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While there remains a good deal to learn about the mechanisms and factors related to intrinsic skin aging, scientists have a stronger grasp of the numerous exogenous factors implicated in the aging of skin, among them sun exposure and lifestyle choices such as smoking, drinking, and poor nutrition. Of course, the internal ramifications of smoking are much better known than are the external results, but more than two decades of epidemiologic research findings indicate that smokers indeed manifest greater facial aging and skin wrinkling than nonsmokers.1 This chapter reviews the literature and discusses what is known about the effects on skin of chronic cigarette smoking.


A relationship between smoking and skin wrinkling was observed as long ago as 1856.1–3 Despite this relatively early recognition, scant research has focused on the effects of smoking on the skin and skin disease. Therefore, the effects of smoking on skin are not nearly as well understood as the strong correlation between smoking and lung cancer, emphysema, chronic bronchitis, heart disease, and other serious systemic conditions.3,4 Recent studies have succeeded, though, in filling in significant gaps in knowledge regarding the typical cutaneous manifestations of the systemic alterations wrought by smoking, and the potential mechanisms behind such changes.


The characteristics typically cited as evidence of “smoker’s face” (Fig. 7-1) or “cigarette skin” include increased facial wrinkling; a slightly red/orange complexion; an ashen, pale, or gray overall skin appearance; puffiness; and gauntness.2,3 A prematurely older appearance is also a typical symptom of chronic smoking. Boyd et al. reported that yellow, irregularly thickened skin forms from the breakdown of the skin’s elastic fibers as a result of smoking.2 In 1999, Demierre et al. noted that case–control studies and other reports suggest a higher prevalence of facial wrinkling among smokers and that smokers, more often than nonsmokers, appear older than their stated age.1 A significant association between smoking and gray hair was also observed in a different study.1


Smokers characteristically develop lines around the mouth.

A German literature review article from the mid-1990s concluded that smoking is at least culpable for promoting, if not actually causing, various skin changes.5 This report noted the strong association between cigarette smoking and yellowed fingers as well as increased facial wrinkling, particularly in women. An elevated incidence of precancerous lesions and squamous cell carcinomas on lips and oral mucosa, as well as vasospasms and deterioration in large arteries and microvasculature were also linked to cigarette smoking in this report. In addition, smoking has recently been shown in an observational study to have a strong correlation with androgenetic alopecia by dint of a multifactorial array of mechanisms.6


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