138 JOURNAL OF COSMETIC SCIENCE Table IX Demographic Chararcteristics of the Subject Population for the Clinical Test of a Wrinkle-Improving Agent Number 15 Age (yr) Mean 42.5 Range 35-54 Sex female Overall severity of wrinkle* Mild 10.0 (67%) Moderate 5.0 (33 %) * Mild = grade 1-5 moderate = grade 6-8. Table X Improvement in Wrinkle Score After an Eight-Week Use of a Wrinkle-Improving Agent Eye corners Agent Placebo Mean baseline score 5.00 4.93 Mean week-8 score 4.40 5.06 Mean change from baseline -0.60 0.07 Percent change from baseline 12.0 -1.42 p Value* 0.01 The data are means of 15 subjects. * Significant (t-test) compared with placebo. more readily affected by photoaging compared with Caucasians. Griffiths et al. demon- strated this based on a profile of a 72-year-old obese Japanese and the results of clinical tests of tretinoin in Mongoloids in Singapore, Indonesia, and Malaysia (14). In the present study, we showed the usefulness of enlarged photo scales for evaluating photo- aging, especially wrinkles, using enlarged photos of the eye corners. However, the decrement of the kappa value of the photo standards at the forehead compared with the kappa value at the eye corners may support the contention of Griffiths et al. that photo scales cannot be used in Japanese. Concerning age-related changes in the scores at each facial site, wrinkles around the eyes were highly correlated with age. A similar high correlation between changes at the eye corners and age was also observed in a three-dimensional (3-D) analysis of skin replicas (15). However, our previous replica analysis showed higher correlations of age with wrinkles at the glabella, nasolabial grooves, and mouth angles compared to wrinkles at other sites (excluding the eye corners) (15). Thus, the wrinkle score at the eye corners visually differed from the 3-D surface morphology analyzed using replicas. Since the slope of the linear approximate expression represents the rate of development of wrinkles, wrinkles more rapidly develop in the order of.' eye corners forehead lower eyelids upper eyelids mouth angles nasolabial grooves cheeks glabella. Wrinkles around the eyes that are highly correlated with age also showed a high wrinkle development rate. A wrinkle score of 3 is considered to represent the initiation of the development of wrinkles. According to the ages at which the present subjects showed score 3, wrinkles appear to develop early and rapidly at the eye corners.

ASSESSMENT OF FACIAL WRINKLES 139 We evaluated an agent for wrinkle improvement using a photo scale and obtained good results and found that an evaluation of pre- and post-treatment wrinkles was possible using a wrinkle photo scale, suggesting the validity and usefulness of this method. REFERENCES (11) (12) (13) (14) (15) (1) R.B. Armstrong, J. Lesiewicz, G. Harvey, L. F. Lee, K.T. Spoehr, and M. Zultak, Clinical panel assessment of photodamaged skin treated with isotretinoin using photographs, Arch. Deramtol., 128, 352-356 (1992). (2) M.J. Stiller, J. Bartolone, R. Stern, S. Smith, N. Kollias, R. Gillies, and L. A. Drake, Topical 8% glycolic acid and 8% I-lactic acid creams for the treatment of photodamaged skin, Arch. Dermatol., 132, 631-636 (1996). (3) J. S. Weiss, C. N. Ellis, J. T. Headington, T. Tincoff, T. A. Hamilton, and J. J. Voorhees, Topical tretinoin improves photoaged skin, JAMA, 259, 527-532 (1988). (4) J.J. Leyden, G. L. Grove, M.J. Grove, E. G. Thorne, and L. Lufrano, Treatment of photodamaged facial skin with topical tretinoin, J. Am. Acad. Dermatol., 21,638-644 (1989). (5) L. Lever, P. Kumar, and R. Marks, Topical retinoic acid for treatment of solar damage, Br.J. Dermatol., 122, 91-98 (1990). (6) G.L. Grove, M.J. Grove, J.J. Leyden, L. Lufrano, B. Schwab, B. H. Perry, and E. G. Thorne, Skin replica analysis of photodamaged skin after therapy with tretinoin emollient cream, J. Am. Acad. Dermatol., 25,231-237 (1991). (7) C. E. M. Griffiths, S. Kang, C. N. Ellis, K. J. Kim, L. J. Finkel, L. C. Ortiz-Ferrer, G. M. White, T. A. Hamilton, and J.J. Voorhees, Two concentrations of topical tretinoin (retinoic acid) cause similar improvement of photoaging but different degrees of irritation, Arch. Dermatol., 131, 1037-1044 (1995). (8) C. E. M. Griffiths, T. S. Wang, T. A. Hamilton, J. J. Voorhees, and C. N. Ellis, A photonumeric scale for the assessment of cutaneous photodamage, Arch. Dermatol., 128, 347-351 (1992). (9) C. Larnier, J.P. Ortonne, A. Venot, B. Faivre, J. C. Beani, P. Thomas, T. Brown, and E. Sendagorta, Evaluation of cutaneous photodamage using a photographic scale, Br. J. Dermatol., 130, 167-173 (1994). (10) Y. Takema, Y. Yorimoto, and M. Kawai, The relationship between age-related changes in the physical properties and development of wrinkles in human facial skin, J. Soc. Cosmet. Chem., 46, 163-173 (1995). J. Cohen, A coefficient of agreement for nominal scales, Educ. Physiol. Measurement, 20, 37-46 (1960). J. D. Fleiss and J. Cohen, Large sample standard errors of kappa and weighted kappa, Psychol. Bull., 72, 323-327 (1969). J. R. Landis and G. G. Koch, The measurement of observer agreement for categorical data, Biometrics, 33, 159-174 (1977). S.H. Goh, The treatment of visible signs of senescence: The Asian experience, Br. J. Dermatol., 122(Suppl. 35), 105-109 (1990). Y. Takema, K. Tsukahara, T. Fujimura, and M. Hattori, Age-related changes of 3-dimensional morphological changes in the human facial skin, Skin Res. Tech., 3, 95-100 (1997).