Wrinkle-prone skin type

BAUMANN SKIN TYPE CLASSIFICATION
In 2006, dermatologist Leslie Baumann, MD introduced the BSTS in the book The Skin Type Solution (Bantam 2006). This approach to classifying skin is based on assessing the skin according to four major parameters: dry vs. oily (D/O), sensitive vs. resistant (S/R), pigmented vs. non-pigmented (P/N), and wrinkled vs. tight (W/T). One focus of this system, which can be used for patients regardless of age, gender, or ethnicity, is to match the most suitable skin care products or treatments with a patient’s skin type. A patient’s four-letter skin type code is obtained through a 64-item self-administered questionnaire, the Baumann Skin Type Indicator (BSTI), which renders a score corresponding to the patient’s prevailing cutaneous proclivities along the four descriptive spectra. The different permutations derived from the simultaneous consideration of these four parameters yields 16 different skin types. (Table 1.)
SKIN AGING: The Wrinkled (W) to Tight (T) Continuum
This parameter identifies the risk for developing wrinkles, considered a quintessential sign of cutaneous aging. Natural intrinsic aging, which is genetically driven, or cellularly programmed, is inevitable. Extrinsic aging, however, is subject to human volition and results from behavior such as excessive alcohol consumption, smoking, other forms of pollution, poor nutrition, and primarily, solar exposure. Both pathways ultimately lead to visible cutaneous changes, especially wrinkles, as well as lost elasticity, and hyperpigmentation. The primary focus in the BSTS is extrinsic aging, which has been more extensively studied. Specifically, the questionnaire asks about habits pertaining to sun exposure, smoking, and tanning bed use. The BSTI also asks questions about the skin of ancestors to determine the genetic influence on wrinkled skin. People with the “W” skin type may not have wrinkles when they complete the questionnaire, but they are more prone to wrinkle development and will need to begin prevention methods due to this risk. The “W” skin type is more often seen in individuals with lighter skin than those with dark skin.
The primary focus of anti-aging skin care - or skin care for the individual with “W” skin - is preventing wrinkle formation.(22) Indeed, treating skin once wrinkles have developed is much more difficult given that few skin care products can actually penetrate deeply enough into the dermis or the deeper epidermis to reverse most wrinkles, despite the claims associated with the marketing of such products. Topical products are, however, formulated to prevent the degradation or stimulate the production of the three primary skin constituents: collagen, elastin, and hyaluronic acid (HA). Topical preparations of retinoids, vitamin C, and copper peptides, as well as oral vitamin C have all been shown to promote collagen production.(23-25) Retinoids have also been demonstrated in animal models to foster HA and elastin synthesis,(26, 27) and glucosamine supplementation is believed to enhance HA levels.(28) No artificial means have yet been developed to increase elastin production.
Treatment approaches for wrinkled skin
Because inflammation is known to support the degradation of collagen, elastin, and HA, reducing inflammation is also an important goal of wrinkle prevention. Antioxidants are used in this context to mitigate the cutaneous effects of free radical activity. Some of the more popular antioxidants used in topical skin care products include vitamins C and E as well as coenzyme Q10, and those originating from botanical sources, such as caffeine, coffeeberry, ferulic acid, feverfew, grape seed extract, green tea, idebenone, mushrooms, polypodium leucotomos, pomegranate, pycnogenol, reseveratrol, rosemary, and silymarin. Although the antioxidant properties of these substances are well established in the literature, their efficacy in topical formulations designed to lessen the cutaneous signs of aging is unproven. Therefore, antioxidants represent just one component in the skin care for individuals with high W scores, who, as stated above, benefit from the use of retinoids. Other approaches to diminish or prevent extrinsic skin aging include avoiding/limiting solar exposure (especially from 10 am to 4 pm), using broad-spectrum sunscreen on a daily basis, avoiding cigarette smoke and pollution, as well as eating a diet high in fruits and vegetables.

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