Background: Precise factors associated with premature skin aging, or photoaging, in the general population are unknown. Objective: To examine the risk factors for photoaging in a Queensland community. Methods: A cross-sectional study of 1,400 randomly selected residents aged 20–54 years, using casts of the back of the hand (surface microtopography) and dermatological assessment of photoaging. Results: 83% of the participants had premature skin aging, worsening after the age of 30. Severe neck wrinkling was 3 times more likely in men and some 4 times more likely in fair-skinned people (odds ratio, OR = 3.86, 95% confidence interval, CI = 2.40–6.23). Red hair and mainly outdoor work or leisure raised the odds of microtopographic photoaging. Current smoking was strongly associated with facial comedones and telangiectasia, and among current smokers, the microtopography grade was significantly associated with moderate and heavy smoking measured by pack-years of exposure, with OR = 3.18 (95% CI = 1.38–7.35) in the heaviest (>20 pack-years) smoking category compared with 1–7 pack-years. Conclusions: Premature skin aging is common in the subtropics, more severe in men and the fair-skinned. It is associated with high sun exposure during leisure or work, and moderate to heavy smoking, and therefore is preventable.

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