Effect of cigarette smoke on skin - CiteSeerX

J. Soc.Cosmet. Chem.,48, 235-242 (September/October 1997)

Effectof cigarettesmokeon skin NEELAM MUIZZUDDIN,

KEN MARENUS, P. VALLON, and

D. MAES, EsteeLauderCompanies, Melville,NY.

Accepted for publication October 31, 1997. Synopsis

Epidermalbarrierquality,skinwrinkling,andskindryness werecompared amonggroupsof activesmokers, passivesmokers,and non-smokers. Epidermalbarrierquality was assessed via transepidermal water loss (TEWL). Skin drynesswasmeasuredby digital imageanalysisof corneocytes that had beenremovedfrom skin by tape strippings,and the degreeof skin wrinkling wasestimatedby digitized imageanalysisof Silflow replicasof the periorbital area.

Dataobtainedfromthisparticularpopulationindicatedthat activesmokers hadpoorerbarrierquality,more wrinkles,and drier skin than non-smokers. Passivesmokerspresentedthe samedegreeof skin barrier damageandskindryness asactivesmokers. Sunexposure appeared to play a largerrolein the enhancement of skin damagethan chronological agingfactors,especiallyin combinationwith chroniccigarettesmoke exposure. Chronicsmokeexposure appeared to contributeequallyor morethansunexposure to deterioration of barrierquality and the degreeof wrinkling.

INTRODUCTION

Cigarettesmokeis still a widespreadcontaminantin the humanenvironmentand has significanthealthimplicationsfor the activesmoker(1). Environmental cigarettesmoke is a dynamic mixture of sidestreamand exhaledmainstreamsmoke resulting from combustionof tobaccoproducts.It is a complexsystem,consistingof thousandsof compounds, many of which areknowncarcinogens, cocarcinogens, or tumor promotors (2-4). Smokealsocontainsnumerousfree radicals,both in the tar and the gasphases (4,5). Due to theirhighlyreactivenature,thesespecies havepotentiallydamagingeffects on the skin surfacewhen interactingwith unsaturatedintercellularlipids and the membranesof keratinocytes(6,7). Sincethe frequencyof exposureto tobaccosmokeis still high and the link between smokingand skin wrinkling is well established(8,9), the effectsof suchexposureon epidermalbarrierfunctionwas examined.The resultsindicatethat thoseexposedto cigarettesmoke, either through active or passivesmoking, demonstratesignificant deficienciesin epidermalbarrierfunctionas well as increases in overallsurfacedryness and wrinkling. MATERIALS

AND

METHODS

The study involvedmeasurements of epidermalbarrier function in a total of 100 vol235

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unteersfrom the New York, New Jersey,and Pennsylvania area.This populationhad variableexposureto cigarettesmoke.Active smokerswere selectedon the basisof self-reported historiesof heavysmoking(at leastonepacka dayfor overfiveyears).There wereforty-fivepanelistsin this sample.Passivesmokersweredefinedasthoseindividuals who worked or lived with heavy smokersfor twenty years, but never smoked themselves. There were thirty panelistsin this group. Non-smokerswere definedas thosewhohadneversmokedandwerenot exposed to tobaccosmokeotherthancasually suchasin a public place.Twenty-fivenon-smokers wereevaluated. All subjectswerein normalhealth,with no evidenceof acuteor chronicdiseaseincluding dermatologicor ophthalmological problems.Subjectsexhibitingcurrentsunburnor unevenskin were excludedfrom the study.The measurement siteswere carefullyselected to be devoid of warts, nevi, moles,sunburn,suntan,scars,and other abnormalities.

The volunteerswereprovidedwith a mild soapto be useda weekprior to the test.They wereinstructednot to useanyskin-careproductsor moisturizers. The panelistsanswered

a questionnaire to providea historyof sun and cigarettesmokeexposure.For sun exposure the panelistsgradedthemselves ashaving"mild," "moderate,"or "severe"sun exposure overpastyears.Fitzpatrickskin types(10) weredeterminedon the basisof evaluationby a clinical technician.

In Part I of the study,the followingmeasurements were obtained:

EPIDERMAL

BARRIER

CONDITION

Measurementof epidermalbarrierconditionin termsof TEWL wasmadeon the cheek areaof the face.Measurements wereobtainedwith an evaporimeter(Servomed,Sweden), which allowsfor determinationof waterflux just abovethe surfaceof the skin (11,12). Prior to water loss measurements,the volunteers remained in the test area at 70øF and

a relativehumidity of 40% or less,with no air drafts,for 30 minutesto allow for skin equilibration.The panelistswere askedto refrainfrom drinking caffeine-containing beveragesprior to coming to the test facility. All measurements were obtainedin triplicatefrom threeadjacentsites.

SKIN

DRYNESS

Degreeof skindryness wasdeterminedby analyzingthe amountsof corneocytes removed on a sticky tape (D-Squame,Cuderm Inc., Dallas, TX) This methodologyhas been described previously(13). For eachsubject,measurements weremadein quadruplicate. The stickytapeswereanalyzedfor skindrynessusinga digitizedimageanalysissystem (I.B.A.S.,Zeiss).The D-Squamewasplacedon a ChromaPro45 light box,andits image wasobtainedvia a CCD Panasonic camera.The imagewasdigitized asa 256 gray level imagewith a resolutionof 512 x 512 pixels.The gray valueinformationwasextracted from the processed image.The field parametersmeasuredweremedianand meanstandardgrayvaluesandits standarddeviation.Field areaandmeangrayvaluesestimatethe total numberof corneocytes presentand the areathey occupy.From this information, integratedoptical density (IOD) was computed.IOD is indicative of the amount of stratumcorneumremovedon onestickytape,an indicationof skin surfacedryness.

EFFECT

SKIN

WRINKLING:

IMAGE

OF CIGARETTE

ANALYSIS

OF SILICONE

SMOKE

ON

SKIN

237

REPLICAS

Two setsof siliconereplicaswereobtainedaroundthe eyeareaon eachsideof the face. The replicaswere analyzedby placingeachreplicaat the samepoint beneatha Sony M3A color cameraand illuminating with a Nikon fiber optic light sourceat a fixed angleof 35o.The camerawasinterfacedto the imageanalysis system,andthe blueimage of eachreplica was analyzed.Skin wrinkles were measuredfrom the total area of the shadowproducedfrom the ridges. In Part II of the study,othervariablessuchaschronological agingandsunexposure were comparedwith the effectof cigarettesmoketo furtherinvestigatethe effectsof cigarette smoke on skin.

RESULTS

PART

I

One hundredpanelistswere evaluated,and resultswere averagedfrom eachgroup for eachof the measurementparameters.

Epidermalbarriercondition. Non-smokersdemonstrateda significantlylower degreeof TEWL whencomparedwith bothactiveandpassivesmokers(p < 0.001). No significant differencewas observedbetweenthe degreeof TEWL in active and passivesmokers (Figure 1).

Skin dryness. The amount of stratum corneumremovedfrom the skin surfaceas determined by image analysisof the stickytapeswas significantlydifferentbetweenboth activeand passivesmokerswhen comparedto non-smokers(p < 0.05). The difference betweenactiveand passivesmokerswasnot significant(Figure 2).

Wrinkling.Significantdifferences in the amountof skin wrinkling wereobservedwhen comparingactive and passivesmokersand non-smokers(Figure 3). Active smokers appearedto exhibit twice as much wrinkling as non-smokers(p < .001).

Effect of Cigarette Smoke on Skin Barrier Functions 17 16

•.15 -r-

14

0 12 '•11

• uJ

i-

•o 9

8 7

I

Active Smokers

Passive

Non Smokers

Smokers

Figure 1. Skin barrierfunctionsmeasured via transepidermal waterloss.

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Effect of Cigarette smoke on skin Dryness

i

i

Active Smokers

Passive Smokers

Non Smokers

Figure 2. Skin drynessmeasured via analysisof corneocytes on D-Squames.

Effect of Cigarette Smoke on skin wrinkling 90 8O 7O 60 5O

40 30 20

I

Active

Passive

Non

Smokers

Smokers

Smokers

Figure 3. Skin wrinkling via imageanalysisof siliconreplicasof the periorbitalarea. PART

II

Efj•ctofchronological ageandsunexposure onbarrierfunctions ofskin.As observedin Figures 4a and 4b, sub-divisionof non-smokersby age indicatesa reductionin TEWL with increasingagepossiblydue to dehydrationof skin. It is clearfrom thesedata that age, unlike smokeexposure,playedno significantrole in skin damage. The degreeof sun exposureappearedto exhibit a gooddoseresponse with the increase in TEWL. Active smokerswho receivedseveresun exposureexhibiteda significantly worseskin barrier(p = 0.025) than non-exposed non-smokers who receivedthe sameUV exposure.Observationof the barrierfunctionsof this populationrevealedthat although somecigarettesmoke-exposed individualsavoidedthe sun, their barrierfunctionwas still significantlymore impaired than that of non-exposed non-smokers (p = 0.02) exposedto a similaramountof sunexposure. Efj•ct of chronological age and sun exposure on skin dryness. There was some correlation betweensmokeexposure, age,and skin drynessand alsobetweensmokeexposure, sun

EFFECT

OF CIGARETTE

Effect of Cigarette Smoke and age on barrier functions

2O

SMOKE

ON SKIN

239

Effect of Cigarette smoke and sun exposure on barrier functions

[] age 35-45 [] age 46-55

18

• age > 56 16

•

[] Slight sun

14

I• Moderate

I-- 12

[] Severe

10

Active

Passive

Non

Active

Passive

Non

Smokers

Smokers

Smokers

smokers

Smokers

Smokers

Figure 4. a: Effectof chronological ageand cigarettesmokeon barrierfunctions.b: Effectof sunexposure and smokeskin barrier functionsmeasuredvia transepidermalwater loss.

exposure,and skin dryness(Figure 5). The panelistswith slight sun exposuredid not exhibitasmuchskindrynessasthosehavingmediumor severeUV exposure. Excessively sun-exposed smokershad 76% drier skin as comparedto non-smokers with low sun exposure.

As observedin Figure 5b, the skin of non-exposed non-smokers who receivedminimal sunexposure waswasnot asdry asthat of smokershavingthe samesunexposure (p = 0.078). Passivesmokersexhibiteda significantlymore arid (p = 0.026) skin than non-smokers.

Efj•ctof chronological ageandsunexposure onskinwrinkling.More wrinkleswere observed in non-smokers over 56 yearsof age, but below 55 yearsof agetherewas no significant doseresponse. Sunexposure appearedto exhibit a gooddoseresponse with the intensity of wrinkling. As observed in Figure6b, non-exposed non-smokingindividualsexposed to mild-to-slightsunexhibiteda significantlylower (p < 0.001) skin wrinkling than activesmokershaving the samesun exposure.

DISCUSSION

Stratumcorneum,composed of skinsurfacelipids,is responsible for the epidermalwater Effect of Cigarette Smoke and age on Skin Dryness 7.5

Effect ofCigarette Smoke and

[]age 35-45

sunexposure onskindryness

m•age 46-55 I mage>56 []Slight sun •aModerate

o_ m

6

•

5.5

:

4.5

'•

4 3.5 3

I

,

I

i

ml[] Sev I i

Active

Passive

Non

Active

Passive

Non

Smokers

Smokers

Smokers

Smokers

Smokers

Smokers

Figure 5. a: Effectof chronological ageand cigarettesmokeon skindryness.b: Effectof sunexposure and smokeon drying of skin.

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[] age 35-45 [] age 46-55 Effect of Cigarette Smoke and [] age > 56 Sun exposureon skinwrinkles ElSlight

Effect of CigaretteSmoke and age on skinwrinkles 90

[] Moderate

80

[] Severe

=• 7o e-

60

'•_

•

5o

-•

40 30

20

i

Active Smokers

i

Passive Smokers

Non Smokers

Active smokers

Passive

Smokers

Non Smokers

Figure 6. a: Effectof chronological ageand cigarettesmokeon skinwrinkling.b: Effectof sunexposure and smokeon skin wrinkling.

barrier(14). Measurement of TEWL is usedin manylaboratories for characterization of the skin barrier function (11).

Air temperatureand humidity are the main factorsthat could interfere with the mea-

surementof skin barrierfunctionsas measuredwith TEWL (11). Skin drynessis also directlyrelatedto the rate of TEWL. Nevertheless, unlessthe skin is excessively damaged or brokenas in a diseasedcondition,the differencesin TEWL can be relatedto demographicfactorslike smokeexposure,sun exposure,and age. Observationof non-smokers by ageand sunexposureindicatedthat age,unlike smoke, playedno significantrole in skin damage.Contraryto expectations, TEWL waslowerin non-smokers over56 yearsof age,while below45 yearsof agethe skinbarrierappeared to be slightlyworse(Figures4a,4b).Theseresultsareconsistent with otherfindings(11) whereno correlationbetweenage and TEWL wasobserved.In somestudiesa slight decrease in TEWL wasobservedafter 60 yearsof age(15). Degreeof sun exposureappearedto exhibit a gooddoseresponse with the increasein TEWL. This couldbe due to actinicdamageand drying of skin overexposed to the sun. Active smokerswho receivedseveresun exposureexhibiteda significantlyworseskin barrier(p = 0.025) thannon-exposed non-smokers who receivedthe sameUV exposure. Observation of the individualswhoavoidedthe sunoverthe yearsshowedthat exposure to environmentalsmokesignificantly(p -- 0.02) changedskin barrierfunctionsin terms of transepidermalwater loss.

From theseresultsit canbe inferredthat sunexposure and cigarettesmokecouldplay a strongerrole in the barrierfunctionof skin than age. A combinationof excessive sun exposureand cigarettesmoking occurringtogether exhibited a 62% higher rate of TEWL.

Accordingto Elias(7), factorslike residualintercellularproteinaceous attachment(desmosomes),the overlappinggeometryof corneocytes, and the generationof excessive

numbersof cellsmayunderlieall orpartof theobserved stratumcorneumdesquamation. Observation of non-smokers by ageand sunexposure showedthat ageplayedno significant role in skin dryness(Figures5a,5b). Sun exposureappearedto exhibit somecorrelationwith skin dryness.The skin of the

EFFECT OF CIGARETTE

SMOKE

ON SKIN

241

panelistswith slight sun exposurewas not as dry as that having medium or severeUV exposure. Excessively sun-exposed smokershad 76% drier skin than non-smokers with low sun exposure.

Skin drynessof non-exposed non-smokers who receivedminimal sunexposure wasmuch lower than that of smokershavingthe samesun exposure(p = 0.078). Passivesmokers exhibiteda significantlydrier (p = 0.026) skin than non-smokers.

Many factorsareinvolvedin the wrinkling response of skin,suchasgeneticdominance, Fitzpatrickskin type etc. However,it is generallyacceptedthat age and sun exposure play the mostimportantrole in skin damagemanifested aswrinklesandfine lines(14). Observationof non-smokers by ageand sunexposureshedfurther light on the subject. Contraryto expectations, age,unlike smoke,did not appearto play a significantrole in skindamage.Skinwrinklingwashigherin non-smokers over56 yearsof age,but below 55 yearsof agetherewasno significantdoseresponse. Sun exposureappearedto exhibit a gooddoseresponse with the intensityof wrinkling. It wasobservedthat non-exposed non-smokingindividualsexposedto mild-to-slight sun exhibiteda significantlylower (p < 0.001) skin wrinkling than activesmokershavingthe samesunexposure(Figures 6a,6b).

Theseresultsare consistentwith the findings of Donald et aL (16) who state that cigarettesmokingis an independent riskfactorfor development of prematurewrinkling. They observed that heavycigarettesmokers(>50 packyears)were4.7 timesmorelikely to be wrinkledthan non-smokers. Sunexposure of morethan 50,000 lifetime hoursalso increasedthe risk of being excessively wrinkled 3.1 fold. When excessive sun exposure andcigarettesmokingoccurred together,the riskfor developingexcessive wrinklingwas multiplicative.In our experiments,excessively sun-exposed smokershad twice asmuch wrinkling as non-smokers with low sun exposure.

CONCLUSIONS

In this study, the group of non-smokers appearedto exhibit a much better barrieras comparedto activeand passivesmokers.Passivesmokersappearedto exhibit a barrier damagesimilarto that of activesmokers.Smokersexhibiteda slightlydrier skin than non-smokers; the difference,however,wasnot significant.Active smokersappearedto exhibit twice as much wrinkling as non-smokers. There wasan excellentdoseresponse of averageskin wrinkling and smokingpattern. A combinationof sun exposureand cigarettesmokeplaya strongerrolein the manifestation of wrinklesanddamageof skin barrier functionsthan age. A combinationof excessivesun exposureand cigarette smokingoccurringtogetherexhibiteda 62% higherrateof TEWL anda 76% drierskin. Excessively sun-exposed smokershadtwice asmuchwrinkling asnon-smokers with low sun exposure.

REFERENCES

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