Smoking and its Effect on Skin

How is Cigarette Smoke Harmful for the Body?

Cigarette smoke is one of the most toxic compounds known and is truly a slow poison. Cigarette smoke, being a mixture of 4000 chemicals is not only disastrous to the smoker, but also to the people who breathe around him. The main toxic compounds include nicotine, tar, carbon mono oxide, hydrogen, among others.

Cigarette smoke contains around sixty cancer-causing agents like benzene, chromium, cadmium, vinyl chloride and arsenic. The chemicals are known to have serious health impacts involving all the major organ systems, lest apart the cancers. Not only do active smokers face these health hazards, the passive smokers suffer as well. It has been estimated in studies that of eight active smoker deaths, there will be one passive smoker who will die.

On an average, cigarette smoking reduces the life expectancy of an individual by thirteen to sixteen years.

How Does Smoking Cause Aging of The Skin?

Tobacco smoke contains many substances, that could damage the skin including nicotine, a serious culprit of aging. Smoking has been linked as a risk factor for premature skin aging, slowing down of wound healing, and increase in infections, and a number of dermatological disorders. UV rays from sunlight have an additive effect on the skin damage due to smoking.

How smoking can cause aging of the skin is a question with many possible theories. One of the possible causes is that nicotine in tobacco smoke leads to oxidative stress and hence insufficient oxygen is supplied to the skin, which results in tissue ischemia and blood vessel occlusion. As a result, the skin of a forty-year-old heavy smoker resembles that of a seventy year old, non-smoking person. In addition, heat from the burning end of the cigarette directly burns the skin, which is considered to bring about changes in the elastic fibers of the facial skin, and the phenomenon is known as elastosis. The heat also causes a reduction in the natural moisture of the skin, which might also contribute to the aging process.

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What are the Various Skin changes caused by Smoking?

The various changes to the skin brought about by smoking include:

• Temporary yellowing of the fingers at the site of holding the cigarette
• Discoloration of teeth and fingernails
• Facial wrinkles and furrows which develop as crows’ feet at the outer side of eye, vertical ear crease, and smoker’s lines around the lips.
• Eyelids appear baggy and jawline is slack
• The skin color is uneven and becomes grayish yellow or orange with the appearance of prominent blood vessels known as telangiectasia and loss of youthful glow. Moderate smokers have double skin wrinkles and heavy smokers have triple skin wrinkles at a very early age, as compared to non-smokers. The threat of facial wrinkles itself, is a greater motivation of smoking cessation than other life-threatening smoking disorders.
• A typical "smoker's face" can be described as having prominent facial wrinkles, an underlying bony structure, atrophy of the skin, mild orangish-red, or gray face complexion.
• Women are more susceptible to the wrinkling effects of smoking in comparison to men.

How does Smoking Delay Skin Wound Healing?

Smoking is known to delay wound healing. Smoking can also have deleterious effects on the healing of skin injuries and surgical wounds and magnifies the risk of wound infection. Post-operative skin complications of a smoker, in which a graft has been placed, includes graft or flap failure, death of tissue and formation of blood clot. Smokers even have a much higher rate of wound infection as compared to non-smokers after undergoing skin biopsies. In addition, smoking also leads to the development and persistence of leg ulcers, especially arterial ulcers, diabetic foot ulcers, and calciphylaxis.

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Smoking leads to slow healing of wounds and wound-related complications through many mechanisms. The peripheral blood flow decreases soon after smoking, which compromises tissue oxygenation and wound healing. In addition, nicotine increases the adhesion of platelets, which leads to the occlusion of small arteries supplying blood to the healing wound and hence causes tissue ischemia, thereby hampering the healing process.

Patients must be counseled prior to surgery to discontinue smoking at least two weeks before and one week after surgery.

What are the Various Skin Infections caused by Smoking?

Smokers have a greater susceptibility towards certain kinds of infections. If not, certain skin infections are aggravated in patients who smoke. Bacterial wound infections are commonly caused by Staphylococccus aureus and Streptococcus pyogenes. Smokers have a higher pre-disposition towards Candida albicans infection and viral infections, especially human papillomaviruses causing genital warts. It has been concluded in a study that, a smoker having genital warts have a much greater chance of developing wart-virus associated cancers, including cervical cancer, vulval intraepitheial cancer, and penile cancer than a non-smoker.

Can Smoking Cause Skin Cancer?

Cigarette smoking increases the risk of developing squamous cell carcinoma, which is a type of skin cancer as compared to non-smokers. In addition, cigarette smoking also increases the risk of development of a pre-cancerous condition called oral leukoplakia. This pre-cancerous condition might eventually lead to the development of oral cancer  and lip cancer. Seventy-five percent cases of oral cancers and lip cancers usually occur in smokers. This is proven by the fact that smoking cessation can minimize the risk of spread of oral cancer to other body parts by two to three folds.

What are the Various Dermatological Disorders Caused by Smoking?

Smoking is known to cause or aggravate the existence of various dermatological disorders. Skin disorders   like palmoplantar pustulosis, psoriasis, hidradenitis suppurativa, cutaneous lupus erythematosus an so on have shown to be linked to smoking.

Palmoplantar Pustulosis

It is resistant to treatment and is a chronic and disabling skin disease, which manifests as pustules, and the appearance of reddish scales on the soles and palms. Middle aged women smokers are most commonly affected. Cessation of smoking leads to clearing up of pustules in many patients.

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Hidradenitis Suppurativa

It is also known as acne inversa and is a chronic disease which manifests as clusters of pus-filled boils like infections more commonly affecting the underarms, groin, buttocks, beneath the breasts, and inner thighs. The majority of patients with this disease are smokers and the disease is aggravated as compared to that in non-smokers. Hidradenitis suppurativa has a genetic predisposition and is more commonly prevalent in obese women. Smokers respond poorly to the medicinal therapy.

Psoriasis

It is an autoimmune disease, which manifests as red and raised plaques covered with white scaly patches, typically occurring on knees, elbows, and scalp. Smokers have more extensive and severe psoriasis when compared with non-smokers. Quitting smoking and cutting back on alcohol consumption leads to a drastic recovery in the condition of psoriasis.

Cutaneous Lupus Erythematosus (CLE)

It is an autoimmune disease affecting multiple organs in the body. It often affects women between twenty to fifty years of age. The lesions are characterized by the appearance of thick red scaly patches on cheek, nose, and ears. This disease has a ten-fold increase in the risk of occurrence in smokers than in non-smokers, with the treatment being less effective too. Smoking activates the lymphocytes and increases the autoimmune activity, which is already set in the patients and it leads to the flare up of disease in the smokers.

What are the Various Skin Disorders of the Oral Cavity Associated with Smoking?

Cigarette smoking has been shown to be an independent risk factor for oral mucocutaneous disorders and the risk is further enhanced with excess alcohol consumption.

Nicotine Stomatitis (Smoker's Palate) – It causes the discoloration and fissuring of the hard palate caused by increased heat, which comes out of the burnt end of cigarette.

Leukokeratosis Nicotina Glossi (Smoker’s Tongue) – Tongue of chronic chain smokers gradually turns black and hairy with the passage of time.

Smoker’s Melanosis – It is the hyperpigmentation of gingiva due to the increased secretion of melanin because of the heat given off by the burning cigarette.

How can you Quit Smoking and What are the Mandatory Lifestyle Changes?

The skin will not be spared from the deleterious effects of smoking. It has been a reported fact that the fear of developing cosmetic and dermatological manifestations of smoking is a greater motivation to quit smoking as compared to the deleterious cardiovascular and respiratory health hazards. Thus, raising awareness of smoking-related conditions and the associated skin changes might provide an added threat to motivate the patients to quit smoking. Doctors must be aware of dermatologic conditions associated with or worsened by smoking as they can play a very important role in counseling patients on ways to quit smoking.

Health Tips to Quit Smoking

• Make a quit plan and stay busy throughout the day to keep your mind off smoking.
• Chew gum or a hard candy whenever you have an urge to smoke
• Drink plenty of water
• Practice deep breathing exercises whenever you get a craving.
• Avoid smoking triggers by throwing away your cigarettes and lighters, spend time with non-smokers, try and avoid the company of smokers, cut back on caffeine as it triggers the cravings.
• Try cinnamon and green tea. Cinnamon helps to quit smoking, and green tea has been shown to reduce the nicotine cravings.
• Nicotine Replacement Therapy: In the form of nicotine chewing gum, nicotine patches, inhalers, sprays, and lozenges are available commercially. These provide nicotine supply without tobacco and harmful chemicals of cigarette smoke. It works best when combined with counseling and behavioral therapy in addition to support with friends. It reduces the amount of nicotine going inside the body and the dose is gradually tapered off with due course of time and eventually stopped when complete success is obtained.
• Drugs: Certain drugs like veranicline help to reduce the nicotine withdrawal and the urge to smoke. The drug bupropion can help to fight off depression as well as helps in smoking cessation.
• Lifestyle Changes: Practice yoga and meditation to boost in positive thoughts and motivation. Try to stay as stress-free as possible because stress triggers the desire to smoke. Get plenty of rest and listen soft soothing music to stay calm. Finally, it must be accepted that quitting the habit of cigarette smoking is not an easy task. Do not hesitate to join a support group, or talk to your family and friends.