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Comprehensive grading scale of rhytides, laxity, and photodamage in skin

Comprehensive grading scale of rhytides, laxity, and photodamage in skin
Grading scale Descriptive parameter Categories of skin aging and photodamage
Rhytides Laxity Elastosis Dyschromia Erythema telangiectasia Keratoses Texture
0 None None None None None None None None
1 Mild Wrinkles in motion, few, superficial Localized to NL folds Early, minimal yellow hue Few (1-3) discrete small (<5 mm) lentigines Pink E or few T, localized to single site Few Subtle irregularity
1.5 Mild Wrinkles in motion, multiple, superficial Localized, NL and early ML folds Yellow hue or early, localized PO EB Several (3-6), discrete small lentigines Pink E or several T localized to 2 sites Several Mild irregularity in few areas
2 Moderate Wrinkles at rest, few, localized, superficial Localized, NL/ML folds, early jowels, early submental/SM Yellow hue, localized PO EB Multiple (7-10), small lentigines Red E or multiple T localized to 2 sites Multiple, small Rough in few, localized sites
2.5 Moderate Wrinkles at rest, multiple, localized, superficial Localized, prominent NL/ML folds, jowels and SM Yellow hue, PO and malar EB Multiple, small and few large lentigines Red E or multiple T, localized to 3 sites Multiple, large Rough in several localized areas
3 Advanced Wrinkles at rest, multiple, forehead, PO and perioral sites, superficial Prominent NL/ML folds, jowels and SM, early neck strands Yellow hue, EB involving PO, malar, and other sites Many (10-20) small and large lentigines Violaceous E or many T, multiple sites Many Rough in multiple, localized sites
3.5 Advanced Wrinkles at rest, multiple, generalized, superficial; few, deep Deep NL/ML folds, prominent jowels and SM, prominent neck strands Deep yellow hue, extensive EB with little uninvolved skin Numerous (>20) or multiple large with little uninvolved skin Violaceous E, numerous T, little uninvolved skin Little uninvolved skin Mostly rough, little uninvolved skin
4 Severe Wrinkles throughout, numerous, extensively distributed, deep Marked NL/ML folds, jowels and SM, neck redundancy and strands Deep yellow hue, EB throughout, comedones Numerous, extensive, no uninvolved skin Deep, violaceous E, numerous T throughout No uninvolved skin Rough throughout
E: Erythema; EB: elastotic beads; ML: melolabial; NL: nasolabial; PO: periorbital; SM: submental/submandibular; T: telangiectasia.
Reproduced from: Alexiades-Armenakas MR, Dover JS, Arndt KA. The spectrum of laser skin resurfacing: Nonablative fractional, and ablative laser resurfacing. J Am Acad Dermatol 2008; 58:719. Table used with the permission of Elsevier Inc. All rights reserved.
Graphic 85936 Version 2.0

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