How can smoking affect your patients’ skin?

The detrimental health effects of smoking, particularly lung cancer, stroke and cardiovascular disease, are well documented. Most smokers know the risks they are taking with their health, however many may be unaware of the effect smoking has on their skin. With National No Smoking Day around the corner, (13th March), it is a timely opportunity for aesthetic practitioners to advise their patients about the damage that smoking causes to the skin and offer potential treatment options to help combat it. What dermatological treatments could you provide to help your patients with smoking-related skin concerns?


Changes to physical appearance

Side effect: Facial ageing

The nicotine in cigarettes accelerates the skin’s ageing process as it causes the narrowing of blood vessels in the epidermis. A reduction in oxygen affects blood flow to the skin, which means that important nutrients cannot flow easily to the skin. Patients who smoke may wish to get rid of their ‘smoker’s lines’ – the vertical wrinkles around the mouth that come from pursing the lips to draw on a cigarette over and over again. They may also wish to treat their ‘crow’s feet’ wrinkles that develop around the outside of the eyes.

Treatment: Topical medical treatments such as vitamin A acid, alpha hydroxy acids, antioxidants, and moisturisers can help limit the effects of ageing for smokers. However, smokers who use these techniques to fight a dull complexion may find little difference, as once the damage has already been done and can be very difficult to reverse. Treatments such as microdermabrasion, skin peels, injection of fillers and botox, and lasers may be a more effective and longer-lasting solution.


Side effect: Sagging skin

The chemicals in cigarettes damage collagen and elastin, causing the skin to sag and wrinkle. It is not just the face that suffers the consequences of smoking, the breasts and upper arms are often affected by the loss of skin elasticity. Studies have suggested that smokers have a stronger likelihood of suffering from elastosis (a condition in which skin loses elasticity as a result of connective tissue degeneration).

Treatment: There are numerous non-invasive skin tightening treatments and technologies you can use to treat patients with sagging skin, including ultrasound skin tightening, radiofrequency (RF) treatments, laser and intense pulse light (IPL).


Side effect: Psoriasis

It is believed by many health professionals that the link between psoriasis and smoking may be the nicotine in cigarettes. Nicotine affects the immune system, skin inflammation, and skin cell growth, all of which can contribute to the development of the disease. According to a study, women who smoke 20 or more cigarettes a day are two and a half times more likely to get psoriasis than non-smokers. For men, the risk is just over one and a half times that of non-smokers.

Treatment: The first point of call when treating psoriasis is to use topical treatments such as lotions, steroids, ointments and cream to decrease inflammation and skin turnover. If topical treatments fail, you may wish to consider using phototherapy (also known as light therapy), which has anti-inflammatory, immunosuppressive (suppresses the immune response) and anti-proliferative (inhibits cell growth) effects.


Key considerations

It is also important to note that smoking has a negative effect on wound healing due to a reduction in blood flow, which slows the body’s ability to repair itself, so recovery time may be longer for a smoking patient than a non-smoking patient. As a practitioner, it is recommended to suggest patients stop smoking before a treatment as it may affect the healing process. If you are aware that your patient smokes, advise them about the physical changes smoking can have, and remind them that there are serious skin conditions associated with smoking. Your advice may even help motivate them to quit!

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