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

1. PRESENTED BY: DR. MD. NAZRUL ISLAMCHAIRPERSON : DR. SHAHAB UDDIN AHMED CHOWDHURY Departartment of Dermatology, Mymensingh Medical College.

2. 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.

3. 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.

4. 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 tostop smoking.

5. 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.

6. B. External manifestations and consequences: Smoker’s face. Wrinkles. Defective wound healing Malignancy- Melanoma. Sq. Cell ca. Cancers of oral cavity,- Lip, anogenital area.

7. 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.

8. Ext. Manifest (Contd) Oral Lesions – Lukoplakia. Black Hairy Tongue. Oral Melanosis. Oral warty dyskaratoma. Smoker’s Palate. Smoker’s Tongue. Trench Mouth.

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

10. Diseases having negative association with smoking. • Vulvar lichen sclerosus. • Severe acne. • Recurrent herpes labialis. • Ulcerative colitis.

11. Smoker’s 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 – Smoker’s face among current smokers - 46% “ “ “ Past smokers - 8% “ “ “ non smokers - 0% “ “ “ Female >Male

12. Wrinkles. Smoking causes premature skin aging and wrinkling. lppen and Ippendefined- Pale, gray and wrinkled skin as "Cigarette skin“ : His Study showed - Cigarette skin among smokers - 79% “ “ “ Nonsmokers- 19% “ “ “ Female > Male.

13. 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

14. Defective wound healing(Contd.) • 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. • SKIN SLOUGH inFace Lift Operation on 1186 patients in 6 Years period showed- Smokers had 12.46 times greater chance of skin slough.

15. Defective wound healing(Contd.) • COMPLICATIONS in reconstruction of frontal hair line surgery on 156 patients showed smokers had complications- 2 times.

16. 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.

17. 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.

18. 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.

19. 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.

20. Diseases having Negative association. • Vulvar lichen sclerosus. • Severe acne. • Recurrent herpes labialis. • Ulcerative colitis.

21. 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.

22. 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.

23. 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.