COPD Facial Wrinkles Not Linked to Disease Severity in Thai Study
Key Takeaways
- In Thai patients with spirometry-confirmed COPD at a Bangkok tertiary center, adjusted analyses did not identify a significant association between facial wrinkle severity and COPD-related measures such as FEV1 % predicted, cumulative smoking exposure, or smoking-related COPD status.
- Age emerged as the most consistent independent predictor of wrinkle severity across the analyses.
- Higher BMI was associated with lower wrinkle severity only on the objective Antera 3D assessment, not on severe Daniell grading.
- Daniell grading and Antera 3D wrinkle measurements correlated significantly, suggesting agreement between the clinical and imaging assessments.
- Severe facial wrinkling was present in 41.9% of the cohort.
At Ramathibodi Hospital in Bangkok, the exploratory Suchonwanit et al cross-sectional study of facial wrinkling and COPD severity in Thai patients screened 119 adults and included 93 with spirometry-confirmed COPD, defined for analysis by post-bronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) <0.70; patients identified only by high-resolution computed tomography (CT) evidence of emphysema were excluded from the final cohort. A blinded dermatologist graded standardized bilateral temporal photographs with the Daniell scale, while Antera 3D imaging provided an objective indentation index. Prespecified multivariable models adjusted for age, sex, body mass index (BMI), occupational sun exposure, cumulative pack-years, and post-bronchodilator forced expiratory volume in 1 second (FEV1) percent predicted; severe wrinkling was defined as a Daniell score of 4 or higher, and sensitivity analyses were planned after excluding never smokers and within smoking-related COPD.
Clinical Daniell grades and objective Antera 3D measurements moved together, and duplicate Antera captures were reliable enough to support the imaging analysis. In adjusted modeling, older age remained associated with greater wrinkle depth on the imaging measure, with β=0.08 (95% CI 0.01–0.24), p=0.042, while higher BMI was inversely associated only with the objective Antera 3D outcome.
After adjustment, COPD-related characteristics including post-bronchodilator FEV1 percent predicted, cumulative smoking exposure, and smoking-related COPD status were not significantly associated with wrinkle severity. Age remained associated with severe wrinkling on the clinical scale, with OR=1.15 (95% CI 1.06–1.23), p<0.001. Sensitivity analyses excluding never smokers and focusing on smoking-related COPD did not materially change that pattern.
Because the study was cross-sectional and single-center, it captured associations at one time point in a cohort that was predominantly older, male, and largely characterized by mild-to-moderate COPD. Without healthy controls or smokers without COPD, it cannot show whether COPD itself is associated with more facial wrinkling than non-COPD status. Diffusion capacity of the lung for carbon monoxide (DLCO), quantitative CT emphysema burden, cumulative ultraviolet exposure, photoprotection habits, passive smoking exposure, and other determinants of skin aging were not systematically collected, so much of the variability in wrinkle severity remained unexplained. For North American readers, these observations come from a Thai tertiary-care cohort and should not be assumed to reflect U.S. populations.
Within this Thai COPD cohort, no association was detected between facial wrinkle severity and the COPD-related characteristics assessed, while age remained the most consistent predictor and the BMI signal was limited to the objective measure. The authors noted that this pattern differs from some earlier Western reports, but their observed finding in Thai patients was a lack of a detectable COPD-linked wrinkling signal after adjustment.
Clinician Questions
How was severe facial wrinkling defined in Thai patients with COPD?
Severe facial wrinkling in Thai patients with spirometry-confirmed COPD was defined as a Daniell score of 4 or higher on the six-point clinical grading scale, assigned from standardized bilateral temporal photographs reviewed by a blinded dermatologist; the Antera 3D indentation index was analyzed separately as the objective continuous wrinkle measure.
Did excluding never smokers change the wrinkle findings in Thai patients with COPD?
No. After excluding never smokers and again in the subgroup defined as smoking-related COPD by at least 10 pack-years, the main pattern was unchanged: age remained associated with wrinkle severity, whereas COPD-related variables such as FEV1 % predicted and cumulative smoking exposure did not.
Why can’t this COPD cohort show whether COPD causes more facial wrinkling than non-COPD status?
This Thai COPD cohort included only patients with COPD and had no healthy control group or non-COPD smoker comparison group, so it tested variation within COPD rather than whether COPD itself is associated with more wrinkling than non-COPD status.
What factors beyond COPD severity did the authors say may have contributed to wrinkle severity?
The authors described wrinkle severity as potentially influenced by unmeasured factors such as lifetime ultraviolet exposure, photoprotection behavior, air pollution, biomass or occupational particulate exposure, diet, skin-care practices, genetic susceptibility, and hormonal factors; they also noted that DLCO and quantitative CT emphysema measures were unavailable, which may have limited detection of COPD phenotypes linked to wrinkling.