Effect of the sun on visible clinical signs of aging in Caucasian skin

Figures & data

Figure 1 Clinical standardized photographic scale of pigmentation of malar area.

Figure 2 Clinical standardized photographic scale of cheek folds.

Table 1 Clinical signs used by dermatologists to establish heliodermal status

Signs	Severity	Scale
Pigmentation	Absence, clods, puddles, poikiloderma	0 to 3
Depigmentation	Absence, drops, plates	0 to 3
Pachydermic appearance	Absence, presence	0, 1
Elastosis	None, mild, moderate, severe	0 to 3
Cutaneous atrophy	None, mild, moderate, severe	0 to 3
Vascular disorders	None, mild, moderate, severe	0 to 3
Fine lines	None, mild, moderate, severe	0 to 3
Wrinkles	None, mild, moderate, severe	0 to 3
Ptosis	None, cheeks, eyelid, face	0 to 3

Table 2 Clinical aging signs of the face, described by atlases, and correlations with age and heliodermal status

Type and signs	Age	Heliodermal status
Wrinkles*
Forehead wrinkles*	0.335	0.282
Crow’s foot wrinkles*	0.602	0.478
Glabellar wrinkles*	0.553	0.396
Underneath eye wrinkles*	0.546	0.395
Upper-lip wrinkles*	0.558	0.531
Corner of the mouth*	0.520	0.402
Ptosis
Eye bag	0.529	0.303
Lower face ptosis	0.764	0.498

Note:

* Signs most affected by UV exposure.

Abbreviation: UV, ultraviolet.

Table 3 Wrinkles/texture signs and correlations with age and heliodermal status

Signs	Heliodermal status	Age	Wrinkles and texture
Upper-lip texture*  In addition to more or less deep vertical lines, the upper lip has a thick aspect, is padded, and has a pronounced microrelief forming a grid	0.541	0.579
Cheek folds*  Deep folds completely anarchic and presenting no specific directions link to muscular movements of face	0.515	0.573
Lower lip wrinkles*  Wrinkles more or less deep from corner of lower lip and extending downward from the chin	0.495	0.531
Jawline folds*  Folds begin at the ear lobe created by a thick skin, marked by dryness and elastosis, and extending over the jaw and neck giving a crumpled paper appearance	0.437	0.581
Wrinkles created by lower face ptosis*  A more or less deep fold is created at the zonal level of separation of chin and cheek	0.495	0.523
Chin texture*  In addition to dimples, the area of the chin and cheek areas adjacent have a thick skin appearance, are padded, and have a pronounced microrelief forming a grid	0.564	0.623

Notes: Correlations are with age and heliodermal status.

* Signs most affected by UV exposure.

Abbreviation: UV, ultraviolet.

Table 5 Microvascular disorders and correlations with age and heliodermal status

Signs	Heliodermal status	Age	Microvascular signs
Couperosis/rosacea  Microvascular alterations on the cheekbone area	0.257	0.086
Vascular disorders  All diffused redness and microvessels visible on the face	0.140	0.031

Note: The signs presented here are not related to UV exposure.

Abbreviation: UV, ultraviolet.

Table 4 Pigmentation disorders and correlations with age and heliodermal status

Signs	Heliodermal status	Age	Pigmentary disorders
Eye contour color contrast*  Difference of color between the area surrounding eyes and the adjacent area weathered by the sun	0.202	0.156
Pigmentation of the malar area*  Area with pigmentation disorders present on the protruding part of the malar area at the edge of the eye	0.302	0.155
Pigmentation of the lateral area*  Area of pigmentation disorders covering the outer lateral region of the maxilla	0.456	0.248
Lower face diffuse dyschromia*  Area of pigmentation disorders covering the lower area of the face under a line defined by the corners of the mouth.	0.354	0.190
Whole-face pigmentation*  Pigmentation disorders covering the entire face.	0.350	0.157
Lower face spot density*  Density of pigmentation spots in the lower part of the face	0.450	0.217

Note:

* Signs most affected by UV exposure.

Abbreviation: UV, ultraviolet.

Figure 3 Heliodermal status grade (mean ± confidence interval) in each age cluster. All bars are significantly different from the other, with an exception being the comparison marked on the graph. The number of people in each cluster is indicated between the brackets.

Abbreviations: yo, years, CI, confidence interval; NS, non significant.

Table 6 Correlations between clinical aging signs and age and heliodermal signs

	Apparent age	Real age	Heliodermal status
Wrinkles/texture	0.860*	0.740*	0.604*
Ptosis	0.803*	0.774*	0.552*
Pigmentation disorders	0.416*	0.317*	0.632*
Vascular disorders	0.054	0.000	0.181

Note:

* Significant at 0.5%.

Figure 4 Comparison of wrinkles and relief texture. Mean scores (± CI 95%) for each age cluster between S-S and S-P.

Note: *Statistically significant difference.
Abbreviations: S-P, sun-phobic; S-S, sun-seeking; CI, confidence interval.

Figure 5 Comparison of ptosis and sagging. Mean scores (± CI 95%) for each age cluster between S-S and S-P.

Note: There is no statistically significant difference between S-P and S-S groups.
Abbreviations: S-P, sun-phobic; S-S, sun-seeking; CI, confidence interval.

Figure 6 Comparison of pigmentation disorders. Mean scores (± CI 95%) for each age cluster between S-S and S-P.

Note: *Statistically significant difference.
Abbreviations: S-P, sun-phobic; S-S, sun-seeking; CI, confidence interval.

Figure 7 Comparison of microvascular disorders. Mean scores (± CI 95%) for each age cluster between S-S and S-P.

Note: *Statistically significant difference.
Abbreviations: S-P, sun-phobic; S-S, sun-seeking; CI, confidence interval.

Figure 8 Difference between apparent and chronological age for the S-S and S-P groups.

Notes: *Statistically significant difference between bars. A positive difference means that the person looks older than their age.
Abbreviations: S-P, sun-phobic; S-S, sun-seeking; SEM, standard error of the mean.

Figure 9 Percentage of sun damage is predictive of how old a woman looks.