck). Dysport, manufactured by Ipsen, received FDA approval and is now used to treat cervical dystonia as well as glabellar lines in adults. In 2010, another form of botulinum toxin, one free of complexing proteins, became available to Americans. Xeomin received FDA approval for medical indications in 2010 and cosmetic indications in 2011. Botulinum toxin treats wrinkles by immobilizing
624-473: Is used to induce remission in people with acute promyelocytic leukemia (APL) who have a mutation (the t(15;17) translocation that gives rise to the PML::RARα fusion gene). It is not used for maintenance therapy. Tretinoin is not effective for the treatment of non-APL forms of Acute Myeloid Leukemia or other forms of leukemia. Preclinical studies and clinical data analysis suggests that retinoic acid promotes
663-444: The epimysium of some facial muscles; a link between facial muscles and the skin of the face is thereby established, enabling facial expression . Over the parotid gland, the SMAS is firmly united with the superficial layer of parotid fascia . The SMAS is clinically important in facial plastic surgery for rhytidectomy (facelift procedure) . During this procedure, the SMAS is accessed through an arch-shaped incision anterior to
702-417: 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 which secrete the protective oil called sebum . In the 1935 study, however, Lewis and Pickering were studying patients with palsy of
741-402: The median nerve when they discovered that skin wrinkling did not occur in the areas of the patients' skin normally innervated by the damaged nerve. This suggested that the nervous system 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 . Water probably initiates
780-494: The retinoic acid receptors (RAR) and the retinoid X receptors (RXR). These events contribute to the normalization of follicular keratinization and decreased cohesiveness of keratinocytes , resulting in reduced follicular occlusion and microcomedone formation. The retinoid-receptor complex competes for coactivator proteins of AP-1, a key transcription factor involved in inflammation. Retinoids also down-regulate expression of toll-like receptor (TLR)-2, which has been implicated in
819-1176: The stratum corneum leading to a decreased barrier against ultraviolet light exposure, as well as an enhanced sensitivity due to the presence of cutaneous irritation. The oral form of the drug has boxed warnings concerning the risks of retinoic acid syndrome and leukocytosis . Other significant side effects include a risk of thrombosis , benign intracranial hypertension in children, high lipids ( hypercholesterolemia and/or hypertriglyceridemia ), and liver damage. There are many significant side effects from this drug that include malaise (66%), shivering (63%), hemorrhage (60%), infections (58%), peripheral edema (52%), pain (37%), chest discomfort (32%), edema (29%), disseminated intravascular coagulation (26%), weight increase (23%), injection site reactions (17%), anorexia (17%), weight decrease (17%), and myalgia (14%). Respiratory side effects usually signify retinoic acid syndrome, and include upper respiratory tract disorders (63%), dyspnea (60%), respiratory insufficiency (26%), pleural effusion (20%), pneumonia (14%), rales (14%), and expiratory wheezing (14%), and many others at less than 10%. Around 23% of people taking
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#1732884245489858-509: The appearance of fine lines and wrinkles on the face; laser ablation , which removes thin layers of skin, and nonablative lasers that stimulate collagen production. Nonablative lasers are less effective than ablative ones but they are less invasive and recovery time is short. After the procedure people experience temporary redness, itching and swelling. Superficial muscular aponeurotic system Superficial muscular aponeurotic system (or superficial musculoaponeurotic system ) ( SMAS )
897-415: 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 (MMPs). Dermal fillers are injectable products frequently used to correct wrinkles, and other depressions in
936-606: The drug have reported earache or a feeling of fullness in their ears. Gastrointestinal disorders include bleeding (34%), abdominal pain (31%), diarrhea (23%), constipation (17%), dyspepsia (14%), and swollen belly (11%) and many others at less than 10%. Cardiovascular side effects include arrhythmias (23%), flushing (23%), hypotension (14%), hypertension (11%), phlebitis (11%), and cardiac failure (6%) and for 3% of patients: cardiac arrest, myocardial infarction, enlarged heart, heart murmur, ischemia, stroke, myocarditis, pericarditis, pulmonary hypertension, secondary cardiomyopathy. In
975-412: The drug. When microencapsulated tretinoin is exposed to benzoyl peroxide and light only 1% degradation takes place in about 4 hours and only 13% after 24 hours. The biological mechanism behind triglyceride and cholesterol elevations remains under investigation. All-trans retinoic acid is produced by the body from dietary factors including retinol, retinyl esters or beta-carotene . The beta-carotene
1014-516: The ear; a portion of the SMAS is then excised and the remaining SMAS is stretched by drawing it posterior-ward and suturing it, thus making the skin of the face which overlies the SMAS taut. This muscle article is a stub . You can help Misplaced Pages by expanding it . Tretinoin Tretinoin , also known as all- trans retinoic acid ( ATRA ), is a medication used for the treatment of acne and acute promyelocytic leukemia . For acne, it
1053-522: The first conducted on human subjects, were performed on inmates at Holmesburg Prison during a long-running regime of non-therapeutic and unethical testing on prison inmates at Holmesburg . The University of Pennsylvania held the patent for Retin-A, which it licensed to pharmaceutical companies. Treatment of acute promyelocytic leukemia was first introduced at Ruijin Hospital in Shanghai by Wang Zhenyi in
1092-441: The following variants apply equally to both tretinoin and isotretinoin . Given that retinoic is pronounced / ˌ r ɛ t ɪ ˈ n oʊ ɪ k / , it is natural that / ˌ t r ɛ t ɪ ˈ n oʊ ɪ n / is a commonly heard pronunciation. Dictionary transcriptions also include / ˌ t r ɪ ˈ t ɪ n oʊ ɪ n / ( tri- TIN -oh-in ) and / ˈ t r ɛ t ɪ n ɔɪ n / . Tretinoin has been explored as
1131-464: The growth of T cell acute lymphoblastic leukemia . Topical tretinoin is for use only on the skin and should not be applied to eyes or mucosal tissues. Common side effects include skin irritation, redness, swelling, and blistering. If irritation is a problem, a decrease in the frequency of application to every other or every third night can be considered, and the frequency of application can be increased as tolerance improves. The fine skin flaking that
1170-420: The habitual sleeping positions which cause the wrinkles are altered. The wrinkles that occur in skin over 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 wrinkly. This wrinkling response may have imparted an evolutionary benefit by providing improved traction in wet conditions, and
1209-401: The inflammatory response in acne. Moreover, tretinoin and retinoids may enhance the penetration of other topical acne medications. The combination of the 10% benzoyl peroxide and light results in more than 50% degradation of tretinoin in about 2 hours and 95% in 24 hours. This lack of stability in the presence of light and oxidizing agents has led to the development of novel formulations of
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1248-554: The loss of the key driver oncogene. This degradation allows the blasts to mature and results in dramatic responses. This response is typically short-lived as Cyp26 genes are rapidly upregulated to degrade tretinoin. The RARA:PML oncogene is not present in other cancer types, thus explaining why tretinoin and other retinoids have not been effective across hundreds of different trials. For its use in acne, tretinoin (along with other retinoids) are vitamin A derivatives that act by binding to two nuclear receptor families within keratinocytes:
1287-467: 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 . Laser resurfacing is FDA-cleared skin resurfacing procedure in which lasers are used to improve the condition of the skin. Two types of lasers are used to reduce
1326-555: The nervous system, side effects include dizziness (20%), paresthesias (17%), anxiety (17%), insomnia (14%), depression (14%), confusion (11%), and many others at less than 10% frequency. In the urinary system, side effects include chronic kidney disease (11%) and several others at less than 10% frequency. For its use in Acute Promyelocytic Leukemia, tretinoin causes the RARA:PML fusion oncogene to degrade, resulting in
1365-444: The platysma and underlying investing layer of deep cervical fascia ). Superiorly, the SMAS extends to the galea aponeurotica of the scalp, becoming continuous with temporoparietal fascia (at the zygomatic arch ) and galea. It becomes continuous with the platysma muscle inferiorly (inferior to the inferior border of the mandible), and indistinct laterally (inferior to the zygomatic arch ). Anteromedially, it blends with
1404-485: The skin. This decrease in fluid would cause a decrease in tension, causing the skin to become wrinkly. This insight resulted in bedside tests for nerve damage and vasoconstriction. Wrinkling is often scored with immersion of the hands for 30 minutes in water or EMLA cream 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
1443-465: The skin. They are often a kind of soft tissue designed to enable injection into the skin for purposes of improving the appearance. The most common products are based on hyaluronic acid and calcium hydroxylapatite. Botulinum toxin is a neurotoxin protein produced by the bacterium Clostridium botulinum . Botox is a specific form of botulinum toxin manufactured by Allergan for both therapeutic and cosmetic use. Besides its cosmetic application, Botox
1482-406: 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 skin, causing them to fire more rapidly. Increased neuronal firing causes blood vessels to constrict, decreasing the amount of fluid underneath
1521-533: The “long" fibers in a folding state permanently. A small fold, namely a permanent wrinkle, then appears. Sleep wrinkles are created and reinforced when the face is compressed against a pillow or bed surface in side or stomach sleeping positions during sleep. They appear in predictable locations due to the underlying superficial musculoaponeurotic system (SMAS), 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
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