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Evidence last reviewed: 17 Apr 2026
Topic last updated: 25 Feb 2026

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
Full details

Other diagnostic factors

  • frouxidão da pele
  • discromia
  • dermoelastose
  • eritema
  • telangiectasia
  • alterações de textura
  • ceratoses actínicas
Full details

Risk factors

  • susceptibilidade genética
  • idade >40 anos
  • pele branca
  • atividade muscular hiperdinâmica
  • exposição ao sol crônica
  • tabagismo
  • alterações hormonais
  • poluição
  • classe socioeconômica baixa
  • baixo índice de massa corporal (IMC)
Full details

Diagnostic tests

1st tests to order

  • macrofotografia
Full details

Tests to consider

  • biópsia de pele
  • imagens tridimensionais (3D)
  • imagens multiespectrais
Full details

Emerging tests

  • microscopia confocal in vivo

Treatment algorithm

ONGOING

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

Charlene Lam, MD, MPH, FAAD

Associate Professor of Dermatology

Assistant Director (Office of Research Diversity and Health Equity)

Vice Chair (Community Health) of Dermatology

Penn State Cancer Institute

Hershey

PA

Disclosures

CL declares that she has no competing interests.

Payvand Kamrani, DO, FAAD

Board-Certified Dermatologist

Aesthetic Solutions

Chapel Hill

NC

Disclosures

PK declares that she has no competing interests.

Acknowledgements

Dr Charlene Lam would like to gratefully acknowledge Dr Dimitrios Dionyssiou, Dr Efterpi Demiri, and Dr Elisavet Lazaridou, previous contributors to this topic.

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

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Shetty MK; IADVL Dermatosurgery Task Force. Guidelines on the use of botulinum toxin type A. Indian J Dermatol Venereol Leprol. 2008 Jan;74(suppl):S13-22.Full text  Abstract

Goldie K, Peeters W, Alghoul M, et al. Global consensus guidelines for the injection of diluted and hyperdiluted calcium hydroxylapatite for skin tightening. Dermatol Surg. 2018 Nov;44 Suppl 1:S32-41. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Rugas images
  • Differentials

    • Cutis laxa
    • Síndrome de Werner (progéria ou pangéria)
    • Xeroderma pigmentoso
    More Differentials
  • Guidelines

    • International consensus recommendations on the aesthetic usage of ready-to-use abobotulinumtoxinA (Alluzience)
    • Guidelines for topical photodynamic therapy 2018
    More Guidelines
  • Patient information

    Rugas

    More Patient information
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