الفهرس 
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Abstract
Summary
Apart from the face and neck, the hand is the most exposed area of the body. Hand ageing is a combination of skin ageing, motion effects and volume loss; involving osseous and subcutaneous structures as well as the skin. A progressive volume loss of both intrinsic muscles of the hand and subcutaneous fat, as well as a loss of elasticity of the skin make the soft tissue envelope too large for its contents. Despite the rising interest in rejuvenative procedures, few authors have investigated basic hand aesthetics and ageing, and even fewer have attempted to study the different factors accelerating the process of ageing.
With age, the appearance of the hand changes due to intrinsic and extrinsic factors. Intrinsic ageing alters deeper soft tissue planes, decreasing skin elasticity, soft tissue volume and dermal vascularity, whereas extrinsic ageing affects the epidermal and dermal layers following sun exposure, chemicals and smoking. Depending on skin type, lifestyle and occupation, extrinsic factors further damage the skin. The ageing process is often accelerated in the hand because of its intense, continuous use and its constant exposure to environmental factors. This acceleration is anticipated to be higher in the more vigorously used dominant hand.
Because the hands are relentlessly used, ‘‘cumulative trauma’’ disorders of the hand and wrist have been widely studied. The focus has always been on soft tissue disorders, such as tendonitis, carpal tunnel syndrome, and myofascial injuries; and has lately expanded to encompass chronic work-related, joint injury leading to hand and wrist arthritis. Despite the rising interest in hand ageing on one hand, and occupational impact on joints, muscles and other skin diseases, on the other hand, the correlation between both has not yet been investigated. Due to the lack of strict objective ageing evaluation reference ranges, and defect in studies, which compare hand anthropometric measurements according to hand preference, comparison between dominant and non-dominant hand of the same individual was done; using the latter as a control.
Previous studies have confirmed the effect of occupation on hand muscle strength, grip strength and osteoarthritis; all being positively correlated with severity of manual work. This study revealed other aspects affected by occupation; including hand ageing grade and muscle bulk. There was a discrepancy between both hands in manual workers as compared to idle subjects. The more vigorously used dominant hand showed accelerated ageing as compared to the non-dominant one; as regards ageing grade and enhanced wrinkling pattern across the joints. The dominant hand also showed an increase in both thenar muscle bulk and hand circumference.
To our knowledge, no previous studies have trodden the ground of occupational impact on hand ageing, and research in that field was lacking. The present findings suggest that skin ageing appears to be affected by the excessive hand use in manual work. Ageing does not start prematurely before the age of 35, yet it progression is accelerated in the group >36. The differences in findings between the dominant and non-dominant side suggest a role of physical load factors on hands. Since each subject served as his or her own control, these differences were independent of the most important confounders.
Skin ageing needs to be further studied, especially in darker skin types, where pigmentary changes are much less apparent. Other parameters of ageing should also be included in hand assessment including roundness and contour, which give the hand a healthy appearance.
The conduction of a similar study but with a larger sample, is recomended, in only right-handed people to prevent confusion due to ambidexterity and where occupational tasks are more clearly specified to minimize confounders