CIGARETTES AND AGING SKIN in Visual Studio .NET

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CHAPTER 7 CIGARETTES AND AGING SKIN
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Several bodily tissues endure wideranging pharmacologic effects from the over 1500 ingredients of cigarette smoke Although the clinical trials discussed above differed over the extent of the impact of smoking on skin, it is certain that smoking alters skin function and immune-mediated skin disease4 For example, lower stratum corneum water content has been reported in smokers,17 likely because of the diuretic effect of nicotine Although little is known about the mechanism through which cigarette smoking manifests in facial wrinkling, the dynamic is probably multifactorial3 Matrix metalloproteinases (MMPs) likely play a significant role in the premature aging induced by cigarette smoking via the same mechanism that MMPs cause aging in patients with significant sun exposure (see 6) A recent study demonstrated that MMP-1 mRNA levels are significantly increased in the skin of smokers as compared to the skin of nonsmokers18 Because MMPs are known to degrade collagen, this finding may help explain the mechanism by which smoking causes premature aging Other MMPs are known to affect elastic fibers; therefore, these MMPs likely play a role as well because the elastic fibers in the skin of non-sun-exposed smokers appear thicker and more fragmented than the elastic fibers in the skin of nonsmoking agematched controls These histopathologic findings are similar to those seen in sun-
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damaged skin, though the smokinginduced alterations occur deeper in the reticular dermis as opposed to the solar damage to the papillary dermis In addition to the observed increased levels of MMPs noted in the skin of smokers, there are several other systemic and metabolic alterations induced by smoking Smoking appears to reduce facial stratum corneum moisture as well as vitamin A levels, the latter of which is important in fending off or neutralizing the free radicals thought to contribute to the etiologic pathway of aging Of course, genetic factors also play a role in facial wrinkling because not all smokers exhibit the typical smoker s face Many studies discussing the changes seen in the cutaneous microvasculature of smokers show that chronic smoking diminishes capillary and arterial blood flow, leading to local dermal ischemia18 This compromised blood flow leads to fewer nutrients and oxygen in the skin with a concomitant build-up of toxic waste products that can damage the skin In fact, it is well known that smoking slows wound healing and that patients are strongly advised to stop smoking prior to any elective cosmetic surgery19 This is especially important in face-lifts, laser resurfacing, and dermabrasion procedures because a good blood supply to the skin is vital for a good surgical outcome Another confounding factor in the production of facial wrinkling is infrared radiation (IR) IR comprises 40% of the solar radiation that reaches the earth and has been associated with increasing the number and thickness of elastic fibers in exposed skin The effects of IR are felt as heat, though the cutaneous results of such exposure are similar to the elastosis induced by UV exposure This, along with the fact that several studies have suggested a link between exacerbated elastosis and chronic exposure to heat in the workplace, led investigators to conclude that the presence of a continuous source of heat such as a lit cigarette may have contributed to an increase in the elastosis observed in their patients who smoke19
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that smokers with significant facial wrinkles were more likely to have COPD22 Collagen and elastin levels are affected in both facial wrinkling and COPD, so it is possible that these conditions share common mechanistic or genetic pathways It has been suggested that smokers with significant facial wrinkles should be evaluated for COPD
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TREATMENT OF SKIN AGING INDUCED BY SMOKING
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Of course, cessation of smoking should be the primary goal There are many products available to help patients stop smoking, including nicotine patches and gum, as well as oral antidepressants such as ZybanTM All patients should stop smoking at least 1 month prior to any elective surgery to enhance wound healing All cosmetic patients should be advised that sun exposure and smoking undermine efforts to look younger However, if patients insist on smoking, the addition of an oral antioxidant vitamin formula (see 34) and a topical retinoid (see 30) may help prevent some of the deleterious effects of smoking, although this has not been studied or proven The smoker s wrinkles around the mouth can be treated with dermal fillers such as CosmoPlastTM, Juv dermTM, or RestylaneTM (see 23), or with a very small amount of botulinum toxin (see 22) A more permanent improvement option for these patients is dermabrasion or laser resurfacing However, perioral lines will rapidly reappear if the patient continues or resumes smoking
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