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Facial Wrinkling and Chronic Lung Disease — The Susceptibilities Are Linked!

Some smokers may be in for more than one kind of bad news.

In 1991, a group of dermatologists in Utah linked tobacco smoking with the development of wrinkles (see Ann Intern Med 1991; 114:840). They were bombarded with hate mail from the tobacco industry, which then still denied the association between tobacco and lung cancer (personal communication from the senior study author, 1991). Is there a common predisposition to chronic obstructive pulmonary disease (COPD) and accelerated wrinkling in some smokers?

Investigators assessed facial wrinkles in 149 current and former smokers who were participants in a study of the genetic predisposition to chronic COPD. COPD severity was assessed by CT scan and pulmonary function studies, particularly forced expiratory volume in 1 second (FEV₁). Two independent dermatologists assessed facial wrinkling in patient photographs to assign a Daniell score ranging from I (no wrinkling) to VI (severe wrinkling). (Photographs illustrating grades I, III, and VI accompany the journal article.) Sixty-eight patients had COPD; 124 patients had no or minor wrinkling, and 25 patients were wrinkled (Daniell score, IV). In a comparison of the findings of the pulmonary and wrinkling assessments, the investigators found statistically significant correlations between facial wrinkling and both low FEV₁ and extensive disease on CT. The authors suggest that genetic susceptibility might be the mechanism behind this correlation: Smoking might activate metalloproteinases in susceptible individuals, or such individuals might have defective repair mechanisms affecting both skin and lungs.

Comment: The presence, and perhaps the severity, of COPD might be predictable by examining the facial skin, and accelerated wrinkling could signal the need for studies of lung function. Smoking is associated with other health-related problems, and future studies might attempt to correlate skin findings with cardiovascular disease in smokers. Laboratory elucidation of the specific mechanism behind increased susceptibility would be useful and interesting. If a genetic predisposition is identified, susceptible families and individuals might receive more urgent counsel to avoid smoking and exposure to secondhand smoke.

— Jeffrey P. Callen, MD

Published in Journal Watch Dermatology July 21, 2006

Citation(s):

Patel BD et al. Smoking related COPD and facial wrinkling: Is there a common susceptibility? Thorax 2006 Jul; 61:568-71. (http://dx.doi.org/10.1136/thx.2005.053827)

• Original article (Subscription may be required)
• Medline abstract (Free)