Summary
Definition
History and exam
Key diagnostic factors
- idade >40 anos
- exposição ao sol crônica
- tabagismo
- linhas no rosto
- dobras horizontais no pescoço
- linhas no dorso das mãos e nos punhos
- linhas dinâmicas
- linhas gravitacionais
- rugas profundas
- rugas finas
Other diagnostic factors
- frouxidão da pele
- discromia
- dermoelastose
- eritema
- telangiectasia
- alterações de textura
- ceratoses actínicas
Risk factors
- susceptibilidade genética
- idade >40 anos
- pele branca
- atividade muscular hiperdinâmica
- exposição ao sol crônica
- tabagismo
- poluição
- classe socioeconômica baixa
- baixo índice de massa corporal (IMC)
Diagnostic tests
1st tests to order
- macrofotografia
Tests to consider
- biópsia de pele
Emerging tests
- perfilômetro
- microscopia confocal in vivo
Treatment algorithm
nenhuma ruga óbvia em repouso ou em movimento
rugas superficiais somente em movimento
rugas profundas somente em movimento
rugas superficiais em repouso, rugas profundas em movimento
rugas profundas e pele flácida em repouso e rugas mais profundas em movimento
Contributors
Authors
Dimitrios Dionyssiou, MD, PhD

Associate Professor in Plastic Surgery
Department of Plastic Surgery
Aristotle University of Thessaloniki
Thessaloniki
Greece
Disclosures
DD declares that he has no competing interests.
Efterpi Demiri, MD, PhD

Professor in Plastic Surgery
Department of Plastic Surgery
Aristotle University of Thessaloniki
Thessaloniki
Greece
Disclosures
ED declares that she has no competing interests.
Elisavet Lazaridou, MD, PhD

Professor
Second Department of Dermatology
Aristotle University of Thessaloniki
Thessaloniki
Greece
Disclosures
EL declares that she has no competing interests.
Peer reviewers
George Hruza, MD
Clinical Professor of Dermatology and Otolaryngology
St. Louis University
St. Louis
Director
Laser and Dermatologic Surgery Center
Chesterfield
MO
Disclosures
GH has been reimbursed by Allergan, Dermik, and Colbar Life Sciences to attend educational symposia and has also been paid to teach other physicians. GH is a consultant for Ulthera and has received equipment for research from Syneron. GH is an author of a reference cited in this topic.
Stephanos Papanastasiou, FRCSEd, MSc, EBOPRAS, FESSH
Consultant Plastic Surgeon
Lister Hospital
Stevenage
UK
Disclosures
SP declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Callaghan TM, Wilhelm KP. A review of ageing and an examination of clinical methods in the assessment of ageing skin. Part 2: clinical perspectives and clinical methods in the evaluation of ageing skin. Int J Cosmet Sci. 2008 Oct;30(5):323-32. Abstract
Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol. 1988 Jun;124(6):869-71. Abstract
Bhawan J, Andersen W, Lee J, et al. Photoaging versus intrinsic aging: a morphologic assessment of facial skin. J Cutan Pathol. 1995 Apr;22(2):154-9. Abstract
Callaghan TM, Wilhelm KP. A review of ageing and an examination of clinical methods in the assessment of ageing skin. Part 2: clinical perspectives and clinical methods in the evaluation of ageing skin. Int J Cosmet Sci. 2008 Oct;30(5):323-32. Abstract
Ogden S, Griffiths TW. A review of minimally invasive cosmetic procedures. Br J Dermatol. 2008 Nov;159(5):1036-50. Abstract
Klein AW. Techniques for soft tissue augmentation: an 'A to Z'. Am J Clin Dermatol. 2006;7(2):107-20. Abstract
Papadavid E, Katsambas A. Lasers for facial rejuvenation: a review. Int J Dermatol. 2003 Jun;42(6):480-7. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Cutis laxa
- Síndrome de Werner (progéria ou pangéria)
- Xeroderma pigmentoso
More DifferentialsGuidelines
- Guidelines for topical photodynamic therapy: update
- Global consensus guidelines for the injection of diluted and hyperdiluted calcium hydroxylapatite for skin tightening
More GuidelinesPatient information
Rugas
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