积雪苷治疗35例鱼尾纹12周疗效观察

目的 评估积雪苷治疗鱼尾纹的临床疗效及安全性.方法 采用12周随机、双盲、赋形剂自身对照试验,通过第0、4、8、12周研究者盲法评价皱纹程度、受试者盲法自评、仪器测量3个方面评价试验用药侧与对照侧鱼尾纹的改善情况.结果 完成试验的35名受试者的双侧鱼尾纹程度根据研究者盲法评估,在使用第4周,治疗组与对照组的皱纹变化有统计学意义(P＜0.05).在第8、12周试验用药侧的皱纹程度的减轻优于对照侧,皱纹评分具有统计学意义(P＜0.05).采用Visioscan VC98定量测量双侧鱼尾纹SEw值结果显示,试验用药侧随时间的变化SEw的值增大,即皱纹程度减轻,与对照侧相比,差异有统计学意义.受试者评估显示,双侧药物在使用过程中刺激性及粗皱纹的改善情况无差异,外眦部位肌肤纹理改善方面治疗侧优于对照侧(P＜0.05).结论 积雪苷霜软膏每日3次局部外用改善鱼尾纹有一定疗效,无不良反应.     

Skin ageing: clinical and histopathologic study of permanent and reducible wrinkles

Wrinkles are modifications of the skin associated with cutaneous ageing and develop preferentially on sun-exposed skin. The aim of the study was to analyse the clinicopathological features of wrinkles, among the different types of skin relief modifications. Despite its importance in dermato-cosmetology and skin ageing, few studies have been specifically devoted to wrinkles. In the present study, we analyzed the histological features of the pre-auricular wrinkle compared to retro-auricular skin, obtained from sixteen patients undergoing facial surgery; skin samples were immediately processed for routine histology and histochemical staining. Four types of skin depressions could be defined according to their depth: folds, permanent wrinkles, reducible wrinkles and skin micro-relief. Two different types of pre-auricular wrinkles were observed: (i) permanent wrinkles which were conserved after sampling and, (ii) reducible wrinkles which required in vivo staining to be visible at histology. Histological analysis of the epidermis and dermis of the skin forming the pre-auricular wrinkle revealed a normal skin morphology, identical to that of the skin immediately adjacent to the wrinkle. This was particularly striking for the reducible wrinkles which could not be individualized in the absence of in vivo staining. Both types of wrinkles comprised skin modifications observed in sun-exposed skin, however, in the upper dermis, permanent wrinkles showed a more pronounced accumulation of basophilic fibers, i.e. actinic elastosis, than reducible wrinkles did. These data suggest that the development of wrinkles could be secondary to actinic elastosis and to the disappearance of microfibrils and collagen fibers at the dermal-epidermal junction.     

Supraciliary wrinkles and botulinum toxin A

Background. Injection of botulinum toxin into certain areas of face that carry a high risk of ptosis (danger zone) needs caution in application. An example is the lateral forehead, particularly the lower portion. Aim. In this study, we evaluated the efficacy and safety of treating supraciliary wrinkles in the lower lateral forehead by injections of botulinum toxin at the temporal hairline, keeping a reasonable distance from danger zone. Methods. In this randomized clinical trial, 40 women (mean age 35 years) were selected and divided into two groups, A and B. both groups were treated with botulinum toxin to treat wrinkles in the frown area, as well as frontal lines and lateral canthus lines. Group B received extra injections at each temporal line for treatment of supraciliary wrinkles. Results. There was a significant difference in total wrinkle number and mean number of wrinkles between the two groups after injections (paired t‐test, P < 0.01). No ptosis was seen in either group. Conclusions. Injection of botulinum toxin type A through the temporal hairline to correct supraciliary wrinkles seems to be safe and effective.     

Correlation of skin phototype with facial wrinkle formation

Facial wrinkle formation is a representative sign of photoaging. Skin can be divided into different skin phototypes (SPTs) depending on its sensitivity to solar radiation. We have determined the relationship between SPTs and deep and fine wrinkle scores on the faces of 230 Japanese subjects. This group was chosen because it is relatively easy to quantify acute and chronic sun damage in Japanese individuals. SPT in the Japanese subjects was classified into one of four groups, SPT-I to -IV according to Fitzpatrick's classification method. The subjects were further classified into indoor or outdoor workers. After photographing the outer canthus, deep and fine wrinkles were discriminated visually and scored from 1–11 and from 1–9, respectively. UV light was used as a photographic light source for clear depiction of the fine wrinkles. Higher scores were recorded for deep wrinkles in individuals with SPT-I, who are more sensitive to sunlight than those with SPT-III or IV, who are more tolerant to sunlight. However, the same tendency did not seem to be apparent for fine wrinkle scores. A high incidence of SPT-IV was seen in outdoor workers. Early detection of SPT-I in individuals who are sensitive to sunlight, may help to predict and prevent photoaging of deep wrinkles. Sensitivity to sunlight may play a part in determining an individual's choice of working environment.     

The severity of wrinkling at the forehead is related to the degree of ptosis of the upper eyelid

Background: Most studies on wrinkle formation have focused on changes in the dermal condition that promote the fixation of transiently formed wrinkles. Little is known about the age‐dependent changes in transient wrinkle formation in response to altered facial expression or the mechanism leading to fixed wrinkle formation. Objective: To clarify the mechanism of wrinkle formation at the forehead, we investigated the factors that influence the severity of transient wrinkling and the relationship of transient with fixed wrinkles, using a newly established method to evaluate transient wrinkle formation. Methods: Transient wrinkles were generated by requesting subjects to gaze in an upward direction. Foreheads of the subjects with or without an upward gaze at a fixed angle were photographed and the severity of wrinkles at the forehead was graded from 0 to 5 in 50 healthy Japanese female volunteers in their 20s, 40s, or 60s. Skin elasticity was measured using a Cutometer^®. Frontalis muscle activity and ptosis of the upper eyelid were estimated by measuring movement of the eyebrow during upward gazing and the position of the upper eyelid of the open eye, respectively. Results: Wrinkles formed transiently at the forehead by upward gazing were highly reproducible in each subject. Their severity increased with aging and was highly correlated to that of fixed wrinkles (R=0.81, P<0.001). Therefore, this method appears to be suitable for studying the mechanism of transient wrinkle formation and the relationship between transient and fixed wrinkles at the forehead. The severity of transient wrinkles was correlated with elevation of the eyebrow during upward gazing (R=0.69, P<0.001), but not with dermal elasticity. This suggests that transient wrinkles are induced by increased frontalis muscle activity during upward gazing. Frontalis muscle activation was negatively correlated with upper eyelid position (R=−0.37, P<0.05), which descended with aging, meaning ptosis of the upper eyelid, and negatively correlated with the severity of transient wrinkles induced by upward gazing (R=−0.43, P<0.05). Furthermore, the upper eyelid position was also negatively correlated with the severity of fixed wrinkles (R=−0.44, P<0.05). Conclusion: These results suggest that ptosis of the upper eyelid is associated with increased activation of the frontalis muscle during upward gazing and increased severity of transient and fixed wrinkling at the forehead.     

The Fabi-Bolton chest wrinkle scale: a pilot validation study

Up until now, no objective scale has existed to evaluate chest wrinkles and assess the efficacy of treatment. This study was designed to validate a new photonumeric wrinkle assessment scale using standardized photographic methodology to obtain reference photographs. Multiple photographs from 28 volunteer subjects with varying degrees of chest wrinkles were evaluated by a study team of two independent physicians. Photographs of 16 subjects representing the full spectrum of chest wrinkle severity were selected and classified using the Fabi–Bolton (F–B) 5‐point wrinkle scale (1 = wrinkles absent; 2 = shallow but visible wrinkles; 3 = moderately deep wrinkles; 4 = deep wrinkles, with well‐defined edges; 5 = wrinkles very deep with redundant folds). One representative photograph was chosen by study team consensus for each of the five scale points. A second, independent group of evaluators rated the randomly arranged photographs using the F–B wrinkle scale. The numeric results were then tabulated and compared. The F–B wrinkle scale provided a reproducible and effective method for assessing chest wrinkles with very little interrater variability. The F–B wrinkle scale is a reliable tool for the classification of chest wrinkles and evaluation of therapeutic and cosmetic interventions.     

Relationship between the echogenicity of subcutaneous tissue and the depth of forehead wrinkles

Background/purpose: Subcutaneous tissue is rarely studied in research on wrinkles. We used diagnostic ultrasonography to produce images of subcutaneous tissue of the forehead, one of the areas where age‐related wrinkles form. We quantified the resulting echogenicity and investigated its relationship with wrinkle depth. Methods: One hundred and seventy‐three Japanese subjects were divided into four age groups (21–28 years, 35–41 years, 47–59 years, 65–75 years). Maximum wrinkle depth (R_max) was measured in the forehead. On an ultrasound image, which was captured by scanning perpendicular to the deepest wrinkle, we set a 12.5‐mm‐wide region of interest by aligning the deepest point of the wrinkle at its center and then obtained the ratio of the area exceeding this threshold to the total area as the echogenicity. Results: R _max increased and the echogenicity decreased with age. A negative correlation was found in the oldest group but was not found in other groups, presumably due to individual differences in the echogenicity among younger subjects. Conclusion: This study suggests that the internal structure of subcutaneous tissue, as observed by ultrasonography, is related to wrinkle depth. The relationship between wrinkle depth and echogenicity of subcutaneous tissue is particularly pronounced in the elderly.     

Lysozyme in abnormal dermal elastic fibers of cutaneous aging, solar elastosis and pseudoxanthoma elasticum

Staining of elastic fibres with antilysozyme antibodies has been noted previously. In this study, we examined the staining pattern of dermal elastic fibres in aging, solar elastosis, and lesional skin of pseudoxanthoma elasticum (PXE) using an antibody to lysozyme and the indirect-peroxidase technique. To assess the effects of aging, sun-protected skin (buttock) from a younger and an older group of patients was used. Sun damage was studied in skin specimens from varying sun-exposed body regions (trunk; head and neck). No staining was seen in sun-protected skin from younger individuals, whereas sun-protected skin from older persons had scattered positive fibres. Solar elastotic material was intensely positive and the number of positive fibres appeared to correlate with the amount of sun damage. Abnormal elastic fibres in PXE also stained positively, but less intensely, than fibres in solar elastosis. This study shows that changes in the elastic fibres due to degenerative processes or genetic factors results in altered antigenic expression of the fibres. This may be an epiphenomenon secondary to changes in proteoglycans, which are known to occur with solar elastosis and PXE, or may represent an adaptive phenomenon to maintain the elastic properties of the altered fibres or to decrease their antigenicity.     

Non-invasive evaluation of dermal elastosis by in vivo multiphoton tomography with autofluorescence lifetime measurements

The non-invasive differentiation of dermal elastic fibres from solar elastosis in vivo is of great interest in dermatologic research, especially for efficacy testing of anti-ageing products. To date, no studies on multiphoton excited fluorescence lifetime characteristics of human elastic fibres and solar elastosis are reported. The goal of the present work was the identification of differential criteria for elastic fibres and solar elastosis by the analysis of fluorescence decay curves acquired by time-correlated single photon counting in vivo multiphoton tomography. For this purpose, fluorescence lifetime measurements (FLIM) were performed with 47 volunteers of different age groups at sun-protected and sun-exposed localizations. Bi-exponential curve fitting was applied to the FLIM data, and characteristic differences between age groups and localizations were found in both relevant fit parameters describing the decay slope. The FLIM analyses have shown that dermal autofluorescence has different lifetimes depending on age and in part on localization.     

Bullous solar elastosis

Solar elastosis is a recognized manifestation of chronic sun exposure affecting mainly Caucasian skin. Recognizable clinical manifestations of solar elastosis include cutis rhomboidalis nuchae, Favre-Racouchot syndrome, actinic comedonal plaque, nodular forms such as elastomas, elastic nodule of the ear and elastotic bands, collagenous plaques of the hand, and colloid milia. We report two patients with an unusual presentation of vesicular lesions clinically and histopathologically situated in zones of severe solar elastosis that has been previously referred to as bullous solar elastosis.     

Scanning electron microscope studies of solar elastosis

Scanning electron microscope findings of solar elastosis were compared with those of normal dermis in specimens digested by hyaluronidase and by autoclaving. Solar elastosis showed amorphous masses and broad fibres with irregular shapes and sizes in specimens digested by hyaluronidase, while it showed only fibrous structures in those after autoclaving. It is suggested that the origin of solar elastosis is elastic tissue.     

Fibrillin-rich microfibrils are reduced in photoaged skin. Distribution at the dermal-epidermal junction

Chronic sun exposure results in photoaged skin with deep coarse wrinkles and loss of elasticity. We have examined the distribution and abundance of fibrillin-rich microfibrils, key structural components of the elastic fiber network, in photoaged and photoprotected skin. Punch biopsies taken from photoaged forearm and from photoprotected hip and upper inner arm of 16 subjects with a clinical range of photoaging were examined for fibrillin-1 and fibrillin-2 expression and microfibril distribution. In situ hybridization revealed decreased fibrillin-1 mRNA but unchanged fibrillin-2 mRNA levels in severely photoaged forearm biopsies relative to photoprotected dermal sites. An immunohistochemical approach demonstrated that microfibrils at the dermal-epidermal junction were significantly reduced in moderate to severely photoaged forearm skin. Confocal microscopy revealed that the papillary dermal microfibrillar network was truncated and depleted in photoaged skin. These studies highlight that the fibrillin-rich microfibrillar network associated with the upper dermis undergoes extensive remodeling following solar irradiation. These changes may contribute to the clinical features of photoaging, such as wrinkle formation and loss of elasticity.     

Mechanics of wrinkle formation: micromechanical analysis of skin deformation during wrinkle formation in ultraviolet‐irradiated mice

Background/purpose: The mechanical aspects of wrinkle formation were studied in the dorsal skin of hairless mice. Methods: Wrinkles were induced by irradiating with ultraviolet (UV) B for 10 weeks, while observing skin deformation during wrinkle formation. Changes in skin dimensions were also observed during the specimen excision process. Wrinkle depth and interval were measured before and after removal of the cutaneous muscle layer. Local deformation of wrinkled skin during uniaxial stretch was also measured. Changes in curvature of skin specimens upon muscle layer removal were then observed to determine the force balance in skin layers. Results: The skin showed spontaneous contraction in response to UV irradiation. Wrinkled skin showed a marked decrease in the wrinkle depth and a slight increase in wrinkle interval following muscle layer removal, a peculiar mechanical response that cannot be explained by homogeneous deformation of the skin. This response was due to compressive deformations of dermal tissue caused by the muscle layer and concentrated at valleys of the wrinkles. Curvature measurements indicated that the muscle layer compressed the dermal tissue predominantly in the craniocaudal direction. Morphological observations showed that the wrinkles coincided with rows of pores and sulci cutis, where the structural stiffness of the horny layer was relatively low. The horny layer showed significant thickening. Conclusion: Taken together, we propose the following hypothetical mechanisms of wrinkle formation during UV irradiation: spontaneous contraction of the dermis while maintaining or increasing the epidermal area induces buckling of the epidermis into the dermis at mechanically weak lines, namely, the rows of pores and sulci cutis, and buckling may be amplified by the axial compression of the dermis by the muscle layer.     

Age-related changes in skin wrinkles assessed by a novel three-dimensional morphometric analysis

BACKGROUND: A system has been developed whereby the morphology of the skin surface can be evaluated directly in three dimensions. This system employs a non-invasive device that utilizes white light of halogen origin, and which allows the computation of wrinkle depth and width, and other parameters of skin surface morphology. Using innovative engineering, an optical system has been devised so that light is transmitted via a slit and can be used to measure not only replicas of the skin but also the skin surface directly. The measurement area is 6.4 x 6.4 mm, and the theoretical resolution with a x 50 magnification lens is within 12.5 micro m. OBJECTIVES: To use this system to study age-related changes in the morphology of wrinkles at the eye corner areas of women of varying ages. METHODS: One hundred and one healthy women (age range 20-80 years) residing in the Tokyo area were the subjects used in this study. RESULTS: Wrinkles demonstrated a rapid increase in depth in women aged 40 years or older, and plateaued at the age of 60 years. Surface morphology parameters yielded results similar to those of age-related changes in wrinkles. CONCLUSIONS: This new analytical system provides a rapid and convenient non-invasive method to evaluate skin surface morphology in three dimensions, especially with respect to wrinkle formation. The results obtained using this system provide a deeper insight into the mechanistic relationship between wrinkles and skin elasticity.     

From skin microrelief to wrinkles. An area ripe for investigation

Skin microrelief alters progressively with age. Wrinkles do not result from these changes but are superimposed upon them. Wrinkles result from structural changes in the epidermis, dermis and hypodermis. Four types of wrinkles can be recognized. Type 1 wrinkles are atrophic. Type 2 wrinkles are elastotic. Type 3 wrinkles are expressional. Type 4 wrinkles are gravitational. Each type of wrinkle is characterized by distinct microanatomical changes and each type of wrinkle develops in specific skin regions. Each is likely to respond differently to treatment. Skin microrelief and skin folds can be identified on histological examination. By contrast, only minimal dermal changes are found beneath permanent or reducible wrinkles compared with immediately adjacent skin. A series of objective and non-invasive methods is available to quantify the severity of wrinkling.     

Pseudoxanthoma-like late-onset focal dermal elastosis

A 73-year-old woman presented with a 10-year history of asymptomatic coalescent flat pale yellow lesions forming a cobblestone pattern that resembled pseudoxanthoma elasticum over her neck, upper trunk and axillae. Skin biopsies from both the neck and axilla showed focal upper dermal elastosis with increase in structurally normal elastic fibres. There was no evidence of either pseudoxanthoma elasticum or solar elastosis in either biopsy. This under-recognized presentation has previously been identified as a distinct clinicopathological entity and termed late-onset focal dermal elastosis.     

Retinyl retinoate,a novel hybrid vitamin derivative,improves photoaged skin: a double‐blind,randomized‐controlled trial

Background: All‐trans‐retinoic acid (RA) and all‐trans‐retinol (ROL) are not widely used as anti‐wrinkle agents due to their irritancy and photo‐stability, respectively. Therefore, the safety and photo‐stability in the development of RA or ROL derivatives have been an important issue. Aim: To identify the efficacy of retinyl retinoate as an anti‐aging agent of cosmetics in treating females over 30 years old with periorbital wrinkles. Methods: The clinical study was a prospective, double‐blind, randomized, and controlled study with a total of 11 Korean women. At every 4 weeks, the effectiveness was assessed with a global photodamage score, photographs, and image analysis using replicas and visiometers. The dermal distance and intensity was also evaluated using Dermascan C. Results: A statistically significant improvement in facial wrinkles (P<0.05) in eleven volunteers was observed in a clinical trial. The successive application of 0.06% retinyl retinoate cream for 3 months showed decreased depth and area of wrinkles in comparison with 0.075% retinol cream. The visual wrinkle improvement and the maximum roughness improvement rate (R2) for retinyl retinoate cream were 22% higher than that of retinol cream after 12 weeks. A statistically significant increase was observed after 8 and 4 weeks for dermal distance and dermal intensity, respectively (P<0.05). Conclusions: Retinyl retinoate had characteristic features of new anti‐aging agents, and effectively improved facial wrinkle conditions.     

Inhibition of ultraviolet-B-induced wrinkle formation by an elastase-inhibiting herbal extract: implication for the mechanism underlying elastase-associated wrinkles

BACKGROUND: Previously, we have demonstrated that fibroblast-derived elastase plays an essential role in the increased three-dimensional tortuosity of elastic fibers, contributing to the loss of skin elasticity in UV-B-exposed skin. This decrease in skin elasticity is closely associated with the formation of wrinkles induced by UV exposure. OBJECTIVE: To further clarify the role of elastase in the formation of wrinkles induced by UV exposure, we assessed the effects of an extract of Zingiber officinale (L.) Rose (which inhibits fibroblast-derived elastase) on the wrinkle formation induced by chronic UV-B irradiation. RESULTS: Topical application of an extract of Zingiber officinale (L.) Rose to rat or hairless mouse skin significantly inhibited the wrinkle formation induced by chronic UV-B irradiation at a suberythemal dose, which was accompanied by a significant prevention of the decrease in skin elasticity in both types of animal skin. In the rat hind limb skin, consistent with the inhibition of reduced skin elasticity, wrinkle prevention occurred concomitantly with a significant decrease in the curling and three-dimensional tortuosity of dermal elastic fibers. CONCLUSION: Our results indicate that herbal extracts with an ability to inhibit fibroblast-derived elastase may prove to be effective as anti-wrinkling agents, confirming the important role of elastase in UV-B-induced wrinkle formation.     

Treatment of periorbital wrinkles with 1550‐ and 1565‐nm Er:glass fractional photothermolysis lasers: a simultaneous split‐face trial

Objective This study aimed to compare the clinical efficacies of 1550‐ and 1565‐nm Er:glass lasers in the treatment of periorbital wrinkles and to evaluate histological changes after treatment. Methods Twenty patients received five treatments each at 3‐week intervals. The right periorbital area was exposed to the 1550‐nm Er:glass laser and the left periorbital area was exposed to the 1565‐nm Er:glass laser. Clinical improvement was evaluated by two blinded physicians who assessed comparative photographs using a four‐point scale at baseline and 3 months after the final treatments. Skin biopsies were performed in five volunteers before treatment and at 3 months after the final treatment. Results The mean improvement scores 3 months after treatment with the 1550‐ and 1565‐nm Er:glass lasers were 2.25 ± 0.62 and 2.28 ± 0.59 respectively. Histological examination revealed increased epidermal thickening and decreased solar elastosis 3 months after the final laser treatments. Conclusions Both 1550‐ and 1565‐nm Er:glass lasers are safe and effective modalities in the treatment of periorbital wrinkles with no significant differences between the two lasers.     

女性外眦皱纹(鱼尾纹)分型及相关因素的分析

目的分析中国女性外眦皱纹(鱼尾纹)类型特征及其相关因素。方法采用问卷调查的方法收集人口社会学一般资料以及调查可能影响皮肤老化的主要相关因素。使用图像分析仪SIA0612标准化拍照,采用VisioscanVC98(CK Electronic Gmb H,Germany)进行外眦区域皱纹测量。Photoshopcs2截取双侧眼角固定比率皮肤图像。采用Lemperle分级标准将外眦皱纹分为0～5级。依照Kane鱼尾纹分型对研究对象外眦皱纹进行分型。结果共调查150名南京地区中国女性,年龄19～59岁,平均年龄37.9岁,Fitz-patrick皮肤类型以Ⅲ型为主(占66%),运动状态时(闭眼微笑)时在19～25岁组鱼尾纹发生率是22.2%,在40～44岁年龄组达到100%。115名具有外眦皱纹的中国女性受试者分型以Ⅳ型为主,与白人女性不同。其中,Ⅰ型(完全扇型)13人(11.30%),Ⅱ型(下睑上颊型)12人(10.43%),Ⅲ型(上睑型)14人(12.17%),Ⅳ型(正中型)76人(66.09%)。分析皱纹分型与年龄的关系无统计学意义(P0.05),并与Fitzpatric皮肤类型不相关(P0.05),但与青年期(19～29岁)日晒情况具有统计学差异(P0.05)。结论外眦皱纹分型是独立于皱纹分级概念的,与年龄无关。本次调查的中国女性外眦皱纹分型与白人女性不同,以Ⅳ型为主,肉毒素治疗鱼尾纹时需要考虑分型的差异。青年期日晒情况可能是影响分型的因素。