![]() The hand-search process was repeated for results from the secondary search to ensure a thorough record was obtained (see Fig. Results obtained in the secondary search were deduplicated and screened using the same eligibility criteria as that applied in the primary search. A secondary search was conducted by hand-searching references cited by the eligible articles from the primary search. Eligible articles from the primary search were determined using pre-defined eligibility criteria. Full search terms and filters applied for their respective databases are summarised in Table 1. The search term for all databases included ‘skin aging’ or ‘skin ageing’ in the title or abstract, and ‘risk’, or ‘protective’, or ‘epidemiology’ in all index fields. Search results were restricted to English journal articles published between 19. A primary literature search was performed using the Embase, PubMed and Web of Science databases in October 2020. This review was conducted in accordance with the Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA) guidelines 12 (see Supplementary Table 1 for PRISMA checklist). Lastly, to maximise the scope of possible associations, we focused on non-experimental observational studies (i.e., cross-sectional, or longitudinal study designs). The outcome of interest was skin aging signs assessable through non-invasive means, with emphasis on visual assessment methods, owing to the convenience of execution and cosmetic implications of visually evident skin aging phenotypes. Although the focus was on modifiable epidemiological factors (extrinsic aging), intrinsic aging factors were included due to their potential interaction or confounding effects with extrinsic factors. We aimed to obtain a broad overview of the epidemiology of skin aging hence, all participant subjects available in the literature were considered. This review examines the association of epidemiological factors with human skin aging signs that are assessable by non-invasive means. Thus, skin aging may be categorised as intrinsic or extrinsic, depending on the epidemiological factors affecting the skin aging process, whereby intrinsic aging is attributed chronological and genetic factors, while extrinsic aging is influenced by environmental factors 11. Forming an interface between the human body and the external environment, the human skin is constantly subject to both chronologically and environmentally induced changes. The latter phrase, ‘aging’, requires careful elucidation. With reference to the former, changes to the skin may be categorised as, but not limited to the following: histological, morphological, and physiological. Attention was paid to the phrases ‘changes to the skin’, and ‘aging’. In this article, skin aging is defined simply as changes to the skin that occur due to aging. As such, skin aging has been quantified using different phenotypes and grading systems, allowing the identification of multiple risk factors by various epidemiological studies 9, 10. ![]() There is a rough consensus that skin aging encompasses several phenotypes such as, but not limited to, wrinkling, pigmentation and telangiectasis 3, 4, 5, 6, 7, 8. Yet, a formally agreed definition of skin aging and its signs is still lacking. However, the concept of skin aging as a superimposition of skin changes induced by both chronologic and environmental factors was only introduced later, after 1983 2, 3. This review’s results will guide future works, such as those aiming to examine the interaction between genetic and environmental influences.Įpidemiological evidence of environmentally induced skin changes has existed as early as 1965 1. We identified seven notable risk factors for various skin aging phenotypes: age, gender, ethnicity, air pollution, nutrition, smoking, sun exposure. Otherwise, significant factors were reported in this review. Where odds ratios were reported, meta-analyses were conducted using the random effects model. Embase, PubMed and Web of Science databases were searched in October 2020 using specific search strategies. We conducted our systematic review in compliance with Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA) guidelines. ![]() To better understand skin aging risk factors and collate the available data, we aimed to conduct a systematic review and meta-analysis. However, these studies have yet to be reviewed. The risk factors of skin aging have been studied previously, using methods of quantifying skin aging. Skin aging has been defined to encompass both intrinsic and extrinsic aging, with extrinsic aging effected by environmental influences and overlaying the effects of chronological aging. ![]()
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