International Academy of Cosmetic Dermatology

SMOKING AND THE SKIN

Smoking is the leading preventable cause of disease and death in the developed world with approximately 2 million people dyeing worldwide because of tobacco use every year.

Tobacco consumption is directly linked to cardiovascular disease, pulmonary emphysema and many types of cancer. As an organ closely exposed to cigarette smoke, it is not surprising that tobacco affects the skin in many different ways.
The effects of smoking on the skin can be divided into three categories: skin diseases witch development and smoking influences course; skin diseases directly caused by smoking; and finally the cosmetic consequences of tobacco use.

SKIN DISEASES AFFECTED BY SMOKING
Smoking is associated with an increased risk of developing psoriasis, particularly the pustular forms and more significantly in women. Smoking also reduces the response to psoriasis treatments and has been associated with more severe forms of the disease.

Some of the components of cigarette smoke (nicotine and carbon monoxide) interfere with wound healing. Smokers are at a higher risk of developing skin-related post-surgical complications such as unsightly scars and suture failure. This is why it is extremely important that patients stop smoking 4 weeks before, and continue without smoking up to 4 weeks after surgery to improve scarring and healing.

Approximately 80% of the patients who develop lip cancer are smokers, and tobacco use is responsible for 91% of the cancers of the oral cavity (mouth) seen in men. Furthermore, smoking is associated with an increased risk of developing carcinomas of the anogenital region.

SKIN DISEASES DIRECTLY CAUSED BY TOBACCO CONSUMPTION
Smoking may be a cause of allergic contact dermatitis most often affecting the face and hands. Nickel, fragrances and formaldehyde found in cigarettes are among the causative agents.

Smoking has also been associated with urticaria, either generalized or affecting only the lips.

Finally, tobacco is responsible for over half of the cases of periodontal disease in adults in the USA.

COSMETIC CONSEQUENCES OF TOBACCO USE
Yellow-stained fingers and fingernails, changes in tooth color and smoker’s breath are typical findings among smokers. Furthermore, the direct contact between tobacco smoke and the face reduces the moisture of the skin and contributes to the greater dryness of facial skin seen in smokers. Additionally, several studies have shown that smoking is an independent risk factor for the development of increased facial wrinkles. A prematurely older appearance and a duller complexion are typical of chronic smokers. These changes are dose-dependent and tend to become more evident after 35 years of age. Women seem to be more affected than men, and light skin more than dark skin.

We encourage patients to stop smoking not only to improve their general health and to help alleviate specific skin conditions, but also to maintain a healthier physical appearance.

Mari Paz Castanedo-Tardan, MD
Lebanon, NH, USA