Smoking and the Skin

-Smoking is a major problem and particularly in young people. In the past years, increased smoking has been observed in young women.
-It would be responsible for at least a quarter of all deaths, because of cardiovascular diseases and lung cancer.

• On the skin, smoking is responsible for the following changes:

1. Premature Aging: the skin is very wrinkled, is thickened and has a yellowish aspect. Sun exposure would have an added negative effect (solar elastosis).
2. Yellow discoloration of the tip of the fingers and nails.
3. Poor wound healing: this can be explained by reduced synthesis of collagen and reduced blood supply of nutrients and oxygen.

Some skin diseases are associated with smoking:

• Strong associations:

1. Palmoplantar pustulosis and palmoplantar psoriasis
2. Hidradentitis Suppurativa (Verneuil’s Disease)
3. Squamous Cell Carcinoma (SCC) of the lips and of the oral mucosa.
4. Genital Warts (Condyloma Accuminata) and Carcinoma of the Cervix.

• Possible associations:

1. Atopic Dermatitis (including for example through passive smoking from the parents)
2. Malignant Melanoma: smokers have a worse prognosis
3. Lupus Erythematosus: smokers respond less well to treatment with antimalarials.

• Moreover, topical medication containing an alcohol base should never be prescribed to smokers as these are highly inflammable.

Bibliography: Thieme Clinical Companions. Dermatology, Sterry W. et al. Translation into English of the 5th Edition in German (2006).