title: Perioral wrinkles are associated with female gender, aging, and smoking: Development of a gender-specific photonumeric scale.
abstract: BACKGROUND
  Perioral wrinkling is commonly reported among older adults, but its objective evaluation and causes remain poorly understood.
  
  
  OBJECTIVE
  We sought to develop a photonumeric scale for perioral wrinkling and to elucidate contributory lifestyle factors.
  
  
  METHODS
  In this cross-sectional study, we recruited participants for facial photographs and a survey. A gender-specific photonumeric scale for perioral wrinkling was developed and used by 3 graders to evaluate participant photographs. Scores and survey responses were used to create a multiple regression model to predict perioral wrinkling.
  
  
  RESULTS
  In all, 143 participants aged 21 to 91 years were enrolled. Intraclass correlation coefficient values for interrater and intrarater reliability were high (>0.8) across 2 trials and 3 graders. A multiple regression model for prediction of perioral wrinkling severity included age, gender, and years of smoking as variables.
  
  
  CONCLUSIONS
  The study was limited by sample size and a predominantly Caucasian study population.
  
  
  CONCLUSIONS
  We created a photonumeric scale that accounts for gender differences in perioral wrinkling and highlighted contributory variables to photoaging in this anatomical location.
authors.affiliation: Department of Dermatology, Johns Hopkins University, Baltimore, Maryland. Electronic address: achien3@jhmi.edu.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Chien
authors.affiliation: Department of Dermatology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Ji
authors.initials: J
authors.lastname: Qi
authors.affiliation: Department of Dermatology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Nancy
authors.initials: N
authors.lastname: Cheng
authors.affiliation: Department of Dermatology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Thy Thy
authors.initials: TT
authors.lastname: Do
authors.affiliation: Department of Dermatology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Missale
authors.initials: M
authors.lastname: Mesfin
authors.affiliation: Department of Dermatology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Robert
authors.initials: R
authors.lastname: Egbers
authors.affiliation: Department of Dermatology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Wenfei
authors.initials: W
authors.lastname: Xie
authors.affiliation: Department of Dermatology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Conroy
authors.initials: C
authors.lastname: Chow
authors.affiliation: Department of Dermatology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Heather
authors.initials: H
authors.lastname: Chubb
authors.affiliation: Department of Dermatology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Dana
authors.initials: D
authors.lastname: Sachs
authors.affiliation: Department of Dermatology, University of Michigan, Ann Arbor, Michigan.
authors.forename: John
authors.initials: J
authors.lastname: Voorhees
authors.affiliation: Department of Dermatology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Sewon
authors.initials: S
authors.lastname: Kang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D015331:Cohort Studies; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009055:Mouth; D015999:Multivariate Analysis; D010781:Photography; D012044:Regression Analysis; D012307:Risk Factors; D015595:Skin Aging / Q000502:physiology*; D012907:Smoking / Q000009:adverse effects*; D055815:Young Adult
keywords: crows feet; gender differences; perioral wrinkling; photoaging; photonumeric scale; smoking