June 6th, 2009
The doctor could tell the patient had once been an attractive woman. But now, though only in her 50s, her face was etched with wrinkles, her features gaunt-looking with prominent underlying bones and her skin shriveled and gray with purplish blotches. Diagnosis: smoker’s face.
Doctor Douglas Model of Eastbourne, England, added this condition to the medical lexicon in 1985 after surveying 116 patients and correctly identifying roughly half of current smokers by their facial features alone.
The distinctive characteristics of smoker’s face, which makes people look far older than their years, were present in 46% of the current smokers, 8% of the former smokers, and none of the nonsmokers, irrespective of their age, social class, recent weight fluctuations, and exposure to sunlight.
Dr. Jeffrey B. Smith, a senior resident in dermatology at the University of South Florida in Tampa, recalled this poignant diagnosis in a review of the effects of smoking - related skin conditions: Smoking damages cells and tissues in so many ways that it can have myriad effects on the body.
Wrinkles: “For some patients the threat of wrinkles may be a more powerful motivator to help them stop smoking than the more deadly consequences of smoking,” Smith wrote. He explained that, as with skin that is overexposed to sunlight, smoking causes thickening and fragmentation of elastin, the elastic fibers that are long and smooth in healthy skin. Smoking also depletes the skin’s oxygen supply by reducing circulation. It decreases the formation of collagen, the skin’s main structural component, and may reduce the water content of the skin, all of which increase wrinkling.
Smoking also interferes with the skin’s ability to protect itself against damage by free radicals, highly reactive substances that are omnipresent in tobacco smoke. In women, smoking diminishes the level of circulating estrogen, which in turn fosters dryness and disintegration of skin tissues.
Skin Cancers: Two kinds of skin cancers, the more curable squamous cell carcinomas and the often lethal melanomas, are influenced by smoking. Smith said that although smoking did not cause melanoma, smokers with melanoma were more likely to die of their disease. They are twice as likely to have advanced disease at the time of diagnosis and are more likely to have their cancers spread within two years of diagnosis, probably because smoking impairs the immune system.
As for squamous cell carcinoma, even when exposure to sunlight was taken into account, smokers were found to be at greater risk of developing this cancer. In a study of more than 107,000 nurses, for example, the risk of developing squamous cell carcinoma was 50 per cent greater in smokers than in those who had never smoked. Smokers also tend to get particularly “large, bad” skin cancers, Smith said.
Other Cancers: Cancers of the lip, mouth, penis, anus and vulva are also more common in smokers than nonsmokers. For example, in one study of 903 female cancer patients, 60 percent of those with vulvar and anal cancers and 42 percent of those with cervical and vaginal cancers were smokers as against only 27 percent of comparable women without cancer. Smoking more than 10 cigarettes a day more than doubles a man’s risk of developing penile cancer.
Delayed Wound Healing: The problem of slow or incomplete healing of wounds associated with exposure to cigarette smoke was clearly demonstrated in laboratory animals in the 1970s. Then surgeons began reporting on similar problems in patients who smoked: larger scars in women undergoing exploratory abdominal surgery, more complications and skin sloughing after facelifts and a much higher failure rate of skin grafts, for example. The more and the longer patients had smoked, the greater the likelihood of impaired wound healing. Even resuming smoking during an uneventful recovery could lead to adverse effects. Smith linked the slow healing of wounds to known effects of cigarette smoking, which constricts surface blood vessels, reduces the oxygen level in the blood, thickens the blood and impedes the laying down of collagen needed for healing.
Psoriasis and related disease: Studies of both men and women with this unsightly and discomforting skin condition have shown that smokers are about two to three times as likely to develop it as nonsmokers. And the more cigarettes smoked, the greater the risk. Palmoplantar pustulosis, a difficult-to-treat skin condition that resembles psoriasis, occurs only on the palms of the hands and soles of the feet. The skin blisters, then forms a scaly rash. It occurs almost exclusively in smokers and it does not necessarily go away when the patient quits smoking.
Oral lesions: In addition to smoker’s face, there is also smoker’s palate and smoker’s tongue. The tars and heat of tobacco smoke can cause tiny red pimples in the mouth that result from an inflammation of the openings of salivary glands. Smokers also often develop depressions on the surface of the tongue. Potentially more serious, however, are lesions called leucoplakia, which are about six times more common in smokers than in nonsmokers. Although benign, these white patches in the mouth can become cancerous.
Buerger’s disease: This blood vessel disease results in poor circulation in the lower legs, causing skin problems like burning, tingling and ulcerations. “It usually occurs in young men who smoke, men in their 30s,” Smith said. “But now that women are smoking a lot more, we’re seeing it in women too.”
Other Skin conditions: Many skin diseases are associated with diabetes, which impairs circulation to the outer reaches of the body. A study of more than 112,000 female nurses followed for 12 years showed that current smokers faced an increased risk of developing noninsulin-dependent diabetes, and that the risk rose with the number of cigarettes smoked each day. Another study of nearly 43,000 male health professionals showed that smoking 25 or more cigarettes a day doubled a man’s risk of developing diabetes.
People who smoke are much more likely to develop the bowel disorder Crohn’s disease, which can cause “big, ugly-looking ulcerations, most often on the legs, and painful red nodules, usually on the lower legs,” Smith said. Another condition more common in smokers is systemic lupus erythematosus, an autoimmune disease that can cause rashes on the face, scalp, hands and elsewhere, ulcerations in the mouth and hair loss.”
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