Everyone knows about the dangers of smoking for health, that the number of cigarettes smoked daily is clearly correlated with the risk of cardiovascular and pulmonary diseases – . But the fact that smoking greatly affects the appearance and health of the skin, the healing of the skin after cosmetic procedures, the development of dermatological diseases in the mouth and, finally, the premature formation of wrinkles – not known to all patients of a cosmetologist.
Smoking is one of the most common causes of death that a person can prevent. Meanwhile, in the world every year, tobacco takes about 3 million human lives. Smoking is clearly associated with the development of lung cancer, emphysema, chronic bronchitis, angina pectoris, stroke, sudden death, aortic aneurysm and peripheral vascular disease, as well as other serious pathologies of the internal organs.
Less known and even less studied are the external manifestations and consequences of smoking. Although the skin manifestations associated with smoking are not as ominous as diseases of the internal organs, they are quite real and cause a significant number of deaths.
Skin diseases provoked by smoking
Knowledge about the effects of smoking on the skin is very much needed by doctors as another argument to explain to patients the dangers of smoking and to promote a healthy lifestyle. Maybe this is what will allow some patients to stop and throw cigarettes out of their lives forever, especially for those people who care more about their appearance than about the potential danger to internal organs.
Leukoplakia
Leukoplakia is keratinization of the oral mucosa or red border of the lips, accompanied by inflammation, usually in response to chronic exogenous irritation. Of paramount importance in the pathogenesis of leukoplakia is the effect of hot tobacco smoke, which causes an increase in cell nuclei, cell sizes and early keratinization in the epithelium.
When leukoplakia is localized on the red border of the lips, great importance in its occurrence is attached to chronic trauma with a mouthpiece, cigarette or cigarette (pressure), systematic cauterization of the lips when smoking the cigarette to the end, as well as unfavorable meteorological conditions, primarily insolation. Although leukoplakia develops not only in smokers, smoking often plays a significant etiological role in the development of this pathology.
Tappeiner Leukoplakia (LCT)
This disease is a type of leukoplakia of the oral mucosa. It occurs on the mucous membrane of the hard palate, and only in smokers. In the literature, you can find other names for this pathological process: nicotinic leukokeratosis of the palate, nicotinic stomatitis, smoker's palate. The mucous membrane of the hard palate, and sometimes the soft palate adjacent to it, appears to be slightly keratinized, grayish-white, often folded. Against this background, red dots – gaping mouths of the excretory ducts of small salivary glands become clearly visible.
With a pronounced process, these red dots are located on top of small hemispherical nodules. This disease is especially common in heavy smokers, as well as in people who smoke pipes or cigarettes. Despite the name of the disease, the main cause of the disease is exposure to tar and heat, not nicotine. Unlike other forms of leukoplakia, this condition resolves quickly, within about 2 weeks of stopping smoking.
Nicotine leukokeratosis of the tongue
Nicotine leukokeratosis of the tongue (NCL), also known as "smoker's tongue", – homogeneous leukoplakia with hemispherical impressions, affecting the anterior 2/3 of the back of the tongue. The disease occurs exclusively in smokers, more often in cigarette smokers, and, as a rule, accompanies LCT. NKJ, like LKT, is most likely related to exposure to resins and high temperatures.
Acute necrotizing ulcerative gingivitis
With this form of gingivitis, perforated ulceration of the papillae between the teeth is most characteristic. Patients complain of soreness, bleeding and bad breath, and in severe cases, lymphadenopathy and general intoxication develop. The disease occurs exclusively in smokers and clearly depends on the number of cigarettes smoked (of the surveyed patients, 75% smoked at least 3 packs of cigarettes per day). Thus, smoking – the most important risk factor for this disease.
The role of smoking in the etiology and pathogenesis of psoriasis
Although there is no clear link between smoking and the development of psoriasis, a number of studies have shown some association between the two. However, women who smoke 1 pack of cigarettes a day have been found to be 3.3 times more likely to develop psoriasis than non-smokers.
In addition, a relationship was established between the number of cigarettes smoked per day and the risk of psoriasis – the highest risk was for people who smoked 20 cigarettes or more per day. The main pathological processes through which tobacco smoke can affect the genesis of psoriasis are probably disorders in the immune system, microcirculation disorders in the skin, as well as a weakening of the body's antioxidant defenses, which are observed in smokers.
Effect of smoking on wound healing
Despite centuries of clinical experience and dozens of scientific studies, it was only in 1977 that L. Mosley and F. Finseth scientifically proved and substantiated the negative effect of smoking on the rate of wound healing. In 1978, the same authors showed in an animal model that systemic nicotine significantly impairs wound healing.
Smoking impairs postoperative wound healing. When examining women who underwent laparotomy, it was found that with a longitudinal incision, the width of the scar in smoking patients averages 7.4 mm, in non-smokers – 2.7mm, and with a transverse – 2.8 and 2 .1 mm respectively.
After a retrospective analysis of all facial cosmetic surgeries performed in the clinic over 6 years, T. Rees et al. found 10.2% of complications manifested in skin detachment of various degrees. Smoking patients accounted for 80% of this group. The authors found that smokers undergoing facial cosmetic surgery had a 12.46 times higher risk of skin flap rejection than non-smokers.
When performing a facelift, peeling of the skin is observed in 5% of non-smokers, 8.3% of former smokers and 19.4% of smokers. Because of this, a special modification of the lifting was even developed, in which a very limited penetration into the skin is performed. The results immediately improved: not a single case of skin detachment in patients, including 32% of smokers. However, even with such a gentle technique, a statistically significant higher incidence of hair loss in the area of the surgical field was found in smokers than in non-smokers.
A direct relationship has been established between the number of packs of cigarettes smoked per day and the development of necrosis of skin grafts during reconstructive operations. Patients who smoked more than 1 pack of cigarettes per day were 3 times more likely to develop necrosis than non-smokers, and those who smoked 2 packs of cigarettes 6 times more often.
The vasoconstrictive effect of cigarette smoke has long been known. Although this smoke contains more than 4,000 poisonous components, it has been established that the main substance that has a vasoconstrictive effect and disrupts blood flow is nicotine. The true mechanism of this effect is unknown, but it may be due to nicotine-induced activation of vasopressin secretion.
Smoking activates the sympathetic nervous system, which in turn also leads to constriction of the peripheral blood vessels. In addition, catecholamines, the release of which increases with the activation of the sympathetic nervous system, are cofactors in the formation of chalons –glycoproteins that inhibit epithelization.
Smoking reduces tissue oxygenation. It also increases the content of carboxyhemoglobin, which further impairs tissue oxygenation by limiting the oxygen capacity of the blood. In addition, smoking causes platelet aggregation, reduces the formation of prostacyclin, collagen deposition, increases blood viscosity.
Smoking just 1 cigarette can cause vasoconstriction of the skin for up to 90 minutes. In this case, for example, the blood flow in the fingers is reduced by 24 - 42%. J. Jensen et al. found that smoking for 10 minutes leads to a decrease in the partial pressure of oxygen in the tissues by almost 1 hour. The authors concluded that the average smoker (1 pack per day) spends most of the day in a state of hypoxia.
It follows from all that has been said that it is very useful to advise smoking patients to abstain from this habit before and after any surgical operation. However, the duration of such a period of abstinence remains unclear. If possible, it is recommended to refrain from smoking for a period of 1 day to 3 weeks before surgery and 5 days to 4 weeks after.
Effect of smoking on wrinkle formation
Smoking causes premature aging and wrinkles on the face. This was first noted as early as 1856. In 1965, M. Ippen et al. proposed the term "cigarette skin" for pale gray wrinkled skin. They found such skin in 79% of smokers and only in 19% of non-smokers aged 35-84 years.
It has been established that the number of wrinkles correlates with the number of packs of cigarettes smoked per year. The authors considered that smoking had a greater effect on wrinkle formation than sun exposure.
In 1985, D. Model proposed the term "smoker's face" and defined its diagnostic criteria. One of the following is sufficient to define "smoker's face":
- protruding lines or wrinkles on the face;
- haggard facial features with an underlined line of skull bones;
- atrophic, slightly pigmented, grayish skin;
- swelling skin, with an orange, purple or reddish tinge.
The risk of premature wrinkling increases with the number of cigarettes smoked per year, and those who smoke more than 50 packs per year are 4.7 times more likely to have wrinkles than non-smokers of the same sex and age. Some authors consider sun exposure to be a more powerful factor in the appearance of wrinkles than smoking. Obviously, the interaction of these factors leads to an even more pronounced effect.
Studies have shown that women are more sensitive to the effects of cigarette smoke than men. The exact mechanisms by which cigarette smoke causes premature skin aging are still unknown, but it is most likely a multifactorial process.
It has been found that the elastin in the skin of smokers is denser and more fragmented than that of non-smokers. These changes in elastic fibers are similar to those caused by exposure to sunlight, with the only difference that in smokers they affect the reticular layer of the dermis, and not the papillary layer, as occurs in actinic elastosis.
Cigarette smoke enhances the activity of neutrophil elastase, thus contributing to the formation of defective elastin. In vitro, cigarette smoke blocks the cross-links in elastin. Chronic ischemia of the dermis probably promotes damage to elastic fibers and also reduces collagen synthesis.
Wrinkles from smoking can also occur due to the pro-oxidant action of cigarette smoke, as well as a decrease in vitamin A levels and therefore protection against free radicals. The pronounced decrease in water saturation of the stratum corneum in smokers also leads to premature and excessive wrinkling.
Increased hydroxylation of estradiol caused by cigarette smoke induces a state of relative hypoestrogenism in women, which may cause dryness and atrophy of the skin, potentially contributing to the formation of wrinkles. The fact that not all smokers develop a "smoker's face" suggests the likely role of genetic factors in the mechanisms of wrinkle formation.
In conclusion, it should be reiterated that for some patients, the risk of premature and severe wrinkling will be a much more powerful motivation to quit smoking than even the risk of any fatal diseases caused by smoking.
According to rmj.ru
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