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The Relationship between Drinking Water Consumption and Sebum Level with Face Skin
Wrinkle of Woman at Gereja Batak Karo Protestant
Ago Harlim, Agita Gloria
Medical Faculty, Universitas Kristen Indonesia, Jakarta
Corresponding Author: agoharlim@yahoo.com
Abstract
Face skin wrinkles are folds or creases that form under the skin layer. The process of forming
skin wrinkles is not known, but there are intrinsic and extrinsic factors that can affect the
formation of skin wrinkles. This study aims to determine whether there is any correlation
between the amount of drinking water consumption and sebum levels with the level of facial skin
wrinkles. This study used observational analytic with a cross-sectional study design method, with
66 respondents as female congregants from the Gereja Batak Karo Protestan, age between 50-60
years. Before the skin examination, the respondents measured the water consumption in one day
with a 500 mL drinking bottle for 3 consecutive days than record the results. In this study,
Dermoprime Viso was used as a skin analyzer to determine the level of sebum and the level of
facial skin wrinkles of the respondents. Besides, Spearman and Kruskal Wallis were used for
statistical assessment purposes. The study results found that there are significant correlations
between the amount of drinking water consumption and sebum levels with the level of skin
wrinkles.
Keywords: Face Skin Wrinkles, Sebum, Water
I. INTRODUCTION
The skin is the largest organ in the human body, which is about 15% of an adult's body
weight. The skin functions as a body protector from environmental exposure namely ultraviolet
(UV), chemical and physical trauma, and microorganisms. Besides, the skin also functions to
prevent dehydration, regulate body temperature, and can regenerate itself [1;2;3]. The skin is the
outermost layer of the body and is constantly exposed to stimuli from the environment [4]. As
we get older, the skin will share the ageing process which causes the skin to become thinner, dry,
wrinkled, and there is uneven pigmentation [5;6].
Wrinkles are wrinkles or curves that form on the bottom surface of the skin. Towards the
age of the third decade, the skin begins to experience structural changes and fine wrinkles begin
to appear. Skin wrinkles are measured in depth and width, wrinkles less than 1 mm are classified
as fine wrinkles. And wrinkles more than 1 mm are classified into deep wrinkles. Wrinkles on
the facial skin, arms and hands are easily observed, so research is often done on these parts [7;8].
According to a 2009 Gover study found that most in diseases related to skin aged 60-70 years are
skin wrinkles that are 95.5%. The most wrinkled locations are the areas of the skin that are often
exposed to sunlight, namely the face, neck, lower limbs and back of the hands [9;10].
The process of the formation of skin wrinkles is not known with certainty, because many
factors affect. Based on research, it is known that skin wrinkles are influenced by two
interrelated factors namely internal factors and external factors [11;12]. The shape and function
of the skin are maintained by the balance of water content in the stratum corneum (SC) and skin
surface lipids (SSL) in the epidermis [3;13].
In SC, if dehydration can cause fine wrinkles on the skin, but it happens reversibly and can
be treated with fluid rehydration. In general, many statements that the consumption of adequate
and regular drinking water will make the skin moist and prevent wrinkles. A research was
conducted to a prospective study of a group of healthy people who consumed 2.25 L of mineral
water or tap water for 4 weeks. From the results of his research stated that an increase in water
content in the epidermis, the skin looks smoother and increased skin density [9;14;15]. The
consumption of adequate drinking water can increase levels of humidity in SC [10;16]. As for
SSL, it is formed from sebum produced by sebaceous glands [17;18]. Radiation from the sun can
accelerate the process of formation of skin wrinkles. One function of sebum is as photoprotection
from UV radiation, to reduce direct exposure to sunlight [19; 20].
Based on this, the researcher is interested in finding out whether there is a relationship
between the amount of drinking water consumption and sebum levels to the level of skin
wrinkles in the female congregation of the Gereja Batak Karo Protestan (GBKP).
II. RESEARCH METHOD
The design of this study was an observational analytical study using a cross-sectional study
design, with the scope of Skin Health and Gender Sciences. The scope of the research location is
the Pondok Gede Ruggun GBKP congregation. When the research was conducted in November -
December 2019. The population in this study was the GBKP female congregation and the sample
used in this study was a portion of the GBKP female congregation aged 50-60 years. The
sampling of this research used total sampling technique. The research tools used in this study
were questionnaires, 500 mL drinking bottles, and skin examination tools using the Skin
Diagnostic System: Dermaprime viso. Dermoprime Viso is a measuring tool that automatically
makes a diagnosis for the skin. This tool is equipped with a camera's optical lens, LED lights,
skin moisture sensor, algorithm calculation, and Artificial Intelligence (AI) system. The
Dermoprime Viso device can measure moisture, pores, skin wrinkles, skin pigmentation, keratin
and skin types (sebum). The amount of drinking water consumption in 1 day is as follows, Less
(<2 L), Enough (2-2.5L) and Lots (> 2.5L).
III. RESULT AND DISCUSSION
The results of research data conducted in November - December 2019, will be analyzed using the
SPSS program or software version 16.0, by testing the results of the univariate analysis using
descriptive and bivariate using nonparametric correlation tests with the Spearman and Kruskal
Wallis methods. The univariate analysis discusses the description and analysis of the description
of the variables in the study. The results of the study obtained primary data, intending to
determine the characteristics of the respondents in this study with the following results.
Table 1. Age Frequency of Respondents
Age (year)
Frequency
%
50
11
16.7
51
9
13.6
52
5
7.6
53
7
10.6
54
5
7.6
55
3
4.5
56
8
12.1
57
6
9.1
58
2
3.0
59
4
6.1
60
6
9.1
Total
66
100.0
Based on table 1, the description of the respondent's age is known, obtained all ages
according to the inclusion criteria, namely female respondents aged 50-60 years. Of the 66
respondents the most number was 50 years old (16.7%) and the lowest number was at the age of
58 years (3%).
Table 2. Frequency of Drinking Water Consumption
Water
Consumption
Frequency
%
Lack
0
0.0
Enough
26
39.4
High
40
60.6
Total
66
100.0
Based on table 2, obtained drinking water consumption data, that there are no respondents
whose drinking water consumption is lacking, as many as 26 respondents (39.4%) consume
enough drinking water, and high water consumption in the many categories is 40 respondents
(60.6%).
Table 3. Frequency of Sebum Content by Skin Type
Skin Types
Frequency
%
Dry
14
21.2
Oily
42
63.3
Combination
10
15.2
Total
66
100.0
Based on table 3, 14 respondents (21.2%) had dry skin types, 42 respondents (63.3%) had
oily skin types, and 10 respondents (15.2%) had combination skin types. From the data table
above, it shows that the majority of respondents have oily skin types.
Table 4. Frequency of Wrinkles
Wrinkle Level
Frequency
%
Good
3
4.5
Fine Lines
35
53.0
Expression Lines
22
33.3
Deep Wrinkle
6
9.1
Total
66
100.0
Based on table 4, it was found that 3 respondents (4.5%) had wrinkle levels Good, 35
respondents (53.0%) had wrinkle levels of fine lines, 22 respondents had wrinkle levels
Expression Lines, and 6 respondents had Deep Wrinkle levels. From the data table above shows
that the majority of respondents have fine lines wrinkles. The bivariate analysis aims to
determine the relationship between the independent variables (drinking water and sebum) with
the dependent variable (skin wrinkles). To test the relationship between the two variables using a
non-parametric test with the Spearman and Kruskal Wallis methods.
The Relationship between Drinking Water Consumption and the Skin Wrinkles Levels
Figure 1. Drinking-Water Consumption and Skin Wrinkles Level
Based on figure 1, it is known that respondents who consume more drinking water tend to
have better levels of wrinkles. The scale used for the variable amount of drinking water
consumption and the level of skin wrinkles is the ordinal-ordinal scale because it was analyzed
by the Kolmogorov-Smirnov normality test method first. Normality test results obtained a P-
value of 0,000 in both drinking water data because the P-value <0.05 so that it can be concluded
that the amount of drinking water data is not normally distributed. Then, it will proceed with the
Spearman analysis test.
Frequency
The relationship between Sebum Level based on Skin Type with the Face Skin Wrinkle Level
Figure 2. Sebum Frequency Based on Skin Type with the Face Skin Wrinkle Level
Based on figure 2, it is known that only respondents with dry skin type have good levels of
skin wrinkles, as well as the deep wrinkle category only dry skin types that do not exist. When
compared with oily and combination skin types. The scale used for variable skin type and level
of skin wrinkles is a nominal-ordinal scale because it was analyzed by the Kolmogorov-Smirnov
normality test method first. Based on the results of the normality test, a P-value of 0,000 was
obtained for respondents with dry and oily skin types and a P-value of 0.035 for respondents for
combination skin types. Because the P-value <0.05, it can be concluded that the three data are
not normally distributed. Then it will be continued with the Kruskal Wallis analysis test.
Table 5. The Relationship of Sebum Level and Face Skin Type with Face Skin Wrinkles
Level
Test
P-value
Result
The relationship of sebum
level and face skin type with
face skin wrinkles level
0.010
Significant
Kruskal Wallis Analysis Test, significant on ≤ p 0.05
From the results of the table above, we got the P-value of 0.010. Because the P-value
<0.05, it can be concluded that there is a significant relationship between sebum levels based on
skin type and the level of skin wrinkles. From the bivariate analysis selection results, the two
independent variables P-value results <0.05, then can be entered into multivariate analysis.
Table 6. The Relationship between Drinking Water and Sebum with Face Skin Wrinkles
Level
Variable
P-value
Drinking-Water Consumption
0.025
Sebum
0.019
Logistic regression test, significant at ≤ p 0.05
The variable is said to be the most significant if the number of P-values is the smallest, so
in this study, the most influential variable on the level of skin wrinkles is sebum because the P-
value is 0.019.
In this study, univariate results did not get the amount of drinking water consumption that
was lacking. Because the respondents that researchers get come from church congregations
whose level of knowledge about drinking water consumption can be said to be good, and can
also be connected with the level of education of respondents, namely the average high school
education and S1 factors that help in terms of the level of consumption knowledge in addition to
the level of education are employment status, family income, maternal nutrition knowledge, and
health education. In this case, health education is intended to raise awareness, provide or increase
community knowledge about the maintenance and improvement of health both himself, his
family and the surrounding community [21;22].
The highest frequency of sebum content based on skin type is oily skin type. And based on
the age of the respondents, the most were 50 years of age. These are interconnected because
sebum production is related to age. Along with the increase, the production of sebum in the skin
will decrease. Sebum production will decrease by 32% every 10 years in women, starting from
the age of 50 years [23; 24;25]. Therefore, the results of the frequency of the level of wrinkles of
respondents obtained the highest level of fine lines wrinkles. This can be attributed to the
majority of respondents' skin types are oily skin types. Because, more levels of sebaceous glands
can prevent the formation of dry skin and wrinkled skin [26;27].
The relationship between drinking water consumption with the face skin wrinkles level - In
this study there is a relationship between the amount of drinking water consumption with the
level of skin wrinkles. This result can also be linearly related to the research, which compares the
skin condition of the respondent with the amount of drinking water consumed daily. In the
results of the study, it was found that the level of hydration and biomechanical conditions of the
skin condition of people who consume more drinking water is better when compared to people
who consume less drinking water [23]. The skin condition will change to become smoother when
skin moisture is maintained, this happens when there is an increase in drinking water
consumption. So that through this research it can be seen, besides consuming enough drinking
water can make the skin condition improve and smoother, consuming enough drinking water can
also have a lower level of skin wrinkles [28; 29].
The manifestation of the ageing process in the form of wrinkled skin and lines, and the
emergence of spots (patches on the skin). This is due to decreased production of type I collagen
and increased extracellular matrix collagen fragmentation. Besides, in the elderly population, dry
skin (xerosis cutis) is associated with loss of adipose tissue and a decrease in body fluids. Water
content in ageing skin, especially the stratum corneum, is less than in younger skin [30;31;32].
Age-related changes in the composition of amino acids, besides, reduce the amount of skin
NMF, thereby reducing the binding capacity of skin water. SC water levels, in particular,
progressively decrease with age, eventually dropping below the level needed for effective
desquamation. Decreased desquamation process causes corneocytes to accumulate and adhere to
the surface of the skin, resulting in rough, scaly, and scaly skin that accompanies xerosis in
ageing skin [33;34;35].
The relationship between Sebum and face skin type with the face skin wrinkles level - The
results of the study between sebum levels and skin types with the level of skin wrinkles are
directly proportional. The association between sebaceous glands and the depth of wrinkles.
Shallow wrinkles on the skin that contain more sebaceous glands, it can be one of the factors that
prevent dry skin and prevent the formation of deep skin wrinkles [36;37].
In addition to the face, manifestations of skin ageing also occur in all skin in other areas.
Some clinical manifestations that often interfere with skin ageing are pruritus senilis, actinic
keratosis, seborrheic keratosis, and lentigo solaris. Senile pruritus or itching complaints in old
age are mainly caused by dry skin syndrome or often called xerosis cutis [38;39]. The incidence
rate in the elderly is reported to be 30-75%, due to the influence of skin ageing which causes a
decrease in the ability to maintain skin moisture, increase transepidermal water loss (TEWL),
decrease sweat and sebum production, and decrease the factors that maintain skin moisture.
Some extrinsic factors can also trigger, including low air humidity, excessive bathing habits, the
use of irritative soaps, the use of clothes that are irritative, and the use of alcohol and acetone on
the skin. Clinical features include the appearance of dull and rough skin that is sometimes
accompanied by squama, and complaints of itching [40;41].
SC integrity depends on regular regulation of total lipids. Total ageing skin lipid content
was reduced by 65%. Ceramide levels, specifically ceramide 1 linoleate and ceramide, are
significantly reduced in older skin. Triglycerides are also reduced, such as the sterol fraction of
the stratum corneum lipids. Although NMF levels in SC are higher in older skin than in younger
ones (a consequence of slower epidermal turnover rates in older people), amino acid levels are
lower. Fewer but much larger corneocytes, with higher intra-corneal cohesiveness [42;43].
The relationship between drinking water and sebum with the face skin wrinkles level - In
the multivariate test results it was found that it was more meaningful and related to the sebum
variable compared to the drinking water variable. This is supported by Popkin in 2010, that the
skin contains about 30% water, which contributes to the skin's elasticity, elasticity, and
durability. SC cellular structures and skin lipids can work to hold water in the skin. Water intake,
especially in individuals with high initial water intake, can increase skin thickness and density.
However, adequate skin hydration is not enough to prevent wrinkles or other signs of ageing,
which are related to genetics and the sun and environmental damage. Which is more useful for
individuals who have been consuming enough fluids from the start.
When compared with sebum, which is indeed influenced by age, sebum production has
decreased by 23% in men and 32% in women every 10 years. Although sebum production
decreases, sebaceous glands continue to enlarge so that the skin pores, especially the face, appear
to be getting bigger too [44;45]. The integrity of SC depends on the regular regulation of total
lipids. Total ageing skin lipid content was reduced by 65%. So that facial skin that contains lots
of sebaceous glands produces more sebum, thus preventing the skin from becoming dry and
deeper skin wrinkles. If the levels of sebaceous glands are less then the shape of the skin is more
easily changed and the risk of formation of skin wrinkles is greater.
IV. Conclusion
From the results of research conducted by researchers, it can be concluded that the
frequency of the level of skin wrinkles in women aged 50-60 years, most with the type of fine
lines wrinkles and no congregations found in the category of the amount of drinking water
consumption is less. The frequency of sebum levels based on skin type in the female
congregation was the oiliest skin type which was 63.3%. There is a significant correlation
between the amount of drinking water consumption and sebum levels with the level of skin
wrinkles. Sebum levels are more or less decisive for facial wrinkles.
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