title: Facial wrinkling in postmenopausal women. Effects of smoking status and hormone replacement therapy.
abstract: BACKGROUND
  There is some evidence that hormone replacement therapy may produce significant improvements in fine wrinkling, while aging skin is more frequently found in smokers. However, studies of the combined effect of a protective factor, such as HRT, and a damaging factor, such as smoking, are rare.
  
  
  OBJECTIVE
  To determine in postmenopausal women the relationship between smoking status and the average number of packets of cigarettes since the subject took up smoking (packs-years) on the one hand, and facial wrinkling on the other, and to evaluate the role of hormone replacement therapy in the prevention of wrinkles in smokers and non-smokers.
  
  
  METHODS
  All subjects were recruited from our menopause clinic at Hospital Clínic i Provincial in Barcelona and were placed into one of three groups according to their smoking status: 215 life-long non-smokers, 306 former smokers and 209 current smokers. Smoking status, pack-years and hormone replacement were assessed by direct questioning. Facial wrinkle scores were estimated by standardized visual assessment.
  
  
  RESULTS
  The relative risk of moderate-severe wrinkling for current smokers compared to that for life-long non-smokers was 2.57 (confidence interval: 1.83-3.06; P < 0.0005). Pack-years was positively related to facial wrinkles. Life-long non-smokers receiving HRT had lower facial wrinkle scores than Life-long non-smokers who had never received HRT. HRT did not, in general, modify the facial wrinkle score in current smokers.
  
  
  CONCLUSIONS
  Our results suggest that the risk of facial wrinkles is greater in smokers and that HRT does not diminish this risk.
authors.affiliation: Department of Gynaecology and Obstetrics, Hospital Clínic i Provincial de Barcelona, Faculty of Medicine, University of Barcelona, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Castelo-Branco
authors.forename: F
authors.initials: F
authors.lastname: Figueras
authors.forename: M J
authors.initials: MJ
authors.lastname: Martínez de Osaba
authors.forename: J A
authors.initials: JA
authors.lastname: Vanrell
mesh_terms: D000328:Adult; D017677:Age Distribution; D015914:Estrogen Replacement Therapy; D005145:Face; D005260:Female; D006801:Humans; D008875:Middle Aged; D017698:Postmenopause / Q000187:drug effects*; D015595:Skin Aging / Q000187:drug effects*; D012907:Smoking / Q000009:adverse effects*; D013997:Time Factors