Tobacco smoke causes premature skin aging

Smoking tobacco is the most preventable cause of morbidity and is responsible for more than three million deaths a year worldwide. In addition to a strong association with a number of systemic diseases, smoking is also associated with many dermatological conditions, including poor wound healing, premature skin aging, squamous cell carcinoma, melanoma, oral cancer, acne, psoriasis, and hair loss. This review focuses on the effects of smoking on premature skin aging. It has been long established that smoking has deleterious effects on skin. Epidemiological studies indicate that smoking is an important environmental factor in premature skin aging. In vitro studies indicate that tobacco smoke extract impairs the production of collagen and increases the production of tropoelastin and matrix metalloproteinases (MMP), which degrade matrix proteins, and also causes an abnormal production of elastosis material. Smoking increases MMP levels, which leads to the degradation of collagen, elastic fibers, and proteoglycans, suggesting an imbalance between biosynthesis and degradation in dermal connective tissue metabolism. Reactive oxygen species are also involved in tobacco smoke-induced premature skin aging. Scavengers of reactive oxygen species ameliorate the induction of MMP. Tobacco smoke extract also impacts dermal connective tissue in nude mice. Thus, in vitro and in vivo evidence indicates that smoking tobacco leads to accelerated aging of the skin. These findings might be useful to motivate those patients who are more concerned about their appearance than the potential internal damage associated with smoking to stop smoking.     

Tobacco smoke extract induces age-related changes due to modulation of TGF-beta

We have recently shown that tobacco smoking, like ultraviolet A radiation, is an important factor contributing to premature skin aging. We found that tobacco smoke extract decreased type I and III procollagen, increased tropoelastin mRNA, and induced abnormal accumulation of proteoglycans and matrix metalloproteinase (MMP)-1 and MMP-3 in cultured skin fibroblasts. This indicated that common molecular features might underlie the premature aging of the skin induced by tobacco smoke extract, including abnormal regulation of extracellular matrix deposition through elevated MMPs, reduced collagen production, abnormal tropoelastin accumulation, and altered proteoglycans. With the exception that reactive oxygen species were mediated in the aging process, transforming growth factor (TGF)-beta1 was found to play a crucial role in the age-related alterations induced by tobacco smoke extract. Here we report that tobacco smoke extract blocks cellular responsiveness to TGF-beta1 through the induction of a non-functional latent form of TGF-beta1, and downregulation of the TGF-beta1 receptor. This paper shows the evidence for the role of tobacco smoking in skin aging and describes how modulation of TGF-beta1 levels might retard premature skin aging.     

Association between smoking and hair loss: another opportunity for health education against smoking?

Besides being the single most preventable cause of significant morbidity and an important cause of death in the general population, tobacco smoking has been associated with adverse effects on the skin. Smoke-induced premature skin ageing has attracted the attention of the medical community, while only recently an observational study has indicated a significant relationship between smoking and baldness. The mechanisms by which smoking causes hair loss are multifactorial and are probably related to effects of cigarette smoke on the microvasculature of the dermal hair papilla, smoke genotoxicants causing damage to DNA of the hair follicle, smoke-induced imbalance in the follicular protease/antiprotease systems controlling tissue remodeling during the hair growth cycle, pro-oxidant effects of smoking leading to the release of pro-inflammatory cytokines resulting in follicular micro-inflammation and fibrosis and finally increased hydroxylation of oestradiol as well as inhibition of the enzyme aromatase creating a relative hypo-oestrogenic state. In view of the psychological impact of androgenetic alopecia on affected men and women, increasing public awareness of the association between smoking and hair loss offers an opportunity for health education against smoking that may be more effective than the link between smoking and facial wrinkles or grey hair, since the latter can be effectively counteracted by current aesthetic dermatologic procedures, while treatment options for androgenetic alopecia are limited.     

Cutaneous Effects of Smoking

Background

Cigarette smoking is the single biggest preventable cause of death and disability in developed countries and is a significant public health concern. While known to be strongly associated with a number of cardiovascular and pulmonary diseases and cancers, smoking also leads to a variety of cutaneous manifestations.

Objective

This article reviews the effects of cigarette smoking on the skin and its appendages.

Methods

A literature review was based on a MEDLINE search (1966–2004) for English-language articles using the MeSH terms cutaneous, dermatology, tobacco, skin, and smoking. An additional search was subsequently undertaken for articles related to smoking and associated mucocutanous diseases, with the focus on pathogenesis and epidemiologic data. Articles presenting the highest level of evidence and latest reports were preferentially selected.

Results

Smoking is strongly associated with numerous dermatologic conditions including poor wound healing, wrinkling and premature skin aging, squamous cell carcinoma, psoriasis, hidradenitis suppurativa, hair loss, oral cancers, and other oral conditions. In addition, it has an impact on the skin lesions observed in diabetes, lupus, and AIDS. The evidence linking smoking and melanoma, eczema, and acne is inconclusive. Anecdotal data exist on the possible protective effects of smoking in oral/genital aphthosis of Behçet’s disease, herpes labialis, pyoderma gangrenosum, acral melanoma, and Kaposi’s sarcoma in AIDS patients.

Conclusions

An appreciation of the adverse cutaneous consequences of smoking is important. Dermatologists can play an integral role in promoting smoking cessation by providing expert opinion and educating the public on the deleterious effects of smoking on the skin.

     

吸烟对皮肤病发病影响的研究进展

近年来有文献报道烟草中的氧自由基(ROS)、芳香烃受体(AhR)及烟碱乙酰胆碱受体(AChR)在吸烟影响皮肤病发病的机制中扮演着重要角色,本文就近年来吸烟对常见皮肤病(如银屑病、化脓性汗腺炎、痤疮等)发病影响的相关文献进行综述.     

Skin premature aging induced by tobacco smoking: the objective evidence of skin replica analysis

Epidemiological studies have showed that heavy smoking causes premature skin aging. Using a silicone rubber replica combined with computerized image processing, an objective measurement of skin's topography, we investigated the association between wrinkle formation and tobacco smoking in this study. The replica analysis was used to study the changes in the surface furrows of the volar forearm in 63 volunteers. Results confirmed that the depth (Rz) and variance (Rv) of furrows were increased and lines of furrows (Rl) were decreased with age. The replica analytic results showed that Rz and Rv in subjects with a smoking history > or =35 pack-years were significantly higher than non-smokers (P<0.05). Rl in subjects with a smoking history were significantly lower than non-smokers (P<0.05). In addition, the present results gave a good correlation between the parameters from the computerized replica analysis with the clinical grading assessment of wrinkles, which further confirmed that skin replica technique is an objective and efficacious tool in evaluation of skin premature aging.     

Does tobacco smoking influence the occurrence of hand eczema?

Background  Tobacco smoking is known to influence various inflammatory skin diseases and an association between tobacco smoking and hand eczema has been proposed in some studies.
Objectives  To examine a possible association between reported current tobacco smoking and the occurrence of hand eczema.
Subjects and methods  Previously collected questionnaire data on the occurrence of hand eczema in three occupational cohorts and corresponding controls from the general population were studied. The questionnaires used included questions on 1-year prevalence of hand eczema and questions on smoking habits. For one occupational group, hairdressers and their controls, information on amount of smoking was obtained. Information on age, sex and history of atopy was also available.
Results  In total, answers regarding smoking and hand eczema were obtained from 13 452 individuals. Out of 3493 smokers, 437 (12·5%) reported hand eczema compared with 1294 out of 9959 nonsmokers (13·0%) ( P  =   0·51). With regard to the number of cigarettes smoked, 22·6% of the hairdressers smoking more than 10 cigarettes per day reported hand eczema compared with 17·4% of those smoking 0–10 cigarettes per day ( P  =   0·01). Corresponding figures for the controls were 14·5% and 11·7%, respectively ( P  =   0·06).
Conclusions  No clear association was found between 1-year prevalence of hand eczema and smoking. Heavy smoking, more than 10 cigarettes per day, may give a slightly increased risk of hand eczema. Further studies with information on the amount of tobacco consumption and on possible confounders are needed to evaluate smoking as a risk factor for hand eczema.     

Unklare akrale Nekrosen an den Fingern

A 63-year old woman presented with dry necrotic areas on the distal and medial phalanges of her right index and middle finger caused by burns while smoking. Differential diagnostic considerations included occlusive arterial disease, vasculitis, endangiitis obliterans, peripheral embolisms and exposure to chemicals. The patient had the habit of smoking her cigarettes until the last possible drag, putting her skin in direct contact with the burning tobacco.     

Smoking and skin: a study of the physical qualities and histology of skin in smokers and non-smokers

Tobacco smoke is toxic to cells and could be a factor contributing to accelerated skin ageing. The aim of this study was to provide new information on the possible effects of smoking on the physical qualities of skin and the morphology of elastic fibres. The study population consisted of 98 men, including 47 current smokers and 51 never-smokers. Skin thickness and elasticity were measured from cheek, temple, abdomen, dorsal forearm and non-sun-exposed upper inner arm. Verhoeff-stained punch biopsies from the non-sun-exposed upper inner arm were assessed with a computerized image analyser in a blinded fashion to assess the amount and width of elastic fibres. The thickness of cheek skin was increased in the smokers, but skin thickness in other measured sites did not differ between the groups. The amount and width of elastic fibres in the sun-protected skin of the smokers and non-smokers did not differ significantly, nor did skin elasticity in this or any other region under evaluation, suggesting that smoking alone affects neither the amount and width of dermal elastic fibres nor the elasticity of skin in male smokers.     

Water pipe smoking and dermatologic consequences

Water pipe smoking is a recently growing addiction worldwide. It has become popular in Africa and the Western World and enfaces a renaissance in Middle East and Asia. The smoking technique leads to a different exposure to potential hazardous compounds compared to cigarette or classical pipe smoking. The common assumption that water pipe smoking is less dangerous to health is not substantiated by scientific data. Non‐tobacco‐based preparations reduce the exposure to nicotine but may contain equal or even higher concentrations of other toxic compounds. The medical literature on adverse effect of water pipe smoking on skin and oral mucosa is reviewed but future research is a demand.     

Association between smoking and cutaneous ageing in a Brazilian population

Objective This study aims to determine the relationship between smoking and cutaneous ageing. Methods A cross‐sectional study was carried out on 301 subjects (191 women and 110 men, aged between 25 and 86 years), of which 165 were non‐smokers and 136 were smokers and ex‐smokers. The association between tabagism and cutaneous ageing was controlled for other variables (solar exposure, age, skin phototype, sex, sunscreen use, alcohol consumption, coffee consumption, sports participation, body mass index, and history of relatives with precocious ageing). Results Analysis revealed that age, chronic solar exposure, skin phototype and tobacco load significantly contributed to the formation of facial wrinkles. The larger the tobacco load, the larger was the amount of facial wrinkling, with an odds ratio of 3.92 in ‘heavy’ smokers (> 40 packs/year) in relation to non‐smokers. Conclusion The results of this study point to smoking as one of the main factors involved in facial wrinkling. The relationship between smoking and cutaneous ageing is an important element in educational campaigns against tabagism.     

Alcohol and smoking: risk factors for infectious eczematoid dermatitis?

Risk factors for infectious eczematoid dermatitis (IED) were analyzed in a study of males aged 19-50 years. The subjects were 43 IED patients and 226 controls with other skin diseases from the dermatological outpatient clinics of three University Hospitals in Finland. The patients' lifestyles were assessed by a self-administered questionnaire pertaining to two specified periods: the period 12 months before the onset of the skin disease and the period 12 months before the examination date. Recalled mean alcohol intake before the onset of the skin disease was 39.2 g/day for the IED patients and 17.1 g/day for the controls (p = 0.04). The average number of cigarettes smoked daily was 17.7 for the IED patients and 10.4 for the control patients (p = 0.001). The IED patients significantly reduced their alcohol intake after the onset of the skin disease. In logistic regression analysis, IED associated with alcohol intake and smoking but not with coffee consumption, life events, age, marital status, or social group. The odds ratio for IED at an alcohol intake of 50 g/day as against no intake, was 1.7 (95% confidence interval 1.03-2.7), and the odds ratio at a tobacco consumption rate of 20 cigarettes/day as against no use of tobacco, was 2.1 (1.2-3.7). We conclude that alcohol intake and smoking appear to be risk factors for infectious eczematoid dermatitis among males.     

Is smoking tobacco an independent risk factor for HIV infection and progression to AIDS? A systemic review

OBJECTIVES: To systematically review the evidence of the relation between smoking tobacco and HIV seroconversion and progression to AIDS. METHODS: A systematic review was undertaken of studies to look at tobacco smoking as a risk factor for either HIV seroconversion or progression to AIDS. RESULTS: Six studies were identified with HIV seroconversion as an outcome measure. Five of these indicated that smoking tobacco was an independent risk factor after adjusting for important confounders with adjusted odds ratios ranging from 1.6 to 3.5. 10 studies were identified using progression to AIDS as an end point of which nine found no relation with tobacco smoking. CONCLUSIONS: Tobacco smoking may be an independent risk factor for HIV infection although residual confounding is another possible explanation. Smoking did not appear to be related to progression to AIDS although this finding may not be true in developing countries or with the longer life expectancies seen with highly active antiretroviral therapy.     

Public knowledge, awareness, and perceptions of the association between skin aging and smoking.

BACKGROUND: Although the tobacco industry promotes images of glamour, 2 decades of epidemiologic research have concluded the opposite: smokers have enhanced facial aging and skin wrinkling compared with nonsmokers. OBJECTIVE: The purpose of this study was to obtain information on the public's awareness of the association between cigarette smoking and skin aging. METHODS: In the spring of 1994, the Maine-wide Cooperative Telephone Survey conducted telephone interviews in 678 randomly selected, nonseasonal dwelling units in Maine. From each dwelling unit, one randomly selected adult resident was interviewed to assess awareness of the association of skin aging with smoking. RESULTS: Fifty-eight percent of those persons interviewed had smoked at least 100 cigarettes, and among them, 24% were current smokers (28% men, 21% women). After adjusting for sex, age, and education, current smokers remained less likely to be aware of this association compared with former (prevalence ratio, 0.78; 95% confidence interval, 0.64-0.95) and never smokers (prevalence ratio, 0.87; 95% confidence interval, 0.70-1.07). However, nearly one fourth of smokers in this study believed that most or some smokers would consider this information in their decision to quit, with slightly higher findings in young smokers. CONCLUSION: These findings are of public health importance. While strategies for framing messages about the association between smoking and facial aging await further study, this association deserves to be considered in all tobacco control and counter-advertising campaigns.     

Implication of Cigarette Smoking and Cessation on Sexual Function in Men and Women

Sexual dysfunction is a major public health problem that negatively affects the lives of hundreds of millions of individuals worldwide. There is strong evidence suggesting that tobacco use and sexual dysfunction are linked. In fact, cigarette smoking is independently associated with an increased risk of erectile dysfunction (ED). This relationship has been observed among both current and former smokers and among both passive and active smokers, and many studies suggest a dose-response relationship. Further, prospective studies indicate that cigarette use increases the risk of incident ED, whereas smoking cessation appears to improve erectile function. The link between tobacco use (and disuse) and sexual function in women is relatively understudied, and results remain inconclusive. Future research would benefit from utilizing more prospective designs and assessing the effects of smoking (and particularly passive smoking) on a wider range of sexual function outcomes (physiological, sexual dysfunctions other than male and female arousal disorders), especially among women.     

Skin aging induced by ultraviolet exposure and tobacco smoking: evidence from epidemiological and molecular studies

BACKGROUND: Tobacco smoking, similar to ultraviolet (UV) A radiation exposure, has previously been identified as an important factor contributing to premature aging of human skin. OBJECTIVE AND DESIGN: To investigate the relationship between these two environmental factors, we have conducted a cross-sectional study of 83 subjects (48 males, 35 females, age range 23-95), in which sun exposure, pack-years of smoking history and potential confounding variables were assessed by questionnaire. Facial wrinkles were quantified using the Daniell score. In order to study the molecular mechanism by which smoking caused wrinkle formation, in vitro studies were conducted to assess the alteration of matrix metalloproteinase-1 (MMP-1) mRNA expression in human fibroblasts stimulated with tobacco smoke extract or/and UVA. RESULTS: Logistic statistic analysis of the data revealed that age [odds ratio (OR)=7.5, 95% confidence interval (CI)=1.87-30.161, pack-years (OR=5.8, 95% CI=1.72-19.87), and sun exposure (OR=2.65, 95% CI=1.0-7.0) independently contributed to facial wrinkle formation. When excessive sun exposure (>2 h/day) and heavy smoking (35 pack-years) occurred together, the risk for developing wrinkles was 11.4 times higher than that of non-smokers and those with less sun exposure (<2 h/day) at the same age. The in vitro studies revealed that MMP-1 expression was significantly increased in fibroblasts after the stimulation with either tobacco smoke extract or UVA. Maximum induction was observed when cells were treated with tobacco smoke extract plus UVA, indicating that the two factors act in an additive manner. MMP-1 induction was significantly higher in the low glutathione (GSH) content fibroblast compared to that in the high GSH fibroblast, indicating that the differences in glutathione content define the susceptibility of fibroblasts towards UV- or tobacco smoking-induced MMP-1 expression. CONCLUSION: Tobacco smoke and UVA cause wrinkle formation independently of each other. We propose that both factors cause aging of human skin through additive induction of MMP-1 expression.     

Association between smoking and hand dermatitis – a systematic review and meta‐analysis

Tobacco smoking is known to influence various inflammatory skin diseases. A systematic review with a meta‐analysis was conducted to analyse a possible association between the lifestyle factor tobacco smoking and hand dermatitis. We performed a systematic review using the MEDLINE, Embase and Cochrane Central Register databases. Our search was limited to English and German language, human‐subject studies published between January 1, 1980 and December 31, 2013. A total of 43 articles were identified from the initial search, and after taking into account exclusion criteria, only three studies remained investigating the risk factors for hand eczema in the general and in high‐risk populations (e.g. bakers, hairdressers, dental technicians). The extracted data were pooled and analysed by standard statistical methods. The studies meeting inclusion criteria consisted of one cohort study and two cross‐sectional studies based on a total of 4.113 subjects with hand dermatitis and 34.875 subjects without hand dermatitis. While one of the studies had reported a significant association between hand dermatitis and smoking, the meta‐analysis did not confirm this finding (OR 0.99; 95% CI 0.88–1.11). However, heterogeneity across studies was high (I² = 72%). Our meta‐analysis did not show tobacco smoking to be a risk factor for hand dermatitis. However, these results depend mainly on two large studies from one country. From present data, it cannot be excluded that smoking may influence the course of hand dermatitis. Even though smoking does not seem to be associated with hand dermatitis, it may still negatively influence the course of the disease.     

Smoking and Hand Dermatitis in the United States Adult Population

BackgroundHand dermatitis is a common chronic relapsing skin disease resulting from a variety of causes, including endogenous predisposition and environmental exposures to irritants and allergens. Lifestyle factors such as smoking have been implicated in hand dermatitis.ObjectiveTo evaluate the association between tobacco exposure and hand dermatitis using the 2003~2004 National Health and Nutrition Examination Survey (NHANES) database.MethodsData were retrieved and analyzed from 1,301 participants, aged 20~59 years, from the 2003~2004 NHANES questionnaire study who completed health examination and blood tests. Diagnosis of hand dermatitis was based on standardized photographs of the dorsal and palmar views of the hands read by two dermatologists.ResultsThere were 38 diagnosed cases of active hand dermatitis out of the 1,301 study participants (2.9%). Heavy smokers (>15 g tobacco daily) were 5.11 times more likely to have active hand dermatitis (odds ratio [OR], 5.11; 95% confidence interval [CI], 1.39~18.88; p=0.014). Those with serum cotinine >3 ng/ml were also more likely to have active hand dermatitis, compared with those with serum cotinine ≤3 ng/ml (OR, 2.50; 95% CI, 1.26~4.95; p=0.007). After adjusting for confounding factors such as age, atopic diathesis, occupational groups, and physical activity, the association between tobacco exposure and active hand dermatitis remained significant.ConclusionSmoking has a significant association with the presence of active hand dermatitis. It is important to consider smoking cessation as part of management of hand dermatitis.