Transcript Slide 1 - Mymensingh Medical College

PRESENTED BY:
DR. MD. NAZRUL ISLAM
CHAIRPERSON :
DR. SHAHAB UDDIN AHMED CHOWDHURY
Departartment of Dermatology,
Mymensingh Medical College.
Sub:-“Cutaneous
manifestations
and consequences of
smoking"
Jeffrey B, smith M.D and Neil A
Ref
: Journal of the American academy
Vol : 34, Number-5 Part-1, May 1996.
Feuske M.D.
of Dermatology.
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.
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.
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.
B. External manifestations
and consequences:
Smoker’s face.
Wrinkles.
Defective wound healing
Malignancy- Melanoma.
Sq. Cell ca.
Cancers of oral cavity,Lip, anogenital area.
Ext. Manifest (Contd.)
MiscellaneousSkin lesions –
Psoriasis
Genital warts.
Yellow brown discolorationof finger nails & Quitter’s nail.
Infictious eczematoid dermatitis.
Periductal Mastitis.
Thromboangitis obliterans.
Ext. Manifest (Contd)
Oral Lesions – Lukoplakia.
Black Hairy Tongue.
Oral Melanosis.
Oral warty dyskaratoma.
Smoker’s Palate.
Smoker’s Tongue.
Trench Mouth.
Theoretical Concerns
The following disease related dermatoses
increases in smokers.
AIDS.
Non insulin dependant diabetes mellitus.
Inflamwatory Bowel diseases.
SLE.
Diseases having
negative association
with smoking.
Vulvar lichen sclerosus.
Severe acne.
Recurrent herpes labialis.
Ulcerative colitis.
Smoker’s face
Criteria for “smoker face" : one or more of the followingProminent 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
Wrinkles.
Smoking causes premature skin aging and
wrinkling.
lppen and Ippen definedPale, gray and wrinkled skin as
"Cigarette skin“ :
His Study showed Cigarette skin among smokers 79%
“
“
“
Nonsmokers19%
“
“
“
Female > Male.
Defective wound healing
Smoking is detrimental to healing wound.
Systemic administration of nicotine impair
wound healing.
I.
SCAR WIDTHScar width (Smokers)
- 7.4 mm.
Scar width (Non smokers)
- 2.7 mm.
Study by Siana et al
Defective wound healing(Contd.)
II.
NECROSIS of flaps and full thickness grafts.
Smokers (>1 Pack per day)
“
(>2 Packs per day)
-
3 times.
-
6 times.
Study by gold minz on 916 patients.
III.
SKIN SLOUGH in Face Lift Operation on 1186 patients
in 6 Years period showedSmokers had 12.46 times greater chance of skin slough.
Defective wound
healing(Contd.)
IV. COMPLICATIONS in reconstruction of
frontal hair line surgery on 156 patients
showed smokers had complications2 times.
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.
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.
MALIGNANCIES(Contd.)
Lip Cancers.- The major risk factors are tobaccoexposure 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:
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 outward appearance than internal disease to
stop smoking.
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.