In classic movies, cigarette smoking was used as shorthand to convey sultriness and beauty. In the real world, the connection between smoking and one's appearance - as many studies have shown - has more to do with premature signs of aging and less to do with glamour and refinement. A new study from the University of Michigan Health System adds another dimension to the link between cigarette smoking and skin damage. The study suggests that smoking may be associated with a higher degree of aging on areas of skin, such as that of the inside of the upper arm, that are not normally exposed to sunlight. "We examined non-facial skin that was protected from the sun, and found that the total number of packs of cigarettes smoked per day and the total years a person has smoked were linked with the amount of skin damage a person experienced," says Yolanda R. Helfrich, M.D., lead author and assistant professor of dermatology at the U-M Medical School. The study appears in the March issue of the journal Archives of Dermatology. The researchers developed a photonumeric scale that can be easily reproduced by other medical institutions to measure the degree of aging on patients' skin. The nine-point scale used information from photographs of the inside-upper-arm skin of the 77 participants. Two medical residents and a medical student were asked to look at the photographs and assign a grade in which zero represented no fine wrinkling and eight represented severe fine wrinkling. The same three people reviewed photos of the participants one year later, and the scores were used to determine the level of increase in the skin damage. Researchers also collected data about the participants from interviews, such as their age, ethnicity, history of cigarette smoking, use of non-steroidal anti-inflammatory drugs, use of dietary or herbal supplements, sun exposure, sunscreen use, tanning bed use and, for women, how many children they had given birth to, hormone therapy use and oral contraceptive use. Among the people in the study who were current or former smokers, they had smoked an average of about 24 years. In all, among participants who were 45 years or older, the degree of skin aging was found to be significantly higher in smokers than nonsmokers. In the 45-65 age group, smokers had an average score on the photonumeric scale of more than two, while nonsmokers had an average score of less than one. In the 65 and older age group, smokers had an average score of about six, while nonsmokers had an average score of approximately four. ### In addition to Helfrich, authors were Abena Ofori, M.D.; Ted A. Hamilton, M.S.; Jennifer Lambert, M.S.; Anya King, M.P.H.; John J. Voorhees, M.D.; and senior author Sewon Kang, M.D., all of the U-M Department of Dermatology; and Le Yu, M.D., now with Cedars Sinai Medical Center in Los Angeles. The study was supported in part by grants from the Babcock Endowment for Dermatologic Research and the National Institutes of Health. Reference: Archives of Dermatology, 2007; 143:397-402. Contact: Katie Gazella

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