3.14 Effects of smoking on the skin

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3.0 Background

3.1 Tobacco—a leading preventable cause of death and disease

3.2 Cardiovascular diseases

3.3 Lung cancer

3.4 Respiratory diseases

3.5 Other cancers caused by or associated with smoking

3.6 Reproductive health and smoking

3.7 Pregnancy and smoking

3.8 Infant health and smoking

3.9 Increased susceptibility to infection in smokers

3.10 Eye diseases

3.11 Dental diseases

3.12 Gastrointestinal diseases

3.13 Bone density and risk of fractures

3.14 Effects of smoking on the skin

3.15 Smoking and complications in medical treatment

3.16 Smoking and diabetes

3.17 Poorer levels of general health

3.18 Smoking, motor vehicle crashes and other injuries

3.19 Burns and fires caused by tobacco use

3.20 Tobacco poisoning

3.21 Health effects for younger smokers

3.22 Genetic influences on tobacco-caused disease

3.23 Smoking, dementia and cognitive decline

3.24 Lung disease, smoking and occupational exposures

3.25 Air pollution, cigarette smoking and ill health

3.26 Health effects of smoking brands that claim to deliver lower levels of tar, nicotine and carbon monoxide

3.27 Health effects of smoking tobacco in other forms

3.28 Health 'benefits' of smoking?

3.29 Morbidity (ill health) attributable to tobacco-caused disease

3.30 Deaths attributable to tobacco by disease category

3.31 Morbidity and mortality due to tobacco-caused disease and socioeconomic disadvantage

3.32 Health effects of smoking other substances

3.33 Health effects of chewing tobacco, and of other smokeless tobacco products

3.34 Public perceptions of tobacco as a drug, and knowledge and beliefs about the health consequences of smoking

3.35 Health benefits of cessation

3.36 The global tobacco pandemic

Acknowledgments

References

Several studies have found that smoking affects facial appearance in men and women, independent of sun exposure and age. Increased wrinkling,69–73 and altered complexion colour69 have been attributed to smoking, as have elastosis (loss of elasticity in the skin resulting from degeneration of connective tissue) and in men, telangiectasis (dilation of fine blood vessels in the skin visible as fine red lines).74 One recent study found that smokers appeared up to 4.7 years older than non-smokers, and in the majority of cases smokers and non-smokers could be correctly distinguished by examining photographs of the face and temple region.75

Visible wrinkling is most evident in older smokers, but even smokers aged in their 20s and 30s may show evidence of microscopic superficial wrinkling.72 Combined exposure to both sunlight and tobacco smoke causes a greater degree of damage than exposure to one agent alone,76 possibly through the phototoxic effects of tobacco smoke condensate, which increase the skin's vulnerability to UV radiation.77 Even non-facial, non-sun-exposed skin may be more wrinkled in smokers than non-smokers.78

A possible mechanism for premature wrinkling is that smoke affects the function of human skin fibroblasts (cells present in connective tissue that form collagen and elastin), thereby accelerating the appearance of ageing.71 Recent research has suggested a connection between wrinkling in smokers and the development of chronic obstructive pulmonary disease (COPD). Smokers with severe facial wrinkling may also have a higher susceptibility to developing COPD; possible mechanisms being damage to collagen and elastin, both of which are important to skin and lung function.79

A range of other cutaneous associations with smoking have been observed, a recent review80 pointing to possible relationships between smoking and psoriasis,81 hidradenitis suppurativa (inflammation of sweat glands in the groin and underarm regions, producing painful boils or abscesses), and the impact of skin lesions that occur with diabetes, lupus and AIDS.80