Smoking and Premature Aging

Intrinsic and extrinsic factors are involved in the skin aging process. Intrinsic aging is a slow, permanent degeneration that affects most of the body, with distinguishable characteristics such as wrinkling of the skin, cherry hemangiomas and seborrheic keratoses. Photoaging or photodamage is the most noticeable effect of extrinsic skin aging, caused by long-term solar UV light exposure. Photodamaged skin is illustrated by coarse wrinkles, dyspigmentation and telangiectasia, and is associated with malignant tumors.

Smoking is also an extrinsic factor in skin aging. The association of tobacco smoking and cardiovascular disease, lung cancer and chronic obstructive pulmonary disease is well-documented, and several studies have documented the adverse effect of tobacco smoking on the integumentary system.1 In fact, today, multiple environmental factors are associated with facial aging; evidence suggests that smoking 20 cigarettes per day is equivalent in effect to almost 10 years of chronological aging. Therefore, lifestyle recommendations to stop or delay facial skin aging are also very useful in promoting public health.

Epidemiology of Skin Aging

The sallow complexion and markedly wrinkled skin of smokers was first noticed in 1856 during a large series of British insurance examinations. One year later, skin differences between smoking and nonsmoking British Army officers stationed in India were described. In 1965, the skin of 224 female cigarette smokers, ages 35-84, was evaluated and described as pale and thick, with a grayish hue and without local variations in pigmentation. However, because similar skin changes were noticed in nonsmoking women over the age of 70, these alterations were not fully interpreted.2 In 1971, Daniell studied the severity of wrinkles in 1,104 smoking subjects. After adjusting for age and outdoor sun exposure, she noticed that premature wrinkling is an important sign of smoker’s skin.3

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