Smoker's Face - Beauty is Only Skin Deep

Key Points

Smokers tend to look older than non-smokers of the same age. Smokers’ facial skin is more likely than non-smokers to have:wrinkles, crow’s feet and a sallow, yellow-grey colouring. Smokers’ skin can be prematurely aged by between 10 and 20 years. The damaging effects of cigarette smoke on skin are irreversible but it is likely that further deterioration will be avoided by stopping smoking.

The underlying biological changes that lead to ‘smoker’s face are not yet fully understood but may be due to damage to small blood vessels in the skin and to the protein matrix (or architecture) of the skin brought about by cigarette smoke or the toxic chemicals in cigarettes. Smoker’s skin is more likely to slough after surgery than that of non-smokers. The skin ageing effect of cigarette smoke is likely also to result from second-hand smoke albeit at a reduced rate; young people working in bars, clubs and restaurants need to be aware of this potential risk. The use of smoking as a cachet in the modelling and fashion industry is totally incompatible with one of its principal aims – to promote beauty.


Explanations

Cigarette smoking is causally linked to: fifteen types of cancer (lung, lip, mouth, pharynx, larynx, nasal cavity and nasal sinus, oesophagus, pancreas, bladder, stomach, liver,kidney, cervix, myeloid leukaemia), as well as coronary heart disease, stroke, chronic obstructive lung disease, peripheral vascular disease, still-birth, low birth weight, sudden infant death, infant mortality, congenital abnormalities and miscarriage.

Surveys have shown that the over-whelming majority of smokers are aware that smoking causes premature death and serious diseases like heart disease and cancer. Relatively few are aware of the evidence that smoking prematurely ages the skin.

Those who know smokers as family members or friends may have observed that they look older than their chronological years. This effect has been examined more objectively by scientists who have studied the skin of smokers in comparison to non-smokers to assess its wrinkling,elasticity, colouring and chemical content.

This research has provided considerable scientific credence to the observation that there is a ‘smoker’s face’. In the early 1970s, a study carried out in California noted an association between cigarette smoking and skin wrinkling that was striking in both sexes. Smokers were observed to be as wrinkled as non-smokers who were 20 years older. Further research was called for.

At the beginning of the 1990s researchers from the University of Utah in the USA assessed and graded the degree of facial wrinkling in a group of smokers and non-smokers. They concluded that cigarette smoking was a risk factor for the development of skin wrinkles and ‘crows feet’. Moreover, smoking acted as a risk factor independent of age and sun exposure (both of which, as might be expected, also increased wrinkling). Furthermore, premature skin wrinkling increased with the amount smoked and the duration of smoking.

In the mid 1990s, a well-designed study of smoking status and facial wrinkling was carried out in California by researchers from the University of California, the Department of Veterans Affairs and the Kaiser Permanente Medical Group. After adjusting for age, average sun exposure and body mass the risk of moderate or severe facial skin wrinkling was more than twice as high for men who smoked than those who had never smoked and three times higher for women smokers. These results have been broadly replicated in more recent studies.

Other research has sought to discover the underlying mechanisms of these skin ageing effects amongst smokers. One of the earlier studies had reported the detailed characteristics of smokers’ skin.Compared to non-smokers their skin has a yellow-grey pallor, rarely did they have pink cheeks and they almost never blushed. Scientists have suggested damage to the small blood vessels in the skin or toxic effects of the chemicals in cigarette smoke on the tissues under the skin could be the cause of the classical ‘smoker’s face’. This damage to the blood supply of the skin makes it 12 times more likely to slough off during surgery (e.g.cosmetic surgery) for a smoker than a non-smoker.

The precise mechanisms are not yet properly understood but more recent studies have shown an increase in ‘elastosis’ (degenerative change in the elastic tissue of the skin) amongst smokers.

An increased concentration of an enzyme (matrix metalloproteinase) was found in the skin of smokers compared to non-smokers in another study. This enzyme is known to degrade collagen, the protein matrix or ‘architecture’of the skin. Research in this area is promising but more is needed to elucidate fully the biological mechanisms responsible for the skin ageing effects of smoking.

The effect of cigarette smoke on the skin ageing process could be a particularly salient issue for adolescents and young adults. We know that self-esteem, social image and peer pressure are crucial influences on their smoking behaviour. This partly reflects their sensitivity to these issues as they enter adulthood and have to face many difficult changes and challenges.

It also reflects decades of exploitation of these vulnerabilities by the tobacco industry which has deliberately created evocative brands and associated powerful imagery with their products.Even following the legislation to outlaw advertising and promotion of tobacco, these emotional hooks persist through packaging,ubiquitous distribution accompanied by appealing point of sale promotion and sponsorship. Furthermore they are aided and abetted by a fashion industry whose models smoke in public (a phenomenon that is completely at odds with their overall aim of enhancing beauty) and media – particularly those targeted at young men – that all too often thoughtlessly promotes smoking as a natural and attractive lifestyle choice.

Three responses are needed here.First the risks of skin damage from cigarette smoking should be a stronger feature of health information and health education campaigns, particularly those directed at girls and young women. This should cover the damaging impact of second-hand smoke as well as active smoking. In addition, the many young people who are considering taking jobs in restaurants, bars pubs and other leisure environments where smoking is permitted have a right to be fully informed of all the health and physical hazards they will encounter.

Second, the marketing activities of the tobacco industry should be scrutinised with great care. Branding is a particularly powerful tool in their continuing battle to recruit new smokers and every step should be taken to combat and weaken it.Generic packaging, bigger and pictorial health warnings and limitations on distributions should all be considered.

Finally, I call on the fashion and media industries to distance themselves from tobacco and the tobacco industry. They have much to offer our young people – they under- stand how to communicate with them and help them make astute lifestyle choices. They can and should use this power to help them avoid the profound physical and health hazards of smoking.


Action recommended

• Smokers and non-smokers need to be made more aware of the risks of cigarette smoke for the skin ageing process.
• Health education campaigns directed at young people,particularly girls and young women, should emphasise the irreversible toxic effects of cigarette smoke on facial skin.
• Non-smokers,particularly women, considering employment in environments (e.g.bars, restaurants) where the workplace is not yet smoke-free should be aware of the potential impact on skin ageing of prolonged exposure to second-hand cigarette smoke.
• Smokers undergoing surgery should be aware of the much higher risk of skin sloughing because of the poorer quality of their skin.
• The powerful branding used by the tobacco industry to recruit new smokers should be curtailed through generic packaging and tighter controls on distribution.
• The fashion and media industries should use their influence with the young to discourage rather than encourage smoking.

source: www.dh.gov.uk - HEALTH CHECK CMO ANNUAL REPORT 2003