PRESENTED BY: DR. MD. NAZRUL ISLAM CHAIRPERSON : DR. SHAHAB UDDIN AHMED CHOWDHURY

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PRESENTED BY DR. MD. NAZRUL ISLAMCHAIRPERSON
DR. SHAHAB UDDIN AHMED CHOWDHURY

• Departartment of Dermatology,
• Mymensingh Medical College.

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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.

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

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Introduction (Contd)

• Knowledge of the cutaneous effects of
• smoking is important because it provides
• A tool for counseling, especially those who
  are more concerned about their outward
  appearance and help them to stop smoking.

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EFFECTS OF SMOKING.

• A. Internal diseases strongly associated
• Lung diseases Lung cancer
• Emphysema.
• Chronic Bronchitis.
• Cardiovascular diseases-Heart attack.
• Peripheral vascular disease.
• Aortic aneurysm .
• Stroke.
• Sudden death.

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B. External manifestations and consequences

• Smokers face.
• Wrinkles.
• Defective wound healing
• Malignancy- Melanoma.
• Sq. Cell ca.
• Cancers of oral cavity,-
  Lip, anogenital area.

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Ext. Manifest (Contd.)
Miscellaneous- Skin lesions Psoriasis Genit
al warts. Yellow brown discoloration- of
finger nails Quitters nail. Infictious
eczematoid dermatitis. Periductal
Mastitis. Thromboangitis obliterans.
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Ext. Manifest (Contd)

• Oral Lesions Lukoplakia.
• Black Hairy Tongue.
• Oral Melanosis.
• Oral warty dyskaratoma.
• Smokers Palate.
• Smokers Tongue.
• Trench Mouth.

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Theoretical Concerns

• The following disease related dermatoses
• increases in smokers.
• AIDS.
• Non insulin dependant diabetes mellitus.
• Inflamwatory Bowel diseases.
• SLE.

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Diseases having negative association with smoking.

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

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Smokers face

• Criteria for smoker face" one or more of the
  following-
• Prominent lines or wrinkles.
• A gauntness of facial feature.
• An atrophic, slightly pigmented gray appearance
  of skin.
• A plethoric, slightly orange, Purple and red
  complexion.
• - defined by model.
• In his prospective study
• Smokers face among current smokers - 46
• Past smokers
  - 8
• non smokers - 0
• Female gtMale
  

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Wrinkles.

• Smoking causes premature skin aging and
• wrinkling.
• lppen and Ippen defined-
• Pale, gray and wrinkled skin as
• "Cigarette skin
• His Study showed -
• Cigarette skin among smokers - 79
• Nonsmokers- 19
• Female gt Male.

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Defective wound healing

• Smoking is detrimental to healing wound.
• Systemic administration of nicotine impair
• wound healing.
• I. SCAR WIDTH-
• Scar width (Smokers) - 7.4 mm.
• Scar width (Non smokers) - 2.7 mm.
• Study by Siana et al

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Defective wound healing(Contd.)

• NECROSIS of flaps and full thickness grafts.
• Smokers (gt1 Pack per day) - 3 times.
• (gt2 Packs per day) - 6 times.
• Study by gold minz on 916 patients.
• SKIN SLOUGH in Face Lift Operation on 1186
  patients in 6 Years period showed-
• Smokers had 12.46 times greater chance of skin
  slough.

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Defective wound healing(Contd.)

• COMPLICATIONS in reconstruction of
• frontal hair line surgery on 156 patients showed
  smokers had complications-
• 2 times.

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MALIGNANCIES

• Different studies showed ?smoking increases
• incidence of some malignancies or affects the
• natural coarse malignancy adversely.
• Melanoma.
• Smokers are more likely to
• i. Have metastasis specially visceral and
• metastasis within first 2 years after
  diagnosis.
• ii. Die of their disease.
• Smokers are less likely disease free survival
• after diagnosis.

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MALIGNANCIES(Contd.)

• Sq. Cell Ca.
• Several studies showed
• ?Increased incidence of kerato acanthomas and
  sq. cell ca. in smokers.?
• Other cancers.
• Smokers are in increased risk of cancers in the
  anogenital areas e.g. vulvar, anal and penile
  cancers.

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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.

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Other oral lesions

• Leukoplakia- Smoking often plays a significant
  causative role.
• Smokers palate- Found exclusively in smokers.
• Smokers 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.

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Diseases having Negative association.

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

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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.

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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.

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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.