Smokers’ Faces: Take This Quiz. Can You Pick Out the  Smokers?

When I was a medical student, the chairman of our department of internal medicine held teaching sessions he called “subway diagnosis” (he was from New York). He showed us photographs of people, usually only their faces, and gave little or no additional information. The people in the photos all had a medical problem. We had to try to guess the diagnosis.

Smoking ages the skin

Here’s a type of subway diagnosis. You can often tell whether a person smokes by looking for increased wrinkling of the skin of the face caused by smoking. Smoker’s wrinkles usually begin after age 40, but the process can begin earlier. In fact, increased facial wrinkling caused by smoking is a form of premature aging of the skin. In addition to smoking, age and sun exposure accelerate wrinkling of the skin.

Smoking destroys the connective tissue skeleton of skin and lung

Destruction of the connective tissue of the skin may be the cause of smoking-induced skin damage and wrinkles. Another smoking-related health problem, emphysema, is more common in smokers with severe facial wrinkles than in smokers without severe wrinkles. This result makes sense because both wrinkles and emphysema are probably caused by destruction of the connective tissue which forms the supporting skeleton of skin and lung tissue.

Vanity may convince some smokers to quit

Some smokers may be more concerned about their appearance than about other health risks of smoking. These people might be motivated to kick the habit by vanity, by the wish to avoid a prematurely wrinkled face.

Subway diagnosis

Now are you ready to try some subway diagnosis?  Now that you know what to look for, you can pick out the smokers, at least the smokers over age 40, almost every time.

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