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Summary Background Skin ageing is said to be caused by multiple factors. The relationship with sun exposure is of particular interest because the detrimental cutaneous effects of the sun may be a strong motivator to sun protection. We report a study of skin ageing in participants of an epidemiological study of melanoma. Objectives To determine the predictors of periorbital cutaneous ageing and whether it could be used as an objective marker of sun exposure. Methods Photographs of the periorbital skin in 1341 participants were graded for wrinkles, degree of vascularity and blotchy pigmentation and the resultant data assessed in relation to reported sun exposure, sunscreen use, body mass index (BMI), smoking and the melanocortin 1 receptor ( MC1R) gene status. Data were analysed using proportional odds regression. Results Wrinkling was associated with age and heavy smoking. Use of higher sun-protection factor sunscreen was protective ( P = 0·01). Age, male sex, MC1R variants ('r', P = 0·01; 'R', P = 0·02), higher reported daily sun exposure ( P = 0·02), increased BMI ( P = 0·01) and smoking ( P = 0·02) were risk factors for hypervascularity. Blotchy pigmentation was associated with age, male sex, higher education and higher weekday sun exposure ( P = 0·03). More frequent sunscreen use ( P = 0·02) and MC1R variants ('r', P = 0·03; 'R', P = 0·001) were protective. Conclusions Periorbital wrinkling is a poor biomarker of reported sun exposure. Vascularity is a better biomarker as is blotchy pigmentation, the latter in darker-skinned individuals. In summary, male sex, sun exposure, smoking, obesity and MC1R variants were associated with measures of cutaneous ageing. Sunscreen use showed some evidence of being protective. [ABSTRACT FROM AUTHOR]

Understanding the geographical distribution of COVID-19 through the general population is key to the provision of adequate healthcare services. Using self-reported data from 1 960 242 unique users in Great Britain (GB) of the COVID-19 Symptom Study app, we estimated that, concurrent to the GB government sanctioning lockdown, COVID-19 was distributed across GB, with evidence of 'urban hotspots'. We found a geo-social gradient associated with predicted disease prevalence suggesting urban areas and areas of higher deprivation are most affected. Our results demonstrate use of self-reported symptoms data to provide focus on geographical areas with identified risk factors., Competing Interests: Competing interests: TDS is a consultant to Zoe Global Ltd ('Zoe'). SG, JC, EB, RD and JW are or have been employees of Zoe Global Limited. Other authors have no conflict of interest to declare., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)