Abstract
BACKGROUND: Skin ageing takes on many different forms. Despite this diversity in skin ageing phenotypes, literature published to date is limited in scope, as many research studies either focus on one single phenotype or just a few specific phenotypes. Presently, phenotypes such as wrinkles, pigment spots, and photo-ageing are receiving most of the research attention. We therefore wonder whether the current discourse on skin ageing places a disproportionate amount of focus on a few selected phenotypes, leaving other skin ageing phenotypes underexplored. METHODS: In this cross-sectional study, we performed a broad assessment of forty-one signs of skin ageing and characterised the phenotypes that constituted key components of skin ageing. We also explored the interrelationship among forty-one skin ageing phenotypes using Spearman's Correlation and Principal Component Analysis. RESULTS: We analysed our study population, which is composed of 3281 ethnic Chinese participants from the Singapore/Malaysia Cross-sectional Genetics Epidemiology Study (SMCGES). The first ten principal components cumulatively explain 46.88% of the variance of skin ageing phenotypes in our study population. We discovered that the commonly discussed forms of skin ageing (i.e., wrinkles, pigmentation, and photo-ageing) only accounted for a small portion (24.39%) of the variance of all skin ageing phenotypes in our study population. Telangiectasia, a poor lip fullness, a lighter skin colour, xerosis, ephelides (freckles), ptosis of eyelids (droopy eyelids), eyebags, and a low eyebrow positioning were other key components of skin ageing, accounting for a further 22.49% of the variance of skin ageing phenotypes in our study population. We found that each of these ten skin ageing phenotypes characterises a key and important aspect of skin ageing. In this broad assessment of skin ageing, we first described the prevalence of forty-one signs of skin ageing and then characterised in detail both the prevalence and severity distribution of ten key skin ageing phenotypes. CONCLUSIONS: We presented clear evidence that skin ageing is much more than just wrinkles, pigmentation and photo-ageing. The addition of telangiectasia, poor lip fullness, a lighter skin colour, xerosis, ephelides, ptosis of eyelids, eyebags, and a low eyebrow positioning added more dimensions to skin ageing phenotype presentations.