PRESENTED BY: PRESENTED BY: DR. MD. NAZRUL ISLAMDR. MD. NAZRUL ISLAM

CHAIRPERSON : CHAIRPERSON : DR. SHAHAB UDDIN AHMED CHOWDHURYDR. SHAHAB UDDIN AHMED CHOWDHURY

DepartartmentDepartartment of Dermatology, of Dermatology,

Mymensingh Medical College. Mymensingh Medical College.

Sub:-“Cutaneous manifestations and consequences of

smoking"

Jeffrey B, smith M.D and Neil A Feuske M.D.

Ref : Journal of the American academy of Dermatology.

Vol : 34, Number-5 Part-1, May 1996.

INTRODUCTION :INTRODUCTION :

Smoking is the single greatest Preventable Smoking is the single greatest Preventable

cause of morbidity.cause of morbidity.

Smoking is strongly linked to serious internal Smoking is strongly linked to serious internal diseases. However, external (cutaneous) diseases. However, external (cutaneous) manifestations and consequences of smoking manifestations and consequences of smoking are relatively unknown, but are associated with are relatively unknown, but are associated with significant morbidity.significant morbidity.

Introduction (Contd)Introduction (Contd)

Knowledge of the cutaneous effects ofKnowledge of the cutaneous effects of

smoking is important because it provides smoking is important because it provides

A tool for counseling, especially A tool for counseling, especially those who are more concerned about those who are more concerned about their their outward appearance and help outward appearance and help

them them toto stop smokingstop smoking..

EFFECTS OF SMOKING.EFFECTS OF SMOKING.

A.A. Internal diseases strongly associated :Internal diseases strongly associated :Lung diseases Lung diseases –– Lung cancerLung cancer

Emphysema.Emphysema.Chronic Bronchitis.Chronic Bronchitis.

Cardiovascular diseases-Heart attack.Cardiovascular diseases-Heart attack. Peripheral vascular Peripheral vascular

disease.disease. Aortic aneurysmAortic aneurysm .. Stroke.Stroke. Sudden death.Sudden death.

B.B. External manifestations External manifestations and and consequences:consequences:

Smoker’s face.Wrinkles.Defective wound healingMalignancy- Melanoma.

Sq. Cell ca. Cancers of oral cavity,- Lip, anogenital area.

Ext. Manifest (Contd.)

Miscellaneous- Skin lesions – Psoriasis

Genital warts.

Yellow brown discoloration-

of finger nails & Quitter’s nail.

Infictious eczematoid dermatitis.

Periductal Mastitis.

Thromboangitis obliterans.

Ext. Manifest (Contd)Ext. Manifest (Contd)

Oral Lesions – Lukoplakia.Oral Lesions – Lukoplakia.

Black Hairy Tongue.Black Hairy Tongue.

Oral Melanosis.Oral Melanosis.

Oral warty dyskaratoma.Oral warty dyskaratoma.

Smoker’s Palate.Smoker’s Palate.

Smoker’s Tongue.Smoker’s Tongue.

Trench Mouth.Trench Mouth.

Theoretical ConcernsTheoretical Concerns

The following disease related dermatosesThe following disease related dermatoses

increases in smokers.increases in smokers. AIDS.AIDS. Non insulin dependant diabetes Non insulin dependant diabetes

mellitus.mellitus. Inflamwatory Bowel diseases.Inflamwatory Bowel diseases. SLE.SLE.

Diseases having Diseases having negative negative association with association with smoking.smoking.Vulvar lichen sclerosus.Vulvar lichen sclerosus.

Severe acne. Severe acne. Recurrent herpes labialis. Recurrent herpes labialis. Ulcerative colitis.Ulcerative colitis.

Smoker’s face Smoker’s face Criteria for “smoker face" : one or more of the following-Criteria for “smoker face" : one or more of the following- Prominent lines or wrinkles.Prominent lines or wrinkles. A gauntness of facial feature.A gauntness of facial feature. An atrophic, slightly pigmented gray appearance of skin.An atrophic, slightly pigmented gray appearance of skin. A plethoric, slightly orange, Purple and red complexion.A plethoric, slightly orange, Purple and red complexion.

- - defined by defined by model.model.

In his prospective study –In his prospective study –Smoker’s face among current smokersSmoker’s face among current smokers - 46% - 46% “ “ “ “ “ “ Past smokersPast smokers - 8% - 8% “ “ “ “ “ “ non smokersnon smokers - 0% - 0% “ “ “ “ “ “ Female >MaleFemale >Male

Wrinkles.Wrinkles.Smoking causes premature skin aging Smoking causes premature skin aging

andand

wrinkling.wrinkling.lppen and Ippenlppen and Ippen defined- defined- Pale, gray and wrinkled skin as Pale, gray and wrinkled skin as

"Cigarette skin“ :"Cigarette skin“ :His Study showed -His Study showed -

Cigarette skin among Cigarette skin among smokerssmokers -- 79%79%

“ “ “ “ “ “ Nonsmokers-Nonsmokers- 19%19%

“ “ ““ ““ Female > Male.Female > Male.

Defective wound healingDefective wound healing

Smoking is detrimental to healing wound.Smoking is detrimental to healing wound.

Systemic administration of nicotine impairSystemic administration of nicotine impair

wound healing.wound healing.

I.I. SCAR WIDTH-SCAR WIDTH-

Scar width (Smokers) Scar width (Smokers) - 7.4 mm.- 7.4 mm.

Scar width (Non smokers)Scar width (Non smokers) - 2.7 mm.- 2.7 mm.

Study by Siana et Study by Siana et al al

Defective wound healing(Contd.)

II. NECROSIS of flaps and full thickness grafts.

Smokers (>1 Pack per day) - 3 times.

“ (>2 Packs per day) - 6 times.

Study by gold minz on 916 patients.

III. SKIN SLOUGH in Face Lift Operation on 1186 patients

in 6 Years period showed-

Smokers had 12.46 times greater chance of skin slough.

Defective wound healing(Contd.)Defective wound healing(Contd.)

IV. COMPLICATIONS in reconstruction of

frontal hair line surgery on 156 patients

showed smokers had complications-

2 times.

MALIGNANCIESMALIGNANCIESDifferent studies showed Different studies showed smoking increasessmoking increasesincidence of some malignancies or affects theincidence of some malignancies or affects thenatural coarse malignancy adversely.natural coarse malignancy adversely. Melanoma.Melanoma.

Smokers are more likely to Smokers are more likely to i.i. Have metastasis specially visceral and Have metastasis specially visceral and

metastasis within first 2 years after diagnosis.metastasis within first 2 years after diagnosis.ii.ii. Die of their disease.Die of their disease.Smokers are less likely disease free survival Smokers are less likely disease free survival after diagnosis.after diagnosis.

MALIGNANCIES(Contd.)MALIGNANCIES(Contd.)

Sq. Cell Ca.Sq. Cell Ca.

Several studies showed – Several studies showed –

Increased incidence of kerato Increased incidence of kerato acanthomas and sq. cell ca. in acanthomas and sq. cell ca. in smokers.smokers.

Other cancers.Other cancers.

Smokers are in increased risk of Smokers are in increased risk of cancers in the anogenital areas e.g. cancers in the anogenital areas e.g. vulvar, anal and penile cancers.vulvar, anal and penile cancers.

MALIGNANCIES(Contd.)

Lip Cancers.- The major risk factors are tobacco- exposure and actinic radiation.

Oral Cancers.- has been over whelmingly linked

to smoking. It has been well documented.

Other oral lesions Leukoplakia- Smoking often plays a significant

causative role. Smoker’s palate- Found exclusively in smokers. Smoker’s tongue- Due to adverse effect of tar and

heat on pipe smokers. Trench Mouth- Punched out ulceration of the

interdental papillae. Occurs exclusively in smokers

and dose related.

Diseases having Negative association.

Vulvar lichen sclerosus.Severe acne.Recurrent herpes labialis.Ulcerative colitis.

CONCLUSION:CONCLUSION:

Cigarette smoking is not only linked to internal Diseases, but also associated with significant adverse effects on skin,like delayed and defective wound healing, wrinkling, malignancy and aggravation of many skin diseases.

Conclusion (Contd)

“ Premature skin aging and wrinkling " may be more powerful motivator to those who are more concerned about their out- ward appearance than internal disease to stop smoking.

Conclusion (Contd)Conclusion (Contd)

So, we all medical professionals can use “the adverse effects of smoking on skin " as a tool for counseling, so that this counseling may be fruitful, purposeful and successful to stop smoking.