Effect of Age, Gender, and Sun Exposure on Ethnic Skin Photoaging: Evidence Gathered Using a New Photonumeric Scale

doi:10.1016/j.jnma.2017.05.001

Journal of the National Medical Association

Volume 110, Issue 2, April 2018, Pages 176-181

https://doi.org/10.1016/j.jnma.2017.05.001 Get rights and content

Abstract

Background

African–Americans are less affected by photoaging than lighter skin individuals. Although scales for photoaging have been developed for Caucasians and Asians, no scale exists for African–Americans.

Aim

To develop a photonumeric scale for photoaging and to determine factors that contribute to photoaging in African–Americans.

Methods

Five participants' photographs were selected as standards to create a 9-point photonumeric scale (0 = none, 8 = most severe). Three blinded dermatologists used the scale to grade the remaining participants' photographs.

Results

Interrater reliabilities were 0.775 (95% CI: 0.635, 0.880) for trial 1 and 0.832 (0.747, 0.883) for trial 2. Intrarater reliabilities, assessed over a 1 week interval, were 0.863 (0.727, 0.940), 0.928 (0.890, 0.954), and 0.866 (0.739, 0.935) for the three graders, indicating strong agreement. Photoaging scores were then correlated with participants' survey on lifestyle factors, which yielded age as a significant predictor (r = 0.91, p < 0.001). Furthermore, multiple regression model to predict facial photoaging (adjusted R² = 0.849) selected age (b₁ = 0.111, p < 0.001), sun exposure (b₂ = 0.206, p = 0.014), and gender (b₂ = −0.388, p = 0.063) as the most important variables.

Conclusions

A reliable photonumeric scale for photoaging in African Americans was developed. Age, sun exposure, and male gender were found to be contributory factors to photoaging.

Introduction

Skin aging continues to be a topic of intense interest among the US population. By 2020, the global anti-aging products market is expected to reach $275 billion, with United States accounting for one of the largest markets worldwide.¹ Prevention and treatment of visible skin damage resulting from ultraviolet (UV) radiation and other external factors are common concerns among dermatology clinic patients.² Wide varieties of dermatological products and procedures are currently available to address these issues, and ongoing research will lead to the availability of new therapies.

The features of photoaging, or extrinsic cutaneous damage, are traditionally associated with skin atrophy, wrinkling, leathery skin, and lentigines. However, signs of aging are known to vary with skin phototype. Lighter-skinned patients have more atrophy and premalignant changes as well as more prominent fine wrinkling than darker-skinned patients, who have more pigmentation changes.2, 3 The differences in clinical features give rise to varying considerations in evaluation and management.

In investigating the efficacy of anti-aging interventions, objective assessments of photoaging are necessary. Photonumeric scales have been shown to be more effective than written, descriptive scales for the evaluation of extrinsic skin aging.⁴ Such scales have been developed for Caucasians and Asians.4, 5 However, no similar scales have yet been developed for darker-skinned groups, including African–Americans. By 2050, non-Hispanic Caucasians are projected to no longer make up the majority of the US population.⁶ It is important to ensure that skin of color is not overlooked in the literature.

With this objective in mind, we created a 9-point photonumeric scale consisting of five individuals' facial photographs, designed to assess the severity of photoaging specifically in the African–American population. The validity of this scale was tested by having three independent graders apply the scale to evaluate 70 participants' photoaging. The assigned scores were further correlated with demographic and survey data to determine contributory factors in this population.

Section snippets

Participant recruitment

Participants were screened and enrolled at the Johns Hopkins Outpatient Center, Baltimore, Maryland. The inclusion criteria included: African–American race and willingness to stop topical medication use on the face 2 weeks prior to study. Exclusion criteria included history of topical retinoid use within 1 year of enrollment or topical 5-fluorouracil use, history of facial surgeries or cosmetic procedures, significant or severe illness, pregnancy or breastfeeding status, and significant facial

Results

Seventy-five African–American participants aged 18 to 96 completed the study protocol, including 23 males and 52 females. Additional demographic and survey response data are illustrated in Table 1. Five participants were selected as standards for the photonumeric scale, such that 70 participants had their photographs graded using the scale (Figure 1A–J). Among the participants, the distribution of average photoaging scores as assigned by graders was the following: 27 (39%) in the 0 to <2 group,

Discussion

A photonumeric scale was created which assesses the degree of facial photoaging among African–Americans. To our knowledge, such a scale has not yet been developed or investigated in the current literature. Following two trials involving three independent graders, the scale was found to have high inter- and intra-rater reliabilities according to the ICC method. Thus the scale may be utilized as a clinical and investigational tool for assessment of African–American skin.

Our methodology was

Author contributions

Dr. Chien had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Chien, Okoye, and Kang. Acquisition, analysis, and interpretation of data: Qi, Grandhi, Kuhn, Leung, Rainer, Cheng, Poon, Harris-Tryon, Kim, Olowoyeye, Jang, Cesar, Suh. Drafting of the manuscript: Qi. Critical revision of the manuscript for important intellectual content: Chien, Kang, Okoye. Statistical analysis: Qi.

Acknowledgements

We wish to acknowledge Jessica Esandrio, BA and Jasmine Mensah, BA for their assistance in participant recruitment and study coordination. This study was supported in part by Johns Hopkins Department of Dermatology.

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: The study was IRB approved.

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Original ArticleEffect of Age, Gender, and Sun Exposure on Ethnic Skin Photoaging: Evidence Gathered Using a New Photonumeric Scale

Abstract

Background

Aim

Methods

Results

Conclusions

Introduction

Section snippets

Participant recruitment

Results

Discussion

Author contributions

Acknowledgements

J Dermatol Sci

Anti-aging Products: A Global Strategic Business Report

Mechanisms and treatments of photoaging

Photodermatol Photoimmunol Photomed

Aging of skin

A photonumeric scale for the assessment of cutaneous photodamage

Arch Dermatol

Cutaneous photodamage in Koreans: influence of sex, sun exposure, smoking, and skin color

Arch Dermatol

2012 National Population Projections

Original Article
Effect of Age, Gender, and Sun Exposure on Ethnic Skin Photoaging: Evidence Gathered Using a New Photonumeric Scale