Revised 7/21/03 -- See changes.html for a revision history
go to Index Pageby Jane E. Brody Women's Health Digest Vol 2, Number 3 (year?)
Reprinted with permission from the New York Times Company. Copyright 1996.
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# #
# The doctor could tell the patient #
# had once been an attractive woman. #
# But now, though only in her 50s, her #
# face was etched with wrinkles, her #
# features gaunt-looking with prominent #
# underlying bones and her skin #
# shriveled and gray with purplish #
# blotches. #
# #
# Diagnosis: smoker's face. #
# #
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Doctor Douglas Model of Eastbourne, England, added this condition to the medical lexicon in 1985 after surveying 116 patients and correctly identifying roughly half of current smokers by their facial features alone.
The distinctive characteristics of smoker's face, which makes people look far older than their years, were present in 46% of the current smokers, 8% of the former smokers, and none of the nonsmokers, irrespective of their age, social class, recent weight fluctuations, and exposure to sunlight.
Dr. Jeffrey B. Smith, a senior resident in dermatology at the University of South Florida in Tampa, recalled this poignant diagnosis in a review of the effects of smoking - related skin conditions: Smoking damages cells and tissues in so many ways that it can have myriad effects on the body.
Wrinkles: "For some patients the threat of wrinkles may be a more powerful motivator to help them stop smoking than the more deadly consequences of smoking," Smith wrote. He explained that, as with skin that is overexposed to sunlight, smoking causes thickening and fragmentation of elastin, the elastic fibers that are long and smooth in healthy skin. Smoking also depletes the skin's oxygen supply by reducing circulation. It decreases the formation of collagen, the skin's main structural component, and may reduce the water content of the skin, all of which increase wrinkling.
Smoking also interferes with the skin's ability to protect itself against damage by free radicals, highly reactive substances that are omnipresent in tobacco smoke. In women, smoking diminishes the level of circulating estrogen, which in turn fosters dryness and disintegration of skin tissues.
Skin Cancers: Two kinds of skin cancers, the more curable squamous cell carcinomas and the often lethal melanomas, are influenced by smoking. Smith said that although smoking did not cause melanoma, smokers with melanoma were more likely to die of their disease. They are twice as likely to have advanced disease at the time of diagnosis and are more likely to have their cancers spread within two years of diagnosis, probably because smoking impairs the immune system.
As for squamous cell carcinoma, even when exposure to sunlight was taken into account, smokers were found to be at greater risk of developing this cancer. In a study of more than 107,000 nurses, for example, the risk of developing squamous cell carcinoma was 50 per cent greater in smokers than in those who had never smoked. Smokers also tend to get particularly "large, bad" skin cancers, Smith said.
Other Cancers: Cancers of the lip, mouth, penis, anus and vulva are also more common in smokers than nonsmokers. For example, in one study of 903 female cancer patients, 60 percent of those with vulvar and anal cancers and 42 percent of those with cervical and vaginal cancers were smokers as against only 27 percent of comparable women without cancer. Smoking more than 10 cigarettes a day more than doubles a man's risk of developing penile cancer.
Delayed Wound Healing: The problem of slow or incomplete healing of wounds associated with exposure to cigarette smoke was clearly demonstrated in laboratory animals in the 1970s. Then surgeons began reporting on similar problems in patients who smoked: larger scars in women undergoing exploratory abdominal surgery, more complications and skin sloughing after facelifts and a much higher failure rate of skin grafts, for example. The more and the longer patients had smoked, the greater the likelihood of impaired wound healing. Even resuming smoking during an uneventful recovery could lead to adverse effects. Smith linked the slow healing of wounds to known effects of cigarette smoking, which constricts surface blood vessels, reduces the oxygen level in the blood, thickens the blood and impedes the laying down of collagen needed for healing.
Psoriasis and related disease: Studies of both men and women with this unsightly and discomforting skin condition have shown that smokers are about two to three times as likely to develop it as nonsmokers. And the more cigarettes smoked, the greater the risk. Palmoplantar pustulosis, a difficult-to-treat skin condition that resembles psoriasis, occurs only on the palms of the hands and soles of the feet. The skin blisters, then forms a scaly rash. It occurs almost exclusively in smokers and it does not necessarily go away when the patient quits smoking.
Oral lesions: In addition to smoker's face, there is also smoker's palate and smoker's tongue. The tars and heat of tobacco smoke can cause tiny red pimples in the mouth that result from an inflammation of the openings of salivary glands. Smokers also often develop depressions on the surface of the tongue. Potentially more serious, however, are lesions called leucoplakia, which are about six times more common in smokers than in nonsmokers. Although benign, these white patches in the mouth can become cancerous.
Buerger's disease: This blood vessel disease results in poor circulation in the lower legs, causing skin problems like burning, tingling and ulcerations. "It usually occurs in young men who smoke, men in their 30s," Smith said. "But now that women are smoking a lot more, we're seeing it in women too."
Other Skin conditions: Many skin diseases are associated with diabetes, which impairs circulation to the outer reaches of the body. A study of more than 112,000 female nurses followed for 12 years showed that current smokers faced an increased risk of developing noninsulin-dependent diabetes, and that the risk rose with the number of cigarettes smoked each day. Another study of nearly 43,000 male health professionals showed that smoking 25 or more cigarettes a day doubled a man's risk of developing diabetes.
People who smoke are much more likely to develop the bowel disorder Crohn's disease, which can cause "big, ugly-looking ulcerations, most often on the legs, and painful red nodules, usually on the lower legs," Smith said. Another condition more common in smokers is systemic lupus erythematosus, an autoimmune disease that can cause rashes on the face, scalp, hands and elsewhere, ulcerations in the mouth and hair loss." (end of article)
NEW YORK (Reuters Health) - Distinct lines around the mouth and a dull pallor of the skin often identify long-term smokers in a crowd. Now a study reveals exactly how smoking causes skin to age.
According to researchers, tobacco smoke increased levels of a skin protein called matrix metalloproteinase 1 (MMP-1). This protein causes the degradation of collagen, a compound that keeps skin firm and elastic.
Short of plastic surgery, there is no way to reverse the damage.
``Disruption of collagen balance is like a scar,'' Dr. Antony R. Young, a study author from King's College in London, UK, told Reuters Health.
The study in the March 24th issue of The Lancet found significantly more MMP-1 genetic material in the buttock skin of 14 smokers compared with 19 nonsmokers with an average age of 30 years.
Young said the study originally sought to investigate the effect of artificial sunlight on MMP-1 and the findings about smoking were by chance. Ultraviolet light can also increase MMP-1 levels. The researchers looked at buttock skin because that was the area least likely to be affected by sunlight, Young explained.
``I hope that our observations will encourage further study on the ageing effects of smoking, including interaction with sun,'' he said.
SOURCE: The Lancet 2001;357:935-936.
(I've seen this at at least a couple of web sites, but I don't know where it originated from.)
Within:
* 20 minutes -- Your blood pressure, heart rate and temperature in your hands and feet normalize
* 8 hours -- Oxygen and carbon dioxide levels in your blood normalize
* 1 day -- Your likelihood of having a heart attack decrease.
* 2 days -- Your senses of smell and taste improve. Nerve endings start to regrow.
* 2 weeks to 3 months -- Your circulation becomes better and your breathing improves. Walking becomes easier.
* 1 to 9 months: Coughing, sinus congestion, shortness of breath and fatigue decrease. You have more energy.
* 1 year -- Your excess risk of heart disease is now less than half what it was a year ago.
* 5 years -- Your risk of cancer of the lung, mouth, throat and esophagus is half that of a pack - a - day smoker.
* 10 years -- Your risk of dying from lung cancer is similar to that of a nonsmoker.
* 15 years -- You are no more at risk of heart disease than if you'd never smoked. [end of article]
(November 1999)
CIGARETTE SUBSTITUTES
Richard D. Hurt, M.D., medical director of Mayo Clinic's Nicotine Dependence Center, Rochester, Minn., says the most promising smoking cessation medications currently available use means other than cigarettes to deliver smaller amounts of nicotine to the brain or alter the release of brain chemicals to mimic the effect of nicotine. The treatments are short-term. Their purpose is to relieve the withdrawal symptoms that make it so difficult to stop smoking.
Only about 5 percent of smokers are able to quit without help. The success rate averages about 30 percent for people who combine pharmacologic therapy with support and counseling from a health care provider.
"Pharmacologic therapy, in addition to support and counseling, is the state-of-the-art treatment right now,'' says Dr. Hurt, who leads a team of Mayo scientists evaluating smoking cessation therapies. "It's a pretty small price to pay for an increased success rate."
If you've failed in past attempts to stop smoking, there is still hope for success.
NICOTINE REPLACEMENT MEDICATIONS
The PATCH- The patch is now available without a prescription!
You apply these patches to an area of skin to provide a steady dose of absorbed (transdermal) nicotine. The patch should be rotated to different locations on the upper body to minimize skin irritation. The least hairy, unshaven areas are best. The optimal length of treatment is not well-established; it depends on the individual needs of each person. The usual length of treatment is 6 to 8 weeks.
Advantages: There are few side effects. It's easy to use and only needs to be applied once a day.
Disadvantages: Dosage is less flexible than other products, and the nicotine is delivered relatively slowly to the brain. Mild skin rashes are common.
NASAL SPRAY- The nicotine in Nicotrol NS is sprayed directly into each nostril. It is absorbed through nasal membranes into blood veins, returned to the heart, then sent to the brain. The spray provides a quicker delivery system than nicotine gum, although not nearly as quick as a cigarette. The usual dose - one spray into each nostril - is 1 milligram (mg) of nicotine. People typically are directed to start with one to two doses per hour, with a minimum of eight doses per day and a maximum of 40 doses per day. Ask your doctor or pharmacist for instructions. For most people, use of the spray should be reduced 6 to 8 weeks into the treatment.
Advantages: It's flexible in schedule of use. It delivers nicotine rapidly for quick reduction in cravings. You can use it in response to urges to smoke.
Disadvantages: During the early days of treatment, it can be irritating to the nose, causing a hot, peppery feeling along with watery eyes, runny nose, coughing and sneezing.
NICORETTE GUM - The strategy for using nicotine gum is to "bite a few times and park it between the cheek and gums," says Dr. Hurt. That's because nicotine from the gum is absorbed through the lining of the mouth. It's not absorbed from the stomach. If you chew the gum rapidly and swallow the saliva, you may become nauseated - and you'll not get the desired level of nicotine. Marketed as Nicorette, the gum comes in 2 mg and 4 mg doses. Dr. Hurt says the 4 mg dose is more appropriate for heavy smokers. When properly used, it takes about 30 minutes to absorb all the nicotine from the gum.
Advantages: It's convenient and flexible in schedule of use.
Disadvantages: You can't eat or drink anything when the gum is in your mouth. If you have dental problems or arthritis of the jaw joint, it may be best to avoid nicotine gum.
The INHALER - Marketed as Nicotrol, the inhaler is a plastic cylinder about the size of a cigarette. Inside the cylinder is a cartridge containing nicotine. When you "puff" on the device, nicotine vapors are absorbed through the lining of your mouth. It takes about 80 puffs to equal the amount of nicotine in a single cigarette. The daily dose will vary from person to person. In general, the inhaler must be used fairly often (i.e., at least 6 cartridges per day) to be effective.
Advantages: It's flexible in schedule of use. It helps the smoker mimic the hand-to-mouth behavior of smoking - a behavior that's easier to break after nicotine withdrawal subsides.
Disadvantages: You need to use it frequently throughout the day. Mouth and throat irritation are the most common side effects. Non-nicotine medication
BUPROPION (ZYBAN) - An antidepressant that has been on the market for many years, bupropion is the first non-nicotine medication proven to be effective in treating nicotine addiction. It has been approved by the U.S. Food and Drug Administration as a prescription medication for aiding smoking cessation. It's believed to mimic some of the action of nicotine by releasing the brain chemicals dopamine and norepinephrine. Bupropion is a tablet taken once daily for about 3 days, then twice daily during the week before you try to stop smoking. This assures that you have adequate medication in your system when you stop lighting up. The optimal length of treatment has not been determined, but bupropion is normally used for 6 to 12 weeks. Your physician will help you determine whether you should take it for a longer time.
Advantages: It's easy to use. There are few side effects. And while you're on the medication, it may lessen weight gain associated with stopping smoking.
Disadvantages: The most frequent side effects, dry mouth and insomnia, are usually mild. There is a small risk of seizures with bupropion, as there is with any of the antidepressants. It should not be taken if you have a seizure disorder (e.g., epilepsy) or if you've had previous serious head trauma or a stroke. It is not appropriate to take if you currently have an eating disorder or are taking a monoamine oxidase inhibitor (MAO) for depression or other medications containing bupropion hydrochloride (Wellbutrin).
THE BENEFITS OF CHOICES
Having a broader array of choices allows more people to find a smoking cessation product that may help. People fighting strong urges to light up may want the quicker delivery of nicotine from the spray or gum. People with gum disease or dentures may choose the patch, spray or inhaler instead of the gum. People with dermatitis may want the gum, spray or inhaler instead of the patch. People with nasal problems may avoid the spray. Bupropion is an alternative for many people.
Many nicotine treatment specialists are using these medications in combination, such as using the patch in conjunction with the more rapid delivery of the nasal spray, inhaler or gum. In consultation with your physician, you may be able to combine bupropion with any of the nicotine replacement products.
Dr. Hurt says these medications have been shown to help people stop smoking, but you also need strong personal motivation to do so. Follow-up and support by a health care provider can increase your chance for success.
QUIT-SMOKING AIDS SUCCESS RATES
(This success rate information comes from a different article than the above -- Blair's newsletter, 2/12/00)
Summary: 8-12% with gum, a little higher for patch, around 35% for Zyban
Graduated nicotine replacement. "Nicotine gum and patches bought right off the shelf are an excellent choice," says Cinciripini. While the success rate is only about "eight to 12% with the gum, and a little higher with the patches," says the expert, "it doubles the rates of other therapies when both are used."
Pharmacological aids. Zyban (Bupropion) has been approved by the FDA as a prescription drug for use in treating smoking, with a success rate Cinciripini says "is somewhere in the mid-30% range." Used to reduce cravings, it's also known as the anti-depressant Wellbutrin. Zyban should be avoided if you are pregnant, suffer from eating disorders, or are subject to seizures.
If you find yourself planning to do something "just this once" watch out. It means you're about to compromise your own values. Whatever it is, you already know it's wrong.
When you have to use "just this once" to justify your action, that's a very good reason to avoid the action altogether. "Just this once" has a way of quickly turning into "I got away with it before, so I can do it again." You'll find yourself on a slippery slope, sliding ever downward into a hole of despair and regret.
Don't fool yourself into thinking that "just this once" will bring you anything of value. You already know it won't. When you find yourself saying "just this once" stop it in its tracks by saying "I'll continue to be strong."
"Just this once" is the tiny tip of an enormous wedge of compromise which can quickly drive your best interests far away from you. Refuse to let it get a foothold. Be strong in the little things and you'll be successful in the big things.
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