Facial Wrinkling is Not Associated with Chronic Obstructive Pulmonary Disease Severity in Thai Patients: A...

Western studies have reported associations between facial wrinkling and chronic obstructive pulmonary disease (COPD), suggesting a shared susceptibility to tissue aging. However, data on Asian populations are limited, and population-specific differences in skin biology may modify these relationships.

To investigate the association between facial wrinkle severity and COPD characteristics in Thai patients and to identify independent predictors of wrinkle severity.

This cross-sectional study enrolled 93 Thai patients with COPD. Facial wrinkles were assessed using the Daniell grading scale (a validated six-point subjective clinical grading system) and the Antera 3D imaging system (an objective three-dimensional topographic imaging device). Multivariable linear and logistic regression analyses were performed to identify independent predictors of wrinkle severity after adjustment for age, sex, body mass index (BMI), cumulative smoking exposure, occupational sun exposure, and post-bronchodilator FEV₁ % predicted.

Mean age was 72.6±8.8 years (90.3% male). Severe facial wrinkling, defined as a Daniell score ≥4, was present in 41.9% of the patients. The Daniell grading scale and Antera 3D measurements showed a moderate-to-strong correlation (Spearman's ρ=0.68, p<0.001). In multivariable analyses, age was consistently associated with both objective wrinkle depth (β=0.08; 95% CI: 0.01-0.24; p=0.042) and severe wrinkling (OR=1.15; 95% CI: 1.06-1.23; p<0.001). Higher body mass index was inversely associated with objective wrinkle severity (β=-0.34; 95% CI: -0.65 to -0.03; p=0.031) but not with severe Daniell-grade wrinkling. COPD-related characteristics, including FEV₁ % predicted, cumulative smoking exposure, and smoking-related COPD status, showed no significant associations with wrinkle severity after adjustment.

Among Thai patients with spirometry-confirmed COPD, no significant association was detected between facial wrinkle severity and the COPD-related characteristics assessed. Age was the most consistent independent predictor of wrinkle severity, while higher BMI showed an inverse association with objective wrinkle measurements only. These findings differ from those reported in Western populations and support population-specific validation before applying facial wrinkling as a cutaneous marker of COPD-related disease burden.