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Disease and Condition

Definition

Wrinkles are a natural part of aging, but they’re most prominent on sun-exposed skin, such as the face, neck, hands and forearms. Although genetics are the most important determinant of skin structure and texture, sun exposure is the major contributor to wrinkles. Environmental exposure, such as to heat, wind and dust, as well as smoking, also may contribute to wrinkling.

If your wrinkles bother you, you have more options than ever to help eliminate or at least diminish their appearance. Medications, skin-resurfacing techniques, fillers, injectables and surgery top the list of effective wrinkle treatments.

Alternative medicine

Many wrinkle creams and lotions sold in department stores, in drugstores and on the Internet promise to reduce wrinkles and prevent or reverse damage caused by the sun. But these products are not likely to make a noticeable difference in your skin.

The Food and Drug Administration (FDA) classifies these creams and lotions as cosmetics, which are defined as having no medical value. So the FDA regulates them less strictly than it does drugs. This means that products don’t need to undergo rigorous testing for safety and effectiveness before approval to go on the market.

Because the FDA doesn’t evaluate cosmetic products for effectiveness, there’s no guarantee that any over-the-counter product will reduce your wrinkles.

Prevention

Here are ways to make the most of your skin’s appearance:

  • Protect your skin from the sun. Protect your skin — and prevent future wrinkles — by limiting the time you spend in the sun and always wearing protective clothing and hats. Also, use sunscreen when outdoors, even during winter.
  • Choose products with built-in sunscreen. When selecting skin care products, choose those with a built-in sun protection factor (SPF) of at least 30. Also, be sure to select products that are broad spectrum — meaning they block both UVA and UVB rays.
  • Use moisturizers. Dry skin shrivels plump skin cells, which can lead to premature fine lines and wrinkles. Though moisturizers can’t prevent wrinkles, they may temporarily mask tiny lines and creases.
  • Don’t smoke. Even if you’ve smoked for years or smoked heavily, you can still improve your skin tone and texture and prevent future wrinkles by quitting smoking.
  • Eat a healthy diet. There is some evidence that certain vitamins in your diet help protect your skin, particularly vitamins A, C, B-3 and E. More study is needed on the role of nutrition.

Treatments and drugs

If your wrinkles bother you, you have many options to help eliminate or at least reduce their appearance. Wrinkle treatments include:

Medications

  • Topical retinoids. Derived from vitamin A, retinoids that you apply to your skin may be able to reduce fine wrinkles, splotchy pigmentation and skin roughness. Retinoids must be used with a skin care program that includes daily broad-spectrum sunscreen application and protective clothing because the medication can make your skin burn more easily. It may also cause redness, dryness, itching, and a burning or tingling sensation. Tretinoin (Renova, Retin-A) and tazarotene (Avage, Tazorac) are examples of topical retinoids.
  • Nonprescription wrinkle creams. The effectiveness of anti-wrinkle creams depends in part on the active ingredient or ingredients. Retinol, alpha hydroxy acids, kinetin, coenzyme Q10, copper peptides and antioxidants may result in slight to modest improvements in wrinkles. However, nonprescription wrinkle creams contain lower concentrations of active ingredients than do prescription creams. Therefore results, if any, are limited and usually short-lived.

Surgical procedures and other techniques
A variety of skin-resurfacing techniques, injectables, fillers and surgical procedures are available to smooth out wrinkles. Each works a little differently and has its own set of potential results and side effects. Some studies indicate that a combination of treatments may yield the most satisfying results.

  • Dermabrasion. This procedure consists of sanding down (planing) the surface layer of your skin with a rapidly rotating brush. The planing removes the skin surface, and a new layer of skin grows in its place. Redness, scabbing and swelling generally last a couple of weeks. It may take several months for the pinkness to fade and for you to see the desired results.
  • Microdermabrasion. This technique is similar to dermabrasion, but less surface skin is removed. It’s done using a vacuum suction over your face while aluminum oxide crystals essentially sandblast your skin. Only a fine layer of skin is removed. You may notice a slight redness to the treated areas. Microdermabrasion usually requires repeated treatments to maintain the subtle, temporary results.
  • Laser, light source and radiofrequency treatments. In ablative (wounding) laser resurfacing, a laser beam destroys the outer layer of skin (epidermis) and heats the underlying skin (dermis), which stimulates the growth of new collagen fibers. As the wound heals, new skin forms that’s smoother and tighter. It can take up to several months to fully heal from ablative laser resurfacing. Newer developments in laser technology, such as nonablative fractional resurfacing, in which the laser divides the light up into many smaller pulses, have decreased the healing time. Nonablative lasers are less intense, so they don’t injure the epidermis. These treatments heat the dermis and cause new collagen and elastin formation. After several treatments, skin feels firmer and appears refreshed. Nonablative laser treatment typically needs to be repeated more often and results are subtle. There’s also a device that uses radiofrequency instead of light to heat the dermis and underlying tissue to achieve mildly to moderately tighter skin.
  • Chemical peel. Your doctor applies an acid to the affected areas, which burns the outer layer of your skin. With medium-depth peels, the entire epidermis and a small portion of the dermis are removed. New skin forms to take its place. The new skin is usually smoother and less wrinkled than your old skin. Redness lasts up to several weeks. With superficial peels, only a portion of the epidermis is removed. After a series of peels, you may notice less fine wrinkling in your skin and a fading of brown spots.
  • Botulinum toxin type A (Botox). When injected in small doses into specific muscles, Botox blocks the chemical signals that cause muscles to contract. When the muscles can’t tighten, the skin flattens and appears smoother and less wrinkled. Botox works well on frown lines between the eyebrows and across the forehead, and crow’s-feet at the corners of the eyes. Results typically last about three to four months. Repeat injections are needed to maintain results.
  • Soft tissue fillers. Soft tissue fillers, which include fat, collagen and hyaluronic acid (Restylane, Juvederm), can be injected into deeper wrinkles on your face. They plump and smooth out wrinkles and furrows and give your skin more volume. You may experience temporary swelling, redness and bruising in the treated area. The procedure may need to be repeated every few months.
  • Face-lift. The face-lift procedure involves removing excess skin and fat in your lower face and neck and tightening the underlying muscle and connective tissue. The results typically last five to 10 years. Healing times can be lengthy after a face-lift. Bruising and swelling are usually evident for several weeks after surgery.

Keep in mind that results vary depending on the location of your wrinkles and how deep your wrinkles are. However, nothing stops the aging process of skin, so you’ll likely need the treatments repeated to maintain benefits.

These procedures aren’t usually covered by insurance. In addition, any of the procedures can have side effects, so be sure to discuss them with your doctor. Make sure your dermatologist or plastic surgeon is specially trained and experienced in the technique you’re considering.

Preparing for your appointment

When you make an appointment with a dermatologist, it’s a good idea to prepare for your appointment by making a list of questions about your skin you want your doctor to answer. For wrinkles, some basic questions to ask your doctor include:

  • What is the best course of action?
  • What are my treatment options and the pros and cons for each?
  • What will the treatments cost? Does medical insurance cover these costs?
  • What results can I expect?
  • How often will I need to repeat the treatment?
  • What kind of follow-up, if any, should I expect?

Don’t hesitate to ask any other questions you have.

What to expect from your doctor
Your doctor is likely to ask you a number of questions, including:

  • What products, such as cleansers and moisturizers, do you use on your skin?
  • Do you use sunscreen?
  • Did you expose your skin to sun when you were younger?
  • Do you smoke or have you ever smoked?

Causes

Wrinkles are caused by a combination of factors — some you can control, others you can’t:

  • Age. As you get older, your skin naturally becomes less elastic and more fragile. Decreased production of natural oils makes your skin drier and appear more wrinkled. Fat in the deeper layers of your skin, which gives the skin a plump appearance, starts to diminish. This causes loose, saggy skin and more-pronounced lines and crevices.
  • Exposure to ultraviolet (UV) light. Ultraviolet radiation markedly speeds up the natural aging process and is the primary cause of early wrinkling. Exposure to UV light breaks down your skin’s connective tissue — collagen and elastin fibers, which lie in the deeper layer of skin (dermis). Without the supportive connective tissue, your skin loses its strength and flexibility. As a result, skin begins to sag and wrinkle prematurely.
  • Smoking. Smoking can accelerate the normal aging process of your skin, contributing to wrinkles. This may be due to changes in the blood supply to your skin.
  • Repeated facial expressions. Facial movements and expressions, such as squinting or smiling, lead to fine lines and wrinkles. Each time you use a facial muscle, a groove forms beneath the surface of the skin. And as skin ages, it loses its flexibility and is no longer able to spring back in place. These grooves then become permanent features on your face.
  • Gender. Women tend to develop more wrinkles around their mouths (perioral) than men do. That may be because women have fewer sweat glands and glands that secrete an oily matter known as sebum (sebaceous glands) to lubricate the skin and fewer blood vessels in this area.
  • Poor nutrition. Nutritional deficiencies are believed to contribute to skin aging.

Symptoms

Wrinkles are the lines and creases that form in your skin. Some wrinkles can become deep crevices or furrows and may be especially noticeable around your eyes, mouth and neck.

When to see a doctor
If you’re concerned about the appearance of your skin, see a dermatologist. He or she can help you create a personalized skin care plan by assessing your skin type and evaluating your skin’s condition. A dermatologist can also recommend medical wrinkle treatments.

June 23, 2015

wrinkles

Definition Wrinkles are a natural part of aging, but they’re most prominent on sun-exposed skin, such as the face, neck, hands and forearms. Although genetics are the most important determinant of skin structure and texture, sun exposure is the major contributor to wrinkles. Environmental exposure, such as to heat, wind and dust, as well as smoking, also may contribute to wrinkling. If your wrinkles bother you, you have more options than ever to help eliminate or at least diminish their appearance. Medications, skin-resurfacing techniques, fillers, injectables and surgery top the list of effective wrinkle treatments. Alternative medicine Many wrinkle creams and lotions sold in department stores, in drugstores and on the Internet promise to reduce wrinkles and prevent or reverse damage caused by the sun. But these products are not likely to make a noticeable difference in your skin. The Food and Drug Administration (FDA) classifies these creams and lotions as cosmetics, which are defined as having no medical value. So the FDA regulates them less strictly than it does drugs. This means that products don’t need to undergo rigorous testing for safety and effectiveness before approval to go on the market. Because the FDA doesn’t evaluate cosmetic products for effectiveness, there’s no guarantee that any over-the-counter product will reduce your wrinkles. Prevention Here are ways to make the most of your skin’s appearance: Protect your skin from the sun. Protect your skin — and prevent future wrinkles — by limiting the time you spend in the sun and always wearing protective clothing and hats. Also, use sunscreen when outdoors, even during winter. Choose products with built-in sunscreen. When selecting skin care products, choose those with a built-in sun protection factor (SPF) of at least 30. Also, be sure to select products that are broad spectrum — meaning they block […]
June 23, 2015

wrist pain

Definition Wrist pain is a common complaint. Many types of wrist pain are caused by sudden injuries that result in sprains or fractures. But wrist pain also can be caused by more long-term problems — such as repetitive stress, arthritis and carpal tunnel syndrome. Because so many factors can lead to wrist pain, diagnosing the exact cause of long-standing wrist pain sometimes can be difficult. An accurate diagnosis is crucial, however, because proper treatment depends on the cause and severity of your wrist pain. Prevention It’s impossible to prevent the unforeseen events that often cause wrist injuries, but these basic tips may offer some protection: Build bone strength. Getting adequate amounts of calcium — at least 1,200 milligrams a day for women over age 50, or 1,000 milligrams a day for most adults — can help prevent fractures. Prevent falls. Falling forward onto an outstretched hand is the main cause of most wrist injuries. To help prevent falls, wear sensible shoes. Remove home hazards. Light up your living space. And install grab bars in your bathroom and handrails on your stairways, if necessary. Use protective gear for athletic activities. Wear wrist guards for high-risk activities, such as football, snowboarding and rollerblading. Pay attention to ergonomics. If you spend long periods at a keyboard, take regular breaks. When you type, keep your wrist in a relaxed, neutral position. An ergonomic keyboard and foam or gel wrist support may help. Lifestyle and home remedies Not every cause of wrist pain requires medical treatment. For a minor wrist injury, you may want to try putting ice on it and wrapping your wrist with an elastic bandage. Treatments and drugs Treatments for wrist problems vary greatly, depending on the type, location and severity of the injury, as well as on your age and overall […]
June 23, 2015

yeast infection

Definition A vaginal yeast infection is a type of vaginitis — inflammation of the vagina — characterized by vaginal irritation, intense itchiness and vaginal discharge. A vaginal yeast infection affects your vagina and the tissues at the opening to your vagina (vulva). Vaginal yeast infection — also called candidiasis — is very common. As many as 3 out of 4 women experience a yeast infection at some point in their lifetimes. Many women experience two or more yeast infections. A vaginal yeast infection isn’t considered a sexually transmitted disease, although the fungus that causes the condition can be spread through oral-genital contact. Treatment is usually effective, unless you have recurrent yeast infections — four or more in a single year. In that case, you may need a longer course of therapy and to follow a maintenance regimen. Prevention To reduce your risk of vaginal yeast infection: Avoid douching. Don’t use scented tampons, pads, bubble baths or feminine hygiene sprays. Wear cotton underwear and loosefitting pants or skirts. Avoid tightfitting underwear or pantyhose. Change out of wet clothes, such as swimsuits or workout attire, as soon as possible. Stay out of hot tubs or very hot baths. Lifestyle and home remedies A number of natural products purport to prevent or cure vaginal yeast infections without prescription medication. Some popular yeast infection home remedies include: Vinegar douches Tea tree oil cream Garlic or boric acid vaginal suppositories Anecdotally, some women report success with these home remedies. However, well-designed, randomized, controlled trials are needed to investigate the safety and effectiveness of these therapies before any reliable clinical recommendations can be made. One exception may be lactobacillus, bacteria normally found in the vagina, but scientific evidence of benefit is limited. Some studies show that lactobacillus — available in some types of yogurt — taken […]
June 23, 2015

yellow fever

Definition Yellow fever is a viral infection spread by a particular species of mosquito. It’s most common in areas of Africa and South America, affecting travelers to and residents of those areas. In mild cases, yellow fever causes fever, headache, nausea and vomiting. But yellow fever can become more serious, causing heart, liver and kidney problems along with bleeding (hemorrhaging). Up to 50 percent of people with the more severe form of yellow fever die of the disease. There’s no specific treatment for yellow fever. But getting a yellow fever vaccine before traveling to an area in which the virus is known to exist can protect you from the disease. Prevention Vaccine A safe and highly effective vaccine prevents yellow fever. Yellow fever is known to be present in sub-Saharan Africa and parts of South America. Talk to your doctor about whether you need the yellow fever vaccine at least 10 to 14 days before traveling to these areas or if you are a resident of one of them. Some of these countries require a valid certificate of immunization in order to enter the country. A single dose of the vaccine provides protection for at least 10 years. Side effects of the yellow fever vaccine are usually mild, lasting five to 10 days, and may include headaches, low-grade fevers, muscle pain, fatigue and soreness at the site of injection. More-significant reactions — such as developing a syndrome similar to actual yellow fever, inflammation of the brain (encephalitis) or death — can occur, most often in infants and older adults. The vaccine is considered safest for those between the ages of 9 months and 60 years. Talk to your doctor about whether the yellow fever vaccine is appropriate if your child is younger than 9 months, if you have a weakened […]
June 23, 2015

yips

Definition Yips are involuntary wrist spasms that occur most commonly when golfers are trying to putt. However, the yips can also affect people who play other sports — such as cricket, darts and baseball. It was once thought that the yips were always associated with performance anxiety. However, it now appears that some people have yips that are caused by a focal dystonia, which is a neurological dysfunction affecting specific muscles. Some people have found relief from the yips by changing the way they perform the affected task. For example, a right-handed golfer might try putting left-handed. Treatments and drugs Because the yips may be related to overuse of specific muscles, a change of technique or equipment may help. Possible strategies include: Change your grip. This technique works for many golfers, because it changes the muscles you use to make your putting stroke. However, if you have the type of yips related to performance anxiety, changing your grip likely won’t make much difference. Use a different putter. A longer putter allows you to use more of your arms and shoulders and less of your hands and wrists while putting. Other putters are designed with a special grip to help stabilize the hands and wrists. Mental skills training. Techniques such as relaxation, visualization or positive thinking can help reduce anxiety, increase concentration and ease fear of the yips. Preparing for your appointment While you may initially consult your family physician, he or she may refer you to a doctor who specializes in sports medicine. What you can do You may want to write a list that includes: Detailed descriptions of your symptoms Information about medical problems you’ve had Information about the medical problems of your parents or siblings All the medications and dietary supplements you take Questions you want to ask […]
June 23, 2015

zollinger ellison syndrome

Definition Zollinger-Ellison syndrome is a complex condition in which one or more tumors form in your pancreas, the upper part of your small intestine (duodenum) or the lymph nodes adjacent to your pancreas. These tumors, called gastrinomas, secrete large amounts of the hormone gastrin, which causes your stomach to produce too much acid. The excess acid, in turn, leads to peptic ulcers. Zollinger-Ellison syndrome, also called ZES, is rare. The disease may occur at any time in life, but people are usually diagnosed between ages 20 and 50. It’s slightly more common in men. Treatment for Zollinger-Ellison syndrome most often consists of medications to reduce stomach acid and heal the ulcers. Surgery to remove the tumors may be an option for some people with Zollinger-Ellison syndrome. Treatments and drugs In treating Zollinger-Ellison syndrome, doctors treat the tumors as well as the ulcers. If your doctor can remove the tumors, which are what cause the ulcers, then ulcer treatment may no longer be needed. Treatment of tumors An operation to remove the tumors that occur in Zollinger-Ellison requires a skilled surgeon because the tumors are often small and difficult to locate. If you have just one tumor, your doctor may be able to remove it surgically, but surgery may not be an option if you have multiple tumors or tumors that have spread to your liver. On the other hand, even if you have multiple tumors, your doctor still may recommend removing a single large tumor. In some cases, doctors advise other treatments to control tumor growth, including: Removing as much of a liver tumor as possible (debulking) A liver transplant Attempting to destroy the tumor by cutting off the blood supply (embolization) or by using heat to destroy cancer cells (radiofrequency ablation) Injecting drugs into the tumor to relieve cancer […]