Despite these clinical impressions, O’Hare et al5 asserted that cigarette smoking played a minor role in causing
wrinkling, noting that previous studies2,3 linking smoking and increased wrinkling failed to consider confounding variables such as sun exposure history and were unblinded and therefore subject to bias. O’Hare et al evaluated 82 smokers and 118 nonsmokers who were 35 to 75 years of age and white. After controlling for confounding variables, the overall wrinkle score was greater for the smokers than for the nonsmokers, but the difference was not statistically significant (P_.17). O’Hare et al found that a positive smoking history accounted for only 6% of the explained variance in wrinkle scores between smokers and nonsmokers. Age was found to be the strongest independent predictor of facial wrinkling.
On the other hand, several studies6-9 support a relationship between cigarette smoking and wrinkling. Kadunce et al6 were the first to evaluate a possible relationship between cigarette smoking and wrinkling while controlling for age, sex, sun exposure, and skin pigmentation.