Cigarette Smoking: Risk Factor for Premature Facial Wrinkling
Authors: Donald P. Kadunce, Randy Burr, Richard Gress, Richard Kanner, Joseph L. Lyon, John J. Zone
Journal: Annals of Internal Medicine (1991)

Article15 May 1991Cigarette Smoking: Risk Factor for Premature Facial WrinklingDonald P. Kadunce, MD, Randy Burr, MD, Richard Gress, MS, Richard Kanner, MD, Joseph L. Lyon, MD, John J. Zone, MDDonald P. Kadunce, MD, Randy Burr, MD, Richard Gress, MS, Richard Kanner, MD, Joseph L. Lyon, MD, John J. Zone, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-114-10-840 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptObjective: To determine if cigarette smoking is a risk factor for the development of premature facial wrinkling.Design: Cross-sectional study.Setting: Smoking cessation clinic and community.Patients: Convenience sample of 132 adult smokers and non-smokers in 1988.Measurements: A questionnaire was administered to quantify cigarette smoking and to obtain information about possibly confounding factors such as skin pigmentation, sun exposure, age, and sex. Wrinkling was assessed using photographs of the temple region, and a severity score based on predetermined criteria was assigned. A logistic regression model, which controlled for confounding variables, was developed to assess the risk for premature wrinkling in response to pack-years of smoking.Main Results: The prevalence of premature wrinkling was independently associated with sun exposure and pack-years of smoking. After controlling for age, sex, and sun exposure, premature wrinkling increased with increased pack-years of smoking. Heavy cigarette smokers (> 50 pack-years) were 4.7 times more likely to be wrinkled than nonsmokers (95% CI, 1.0 to 22.6; P value for trend = 0.05). Sun exposure of more than 50 000 lifetime hours also increased the risk of being excessively wrinkled 3.1-fold (CI, 1.2 to 7.1). When excessive sun exposure and cigarette smoking occurred together, the risk for developing excessive wrinkling was multiplicative (prevalence ratio of 12.0; CI, 1.5 to 530).Conclusion:Cigarette smoking is an independent risk factor for the development of premature wrinkling....References1. . The health consequences of smoking: cancer: a report of the Surgeon General. Washington, DC: U. S. Government Printing Office; 1982:21-169. (DHHS publication no. [PHS] 82-50179.) Google Scholar2. Read R Presidential address. Systemic effects of smoking. Am J Surg. 1984;148:706-11. CrossrefMedlineGoogle Scholar3. FletcherPetoTinkerSpeizer CRCF. The Natural History of Chronic Bronchitis and Emphysema. New York: Oxford University Press; 1976. Google Scholar4. Daniell H. Smoker's wrinkles. A study in the epidemiology of "crow's feet". Ann Intern Med. 1971;75:873-80. LinkGoogle Scholar5. Model D. Smoker's face: an underrated clinical sign? Br Med J [Clin Res]. 1985;291:1760-2. CrossrefMedlineGoogle Scholar6. GrahamMarshallHaughey SJB. An inquiry into the epidemiology of melanoma. Am J Epidemiol. 1985;122:606-19. CrossrefMedlineGoogle Scholar7. ScottoFearsFraumeni JTJ. Incidence of nonmelanoma skin cancer in the United States. Bethesda, Maryland: U. S. Public Health Service; 1983. (DHHS publication no. [NIH] 83-2433.) Google Scholar8. Woolf B. On estimating the relationship between blood group and disease. Ann Hum Genet. 1955;19:251-3. CrossrefMedlineGoogle Scholar9. BreslowPowers NW. Are there two logistic regressions for retrospective studies? Biometrics. 1978;34:100-5. CrossrefMedlineGoogle Scholar10. BreslowDay NN. I. The analysis of case-control studies. In: Davis W, Breslow NE, Day NE. Statistical Methods in Cancer Research. Lyon: IARC Scientific Publications; 1980. Google Scholar11. Mantel N. Chi square tests with one degree of freedom: extension of the Mantel-Haenszel procedure. J Am Stat Assoc. 1963;58:690-700. Google Scholar12. Modules: Proc rate and Proc log. In: EPILOGUE, ver. 3. Pasedena, California: Epicenter Software; 1986. Google Scholar13. Soffer A. Smokers' faces. Who are the smokers? [Editorial]. Arch Intern Med. 1986; 146:1496. CrossrefMedlineGoogle Scholar14. CraigRees ST. The effects of smoking on experimental skin flaps in hamsters. Plast Reconstr Surg. 1985;75:842-6. CrossrefMedlineGoogle Scholar15. ReusRobsonZacharyHeggers WMLJ. Acute effects of tobacco smoking on blood flow in the cutaneous micro-circulation. Br J Plast Surg. 1984;37:213-5. CrossrefMedlineGoogle Scholar16. ReesLiverettGuy TDC. The effect of cigarette smoking on skin-flap survival in the face lift patient. Plast Reconstr Surg. 1984;73:911-5. CrossrefMedlineGoogle Scholar17. WaeberSchallerNussbergerBussienHofbauerBrunner BMJJKH. Skin blood flow reduction induced by cigarette smoking: role of vasopressin. Am J Physiol. 1984;247:H895-901. MedlineGoogle Scholar18. NiewoehnerMcGowan DS. Cigarette smoking and the development of chronic airflow obstruction. In: Simmons DH, ed. Current Pulmonology. 7, New York: John Wiley & Sons Inc. ; 1986:23-71. Google Scholar19. LeverSchaumburg-Lever WG. Histology of the skin. In: Histopathology of Skin. 6th ed. Philadelphia: Lippincott; 1983:30-5. Google Scholar20. ChenFleischmajerSchwartzPalaiaTimpl VREMR. Immunochemistry of elastotic material in sun-damaged skin. J Invest Dermatol. 1986;87:334-7. CrossrefMedlineGoogle Scholar21. Gilchrest B. Skin and Aging Processes. Boca Raton, Florida: CRC Press; 1984. Google Scholar22. Gilchrest B. The Aging Skin. Philadelphia: W. B. Saunders; 1986. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: From the University of Utah Health Sciences Center, Salt Lake City, Utah. For current author addresses, see end of text. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByElastic fibers during aging and diseaseDeep Face Age Progression: A SurveyExposing human primary dermal fibroblasts to particulate matter induces changes associated with skin agingThe systemic influence of chronic smoking on skin structure and mechanical functionHolistic dermatology: An evidence-based review of modifiable lifestyle factor associations with dermatologic disordersAging of the Orbit and Rejuvenation OptionsPearl Chapter: Basis of Photoaging and the Use of Chemical PeelingsRisk factors and self‐perception for facial aging among Nepalese populationThe dermoscopic features of facial aging among Egyptians: A comparative study between males and femalesLoss of skin elasticity is associated with pulmonary emphysema, biomarkers of inflammation, and matrix metalloproteinase activity in smokersRole of the Aryl Hydrocarbon Receptor in Environmentally Induced Skin Aging and Skin CarcinogenesisMR-pheWAS with stratification and interaction: Searching for the causal effects of smoking heaviness identified an effect on facial agingWhen the skin is in the center of interest: An aging issueAging of the SkinVieillissement cutané – Vieillissement facial global : orientation thérapeutiqueMechanisms of aging and development—A new understanding of environmental damage to the skin and prevention with topical antioxidantsGender Differences in Facial RejuvenationSmoking status and attractiveness among exemplar and prototypical identical twins discordant for smokingInvecchiamento della pelle - Invecchiamento globale del volto: orientamento terapeuticoA Holistic Approach to Antiaging as an Adjunct to Antiaging Procedures: A Review of the LiteratureIntroduction to skin agingThe Consequences of SmokingAging Skin as a Diagnostic Tool for Internal Diseases: A Chance for DermatologyEnvironmental and Genetic Factors in Facial Aging in TwinsTobacco Smoke and Skin AgingHistological study on the effect of nicotine on adult male guinea pig thin skinAging in the Male Face: Intrinsic and Extrinsic FactorsPerioral wrinkles are associated with female gender, aging, and smoking: Development of a gender-specific photonumeric scaleAge-Associated Skin Conditions and Diseases: Current Perspectives and Future OptionsTobacco Smoke and Skin AgingSkin aging and oxidative stressOpinions regarding skin ageing in the elderly inhabitants of Bialystok, PolandAging Skin as a Diagnostic Tool for Internal Diseases: A Chance for DermatologyEnvironmental and Genetic Factors in Facial Aging in TwinsSecondhand smoke exposure-induced nucleocytoplasmic shuttling of HMGB1 in a rat premature skin aging modelContemporary Thoughts on Lower Eyelid/Midface AgingSénescence cellulaire et pathologies pulmonaires : exemple de la BPCOEffect of the regional environment on the skin properties and the early wrinkles in young Chinese womenFacial wrinkling: A possible mirror of COPD severity.....Effects of sunscreen on skin cancer and photoagingCOPD as a Disease of Premature AgingDiagnosis and TreatmentFacial Changes Caused by SmokingSunscreen and Prevention of Skin Aging A Randomized TrialMaria Celia B. Hughes, MMedSci, Gail M. Williams, PhD, Peter Baker, PhD, and Adèle C. Green, MBBS, PhDDevelopment of skin aging scale by using dermoscopyDoes cigarette smoking mitigate the severity of skin disease in systemic sclerosis?Diagnosis and TreatmentFactors influencing skin ageing in a Mediterranean population from TurkeyEnvironmental influences on skin aging and ethnic-specific manifestationsCigarette Smoking and Facial Wrinkles: A Review of the LiteratureValidation of skin surface microtopography as a measure of skin photoaging in a subtropical population aged 40 and overDifferential expression of elastic fibre components in intrinsically aged skinThe Anatomic Basis of Midfacial AgingHautveränderungen durch Drogen, Rauchen und AlkoholImpaired integumentary integrityNicotine AddictionThe determinants of periorbital skin ageing in participants of a melanoma case-control study in the U.K.Umweltverschmutzung und HautalterungSkin PhotorejuvenationEczema, psoriasis, skin cancers and other skin disorderFactors Associated with Premature Skin Aging (Photoaging) before the Age of 55: A Population-Based StudyEnvironmental and Lifestyle Factors Associated with Perceived Facial Age in Chinese WomenAesthetic effects of topical photodynamic therapyReview Article: A new wrinkle on old skin: the role of elastic fibres in skin ageingCigarette smoke-induced Egr-1 represses TβR-II expression in human skin dermal fibroblastsTobacco and the skinEnvironmental and Genetic Factors in Facial Aging in TwinsTobacco Smoke and Skin Aging*Effect of Tobacco Smoking on HairAging of Scalp and Age-Related Disorders of ScalpAging and the SkinMorphological and Biochemical Changes During Aging and Photoaging of the Skin of C57BL/6J MiceHautalterungNasolabial Fold Angle Measurement Using Anterior Segment Optical Coherence Tomography in Normal SubjectsMolecular Basis of Tobacco Smoke-Induced Premature Skin AgingEffect of cigarette smoking on skin agingAcne and smokingCigarette Smoke Induces Cellular Senescence via Werner's Syndrome Protein Down-regulationThe Aging Process in MenSkin Aging in the Asian PopulationApproaches to the Development of Cosmetic Products to Counter the Effects of Skin AgingInhibitory Effects of Coenzyme Q10 on Skin AgingMammalian Nicotinic Acetylcholine Receptors: From Structure to FunctionLifestyle Factors and Visible Skin Aging in a Population of Japanese EldersAssociation between smoking and cutaneous ageing in a Brazilian populationA review of ageing and an examination of clinical methods in the assessment of ageing skin. Part I: Cellular and molecular perspectives of skin ageingSkin and Wound CareIn contrast to lung fibroblasts – no signs of senescence in skin fibroblasts of patients with emphysemaEvaluation of the effects of a preparation containing asiaticoside on periocular wrinkles of human volunteersHábito de fumar y pielLas arrugas del fumador: ¿qué hay de nuevo?Neuronal Nicotinic Acetylcholine Receptor Expression and Function on Nonneuronal CellsIntoxications chimiquesSmoking and the SkinTobacco smoke causes premature skin agingCutaneous aging: a review of the process and topical therapiesDietary nutrient intakes and skin-aging appearance among middle-aged American womenTobacco smoke extract induces premature skin aging in mouseSmoking related COPD and facial wrinkling: is there a common susceptibility?Peut-on utiliser une valeur fixe du rapport VEMS/CV comme seuil diagnostique de l'obstruction bronchique ?Effect of smoking on skin elastic fibres: morphometric and immunohistochemical analysisInfluence of environmental factors on facial ageingMultiple senile lentigos of the face, a skin ageing pattern resulting from a life excess of intermittent sun exposure in dark-skinned caucasians: a case-control studyPhotoageing: the darker side of the sunNeuronal nicotinic acetylcholine receptor expression and function on nonneuronal cellsManifestaciones cutáneas y tabacoRelationships between lung function, smoking and morphology of dermal elastic fibresReview of Photorejuvenation: Devices, Cosmeceuticals, or Both?The Use of Selected Nigerian Natural Products in Management of Environmentally Induced Free Radical Skin DamageParting thoughts on acne, skin aging, and smokingCutaneous Effects of SmokingSmoking and systemic diseaseUsing Intense Pulsed Light for Cosmetic Purposes: Our ExperienceTobacco smoke is phototoxicSkin aging and natural photoprotectionGiving up smokingAlteraciones de las fibras elásticas de la piel en pacientes fumadores y su relación con el deterioro de la función pulmonarSmoking: suicide for some, manslaughter for others - time for a ban in all public placesSkin ageing and wrinkles: clinical and photographic scoringIdentification of Benzene Metabolites in Dermal Fibroblasts as Nonphenolic: Regulation of Cell Viability, Apoptosis, Lipid Peroxidation and Expression of Matrix Metalloproteinase 1 and Elastin by Benzene MetabolitesTobacco smoke extract induces age-related changes due to modulation of TGF-βAging and photoagingEffect of Smoking and Sun on the Aging SkinCentral Role of Fibroblast α3 Nicotinic Acetylcholine Receptor in Mediating Cutaneous Effects of NicotineRauchen und HautIs skin ageing in the elderly caused by sun exposure or smoking?Smoking affects collagen synthesis and extracellular matrix turnover in human skinWomen and Smoking: Time for a ChangeCigarette smoking associated with premature facial wrinkling: image analysis of facial skin replicasPlanning Elective Operations on Patients Who SmokeSmoking makes you ugly-an innovative approach to smoking cessationCutaneous Photodamage in AsiansSkin premature aging induced by tobacco smoking: the objective evidence of skin replica analysisSmoking effect on skin wrinkling in the aged populationPrevalence and associations with ectropion in an older population: the Blue Mountains Eye StudyMatrix metalloproteinase-1 and skin ageing in smokersTopical L-Ascorbic Acid: Percutaneous Absorption StudiesTopical L-Ascorbic AcidMetabolic Aspects of Hernia DiseaseThe effects of sunlight on the skin of AsiansErbium:YAG Laser for Cutaneous ResurfacingFACIAL IDENTIFICATION | Photo Image IdentificationEpidemiologic determinants of skin photoaging: Baseline data of the SU.VI.MAX. cohortSmoking, ageing, and oestrogenPublic knowledge, awareness, and perceptions of the association between skin aging and smokingTobacco smoking contributes little to facial wrinklingFascial Metabolic DefectsMetabolic factors contributing to herniation A reviewFacial wrinkling in postmenopausal women. Effects of smoking status and hormone replacement therapyUnderstanding Premature Skin AgingThe Nitrite/Elastin ReactionCigarette smokers engage in more high risk ultraviolet light behavior and have different ultraviolet light attitudes and beliefsCutaneous manifestations and consequences of smokingTabaco y mujerSkin AgeingSkinFacial wrinkling in men and women, by smoking status.Essential Hypertension: PathophysiologyTHE RELATIONSHIP BETWEEN FACIAL WRINKLING AND AIRFLOW OBSTRUCTIONSMOKING AND SKIN DISEASEStated AgeSMOKING AND THE SKINSmoking as "independent" risk factor for suicide: illustration of an artifact from observational epidemiology?The clinical identification and quantification of photodamageCigarette Smoking and Facial WrinklingIan Joffe, MDSmoking and Wrinkles: Does It Matter?Thomas E. Kottke, MDTobacco Smoke and Skin AgingPhotoaging 15 May 1991Volume 114, Issue 10Page: 840-844KeywordsCritical careDermatologyMedical risk factorsPreventive medicineQuestionnairesSaltsSmoking cessationVeteran care Issue Published: 15 May 1991 Copyright© 1991 American College of PhysiciansPDF DownloadLoading ...