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
- alterações hormonais
- poluição
- classe socioeconômica baixa
- baixo índice de massa corporal (IMC)
Diagnostic tests
1st tests to order
- macrofotografia
Tests to consider
- biópsia de pele
- imagens tridimensionais (3D)
- imagens multiespectrais
Emerging tests
- 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
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
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.

Differentials
- Cutis laxa
- Síndrome de Werner (progéria ou pangéria)
- Xeroderma pigmentoso
More DifferentialsGuidelines
- International consensus recommendations on the aesthetic usage of ready-to-use abobotulinumtoxinA (Alluzience)
- Guidelines for topical photodynamic therapy 2018
More GuidelinesPatient information
Rugas
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