Solar exposure(s) and facial clinical signs of aging in Chinese women: impacts upon age perception

Figures & data

Table 1 Distribution of volunteers among age classes and for the two subcohorts (sun-phobic and normal exposure)

Age (years)	Sun-phobic	Normal exposure	Total
20–29	28	22	50
30–39	28	22	50
40–49	20	31	51
50–59	20	31	51
60–69	21	29	50
70–80	23	26	49
Total	140	161	301

Table 2 Description of the two subcohorts cohorts (sun-phobic and normal exposure) regarding the solar exposure behavior each day and week during volunteers’ lifetimes – according to the questionnaire completed by each subject

	Period of lifetime (age in years)	0–10	10–20	20–30	30–40	40–50	50–60	60–80	Average
Hours per day	Sun-phobic	3.55	3.59	2.99	2.84	2.78	3.31	3.40	3.21
	Normal exposure	4.04	4.57	5.02	5.07	5.11	4.63	4.31	4.68
Days per week	Sun-phobic	2.25	2.32	2.07	1.79	1.60	1.92	1.91	1.98
	Normal exposure	3.24	4.11	4.72	4.94	4.93	3.77	3.27	4.14
Hours per week	Sun-phobic	7.99	8.34	6.18	5.08	4.47	6.35	6.49	6.41
	Normal exposure	13.10	18.80	23.68	25.02	25.19	17.44	14.13	19.62

Figure 1 Clinical standardized photographic scale of “forehead pigmentation”.

Figure 2 Clinical standardized photographic scale of “importance of facial skin surface texture presenting alteration”.

Table 3 New clinical signs to complete previously published clinical atlases. Correlations with real/chronological age, perceived apparent age, and photoaging status

Clinical cluster	Signs	Photoaging status	Real/chronological age	Perceived apparent age	Visual
Wrinkles and skin texture	Importance of facial skin surface texture presenting alteration Percentage of facial skin surface presenting thick and cracked aspect characteristic to solar elastosis	0.793	0.826	0.884
Wrinkles and skin texture	Texture of the mouth contour Skin around the mouth has thick and cracked aspect, characteristic of solar elastosis	0.729	0.830	0.889
Pigmentation disorders	Forehead pigmentation Hyperpigmentation of the forehead giving a “burn” aspect to the skin	0.766	0.794	0.851
Pigmentation disorders	Cheekbone pigmentation Area with pigmentation disorders present on the protruding part of the malar zone	0.821	0.784	0.804
Pigmentation disorders	Lateral facial pigmentation Severity of pigmentation disorders on pigmentary spots on external lateral area of the face	0.750	0.727	0.769
Pigmentation disorders	Upper lip pigmentation Hyperpigmentation of the upper lip giving a “burn” aspect to the skin	0.750	0.683	0.751
Others	Vascular disorders All diffused redness and microvessels visible on the face and especially cheek	0.574	0.514	0.507

Note: The clinical signs gathered here complete the ones previously described and published in Bazin R, Flament F. Skin Aging Atlas. Volume 2, Asian Type. Paris: Editions Med’Com; 2010.¹⁴

Table 4 Clinical aging signs of the face, described by atlases. Correlations with real/chronological age, perceived apparent age, and photoaging status

Clinical cluster	Signs	Photoaging status	Real/chronological age	Perceived apparent age
Wrinkles and skin texture	Forehead wrinkles	0.740	0.854	0.894
Wrinkles and skin texture	Fine lines of the forehead	0.762	0.868	0.915
Wrinkles and skin texture	Glabellar wrinkles	0.617	0.765	0.788
Wrinkles and skin texture	Interocular wrinkles	0.698	0.859	0.874
Wrinkles and skin texture	Crow’s feet wrinkles	0.773	0.880	0.901
Wrinkles and skin texture	Underneath eye wrinkles	0.803	0.899	0.935
Wrinkles and skin texture	Preauricular wrinkles	0.708	0.792	0.828
Wrinkles and skin texture	Cheek folds	0.788	0.848	0.896
Wrinkles and skin texture	Nasolabial fold	0.706	0.851	0.898
Wrinkles and skin texture	Small folds on nasolabial zone	0.763	0.907	0.938
Wrinkles and skin texture	Upper lip wrinkles	0.735	0.837	0.890
Wrinkles and skin texture	Wrinkles of the corner of the lips	0.682	0.823	0.857
Wrinkles and skin texture	Chin withering	0.634	0.731	0.771
Pigmentation disorders	Density of pigmentary spots	0.803	0.703	0.730
Pigmentation disorders	Localized pigmentary spots of the cheek	0.774	0.694	0.742
Pigmentation disorders	Contrast of isolated pigmentary spot of the face	0.635	0.587	0.617
Pigmentation disorders	Size of an isolated spot	0.623	0.577	0.613
Ptosis and sagging	Drooping of upper outer eyelid	0.712	0.839	0.869
Ptosis and sagging	Eye bags	0.739	0.865	0.885
Ptosis and sagging	Ptosis of the lower part of the face	0.689	0.814	0.848
Others	Cheek sebaceous pores	0.103	0.143	0.126

Note: Standardized photographic scales used for scoring were previously published in Bazin R, Flament F. Skin Aging Atlas. Volume 2, Asian Type. Paris: Editions Med’Com; 2010.¹⁴

Table 5 The four clinical clusters. Correlations with real/chronological age, perceived apparent age and photoaging status

Clinical cluster	Photoaging status	Real/chronological age	Perceived apparent age
Wrinkles and skin texture (15 signs)	0.803	0.925	0.967
Pigmentation disorders (8 signs)	0.829	0.778	0.823
Ptosis and sagging (3 signs)	0.775	0.913	0.943
Others (2 signs)	0.414	0.412	0.398

Figure 3 Comparison of photoaging status scored with Chung’s scales.⁵ Mean scores (±95% CI) for each age class between normal exposure and sun-phobic.

Note: *Statistically significant difference (P<0.05).
Abbreviations: S-P, sun-phobic; NE, normal exposure; CI, confidence interval.

Figure 4 Comparison of wrinkles and skin texture. Mean scores (±95% CI) for each age class between normal exposure and sun-phobic.

Note: *Statistically significant difference (P<0.05).
Abbreviations: S-P, sun-phobic; NE, normal exposure; CI, confidence interval.

Figure 5 Comparison of pigmentation disorders. Mean scores (±95% CI) for each age class between normal exposure and sun-phobic.

Notes: *Statistically significant difference (P<0.05); **tendency (P<0.1).
Abbreviations: S-P, sun-phobic; NE, normal exposure; CI, confidence interval.

Figure 6 Comparison of ptosis and sagging. Mean scores (±95% CI) for each age class between normal exposure and sun-phobic.

Note: *Statistically significant difference (P<0.05).
Abbreviations: S-P, sun-phobic; NE, normal exposure; CI, confidence interval.

Table 6 Estimation of maximum clinical sun-induced damages vs real/chronological Asian facial skin aging for each age class in absence of specific prevention behavior: (Mean of fourth NE quartile – mean of first S-P quartile)/mean of first S-P quartile, that is, ([extrinsic + intrinsic] – intrinsic)/intrinsic

Age (years)	Wrinkles and skin texture	Ptosis and sagging	Pigmentation disorders	Cheek sebaceous pores	Vascular disorders
20–29	3.13	1.97	4.32	4.19	21.20
30–39	1.23	1.43	2.43	2.29	4.86
40–49	1.55	1.25	2.08	2.53	3.49
50–59	1.43	0.87	1.20	2.47	1.81
60–69	1.13	0.57	1.14	1.45	1.88
70–80	0.47	0.46	0.78	1.30	1.62

Abbreviations: S-P, sun-phobic; NE, normal exposure.

Figure 7 Difference between perceived apparent and real/chronological ages for each age class between normal exposure and sun-phobic. Mean differences (±95% CI).

Note: *Statistically significant difference (P<0.05).
Abbreviations: S-P, sun-phobic; NE, normal exposure; CI, confidence interval.

Table 7 Differences in perceived apparent age (younger/older than 3 years) between the two subcohorts of Chinese women (sun-phobic vs normal sun exposure)

	Sun-phobic	Normal exposure
Looks older by 3 years	18.71%	37.65%
Looks one’s age	56.83%	46.91%
Looks younger by 3 years	24.46%	15.43%

BazinRFlamentFSkin Aging Atlas. Volume 2, Asian TypeParisEditions Med’Com2010

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