Criteria

Crinkles, glyphic wrinkles, linear furrows[40]

Crinkles

  • Fine wrinkling in aged skin, even in sun-protected areas

  • Disappear when the skin is stretched

  • Caused by deterioration of elastin, which keeps the epidermis in tight apposition to the dermis.

Glyphic wrinkles

  • Accentuation of the normal skin markings

  • Caused by sunlight-induced elastotic degeneration.

Linear furrows

  • Long, straight, or slightly curved grooves, usually on the face of older people

  • Include the horizontal frown lines of the forehead, 'crow's feet', and nasolabial folds.

Glogau score[41]

Wrinkles may be classified as:

  • Atrophic

  • Elastotic

  • Expressional

  • Gravitational.

and as:

  • Type I: no wrinkles

  • Type II: wrinkles in motion

  • Type III: wrinkles at rest

  • Type IV: only wrinkles.

Fitzpatrick wrinkle score[42]

Class I (score 1 to 3)

  • Fine wrinkles

  • Mild elastosis: fine textural changes with subtly accentuated skin lines.

Class II (score 4 to 6)

  • Fine to moderate-depth wrinkles of moderate number

  • Moderate elastosis: distinct elastosis, yellow translucency under direct light.

Class III (score 7 to 9)

  • Fine to deep wrinkles and numerous lines with or without redundant skin folds

  • Severe elastosis: multipapular and confluent elastosis; yellow, thickened skin; or consistent with cutis rhomboidalis.

Comprehensive grading scale for assessment of rhytides[30]

Rhytides scale based on number and severity

0: None

  • No wrinkles.

1: Mild

  • On motion: few, superficial.

1.5: Mild

  • On motion: multiple, superficial.

2: Moderate

  • At rest: few, localised, superficial.

2.5: Moderate

  • At rest: multiple, localised, superficial.

3: Advanced

  • At rest: multiple, on forehead, periorbital and perioral, superficial.

3.5: Advanced

  • At rest: multiple, generalised, superficial; a few deep.

4: Severe

  • Numerous, extensively distributed, deep.

Photoaged skin[43]

Mild (age 28 to 35 years)

  • Few wrinkles, no keratoses.

Moderate (age 35 to 50 years)

  • Early wrinkling, sallow complexion with early actinic keratoses.

Advanced (age 50 to 60 years)

  • Persistent wrinkling, discoloration of the skin with telangiectases and actinic keratoses.

Severe (age 65 to 70 years)

  • Severe wrinkling, photoageing, gravitational and dynamic forces affecting the skin, actinic keratoses with or without skin cancer.

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