|Year : 2020 | Volume
| Issue : 1 | Page : 14-17
The effect of smoking on oral labial mucosa: A controlled dermoscopic study
Erhan Ayhan1, Isa An2, Murat Özt ürk3, Esref Araç4
1 Department of Dermatology Gazi Yaşargil Training and Research Hospital, University of Health Sciences, Diyarbakir, Turkey
2 Department of Dermatology, Şanlıurfa Training and Research Hospital, Şanlıurfa, Van, Turkey
3 Department of Dermatology, Van Training and Research Hospital, Van, Turkey
4 Departments of Internal Medicine, Gazi Yaşargil Training and Research Hospital, University of Health Sciences, Diyarbakir, Turkey
|Date of Submission||30-Nov-2019|
|Date of Decision||30-Nov-2019|
|Date of Acceptance||21-Dec-2019|
|Date of Web Publication||25-Feb-2020|
Dr. Erhan Ayhan
Department of Dermatology, Gazi Yaşargil Training and Research Hospital, University of Health Sciences, Diyarbakır
Source of Support: None, Conflict of Interest: None
Background/Aim: Although the effects of smoking on large blood vessels are known, research on the effects of smoking on microcirculation continues. In this study, we investigated whether the dermoscopic features of the labial mucosa of smokers differed from the healthy control group. Materials and Methods: In this study, 164 patients (82 smokers and 82 nonsmokers) aged between 20 and 75 years who were admitted to the dermatology department were included. Dermoscopically obtained data were analyzed. Results: Hemorrhagic dot (48.8% vs. 26.8%, P: 0.004), matchstick hairpin vessels (37.8% vs. 15.9%, P: 0.002), microaneursym (35.4% vs. 18.3%, P: 0.014), targetoid brown round areas (37.8% vs. 19.5%, P: 0.010), white dot (22% vs. 9.8%, P: 0.033), and hyperkeratosis (37.8% vs. 18.3%, P: 0.005) were found to be significant in terms of dermoscopic features.Conclusion: In this study, we think that structures such as hemorrhagic dot, matchstick hairpin vessels, microaneursym, which are found to be high in smokers, may be caused by microcirculation disorders.
Keywords: Dermoscopy, labial mucosa, smoking
|How to cite this article:|
Ayhan E, An I, ürk M, Araç E. The effect of smoking on oral labial mucosa: A controlled dermoscopic study. Turk J Dermatol 2020;14:14-7
| Introduction|| |
Smoking is an important modifiable risk factor for cardiovascular disease, and its effects on large-vessel atherosclerosis and thrombosis are well known. Due to the difficulties in imaging the microcirculation, the effect of smoking on the microvascular structure is less pronounced. At present, efforts are being made to clarify the effects of tobacco smoke on microcirculation. The presence of endothelial dysfunction is considered to be an early marker of vascular injury that is prone to the development of atherosclerotic lesions. However, smoking also releases free radicals and pro-oxidant factors that may result in inflammation and oxidative damage to the vascular endothelium and impair coronary circulation functions.
The information about the vascular structures of the oral mucosa has been presented by studies on capillaroscopy. Labial mucosal visibility is probably the best in the oral region. The chronic smoking habit creates significant morphological changes in the microcirculation of the human labial mucosa and these changes can be easily recorded by videocapillaroscopy. Capillaroscopic examination revealed that the diameter of the capillary loops in the labial mucosa decreased and their number increased and the presence of more pronounced tortuous capillary loops. However, there are no dermoscopic studies showing the effect of smoking, the changes on vascular and nonvascular structures in the labial mucosa. In this study, the dermoscopic examination of the oral labial mucosa of smokers and nonsmokers was performed comparatively.
| Materials and Methods|| |
The study included 82 smokers (at least 2 years) and 82 nonsmokers, who presented to the dermatology department and aged 20–75 years. Patients with diseases that could affect microcirculation such as diabetes, hypertension, hyperlipidemia, and heart disease and patients receiving medical treatment were not included in the study.
This study includes three stages including dermatological and dermoscopic examination of the lesions, macroscopic and dermoscopic (Dermatoscope Delta 20; Heine, Herrsching, Germany; Handyscope Fotofinder Systems) photographing, and evaluation of the findings. Macroscopic (at least 2) and dermoscopic (at least 15) pictures of all lesions in the study were taken and the data were recorded. Vascular structures and nonvascular structures were defined as dermoscopically. The pressure on the lesion was relieved to prevent collapse of the vascular structures.
All patient data were uploaded to SPSS 21.0 statistic application software (SPSS Inc., Chicago, IL, USA). The data were analyzed with the Student's t-test for independent samples with regard to parametric data and with the Mann–Whitney U-test with regard to nonparametric data. P < 0.05 was considered statistically significant.
| Results|| |
The study included 82 smokers (64 men and 18 women; mean ± standard deviation [SD] age 38.15 ± 13.54; patients range 20–73) and 82 nonsmokers (64 men and 18 women; mean ± SD age 36.62 ± 16.99; patients range 20–75). There was no significant difference between the groups in terms of age (P > 0.05).
Hemorrhagic dot (48.8% vs. 26.8%, P: 0.004), matchstick hairpin vessels (37.8% vs. 15.9%, P: 0.002), microaneursym (35.4% vs. 18.3%, P: 0.014), targetoid brown round areas (37.8% vs. 19.5%, P: 0.010), white dot (22% vs. 9.8%, P: 0.033), and hyperkeratosis (37.8% vs. 18.3%, P: 0.005) were found to be significant in terms of dermoscopic features.
There was no significant difference between the two groups in terms of deep vascular network (92.7% vs. 96.3%, P: 0.304), superficial vascular network (90.2% vs. 96.3%, P: 0.191), mixed retinal arrangement (82.9% vs. 74.4%, P: 0.182), grouped hairpin vessels (70.7% vs. 62.2%, P: 0.247), dot vessels (54.9% vs. 47.6%, P: 0.349), chain hairpin vessels (24.4% vs. 17.1%, P: 0.248), clear reticular arrangement (17.1% vs. 25.6%, P: 0.086), glomerular vessels (2.4% vs. 6.1%, P: 0.246), yellow background areas (95.1% vs. 91.5%, P: 0.349), yellowish-white streaks (30.5% vs. 26.8%, P: 604), purple areas (20.7% vs. 25.6%, P: 0.459), microulceration (9.8% vs. 4.9%, P: 0.230), and honeycomb appearance (8.5% vs. 3.7%, P: 0.192) (smokers and nonsmokers, respectively) [Figure 1], [Figure 2], [Figure 3], [Figure 4]. All dermoscopic structures are shown in [Table 1].
|Figure 1: Clear reticular arrangement (a and b) and mixed reticular arrangement (c and d)|
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|Figure 2: Chain-shaped hairpin vessels (a), grouped hairpin vessels (b), matchstick hairpin vessels (c and d)|
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|Figure 3: Yellowish-white streaks ([a] starburst-shaped, [b] linear), targetoid brown round areas ([c] in the upper left corner), microulceration ([d] in the upper right corner)|
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|Figure 4: Honeycomb appearance (a), hyperkeratosis (a-d), white dot (a and d), grouped hairpin vessels (b and d), chain hairpin vessels, (a), hemorrhagic dot (b)|
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| Discussion|| |
The properties of the capillary structures in the oral mucosa are probably a mirror of what happens in every organ of the human body. In the studies of microcirculation on retinal vessels, narrow retinal arteriole caliber has been associated with hypertension and may even precede clinical hypertension., In contrast, larger retinal venular diameter is associated with markers of systemic inflammation and various components of the metabolic syndrome (obesity, dyslipidemia, and hyperglycemia),, and can also predict stroke and cardiovascular events.,, Smoking has both acute and chronic effects on microcirculation.,, It has been observed that smoking has negative effects on skeletal muscle, retinal, and coronary microcirculation.,, In the study evaluating the effects of smoking on the microcirculation of the oral labial mucosa by video capillaroscopy, smokers had lower diameter capillary loops, more visible capillary loops, lower background optical permeability, and more pronounced tortuous capillary loops. In our dermoscopic study, hemorrhagic dot, matchstick hairpin vessels, and microaneursym were found to be significantly higher in smokers. Matchstick hairpin vessels have been defined as the condition where the loop portion of the hairpin vessels was more swollen, darker, and more pronounced than the branches. With this change, we think that hemorrhagic dot and microaneursym may be caused by tortuous changes detected in capillaroscopic studies.
Other vascular structures such as deep vascular network, superficial vascular network, mixed reticular arrangement, clear reticular arrangement, chain hairpin vessels, grouped hairpin vessels, dot vessels, and glomerular vessels were not significantly different.
Information on the dermoscopy of the labial mucosa is limited, and in the literature, dermoscopic examination has been performed in several dermatological diseases of the labial mucosa.,, According to our previous dermoscopic experience of labial mucosa, we observed that hairpin vessels occur both in the normal labial mucosa and in the vicinity of any lesion localized to this region. In our study on oral mucocele dermoscopy, we detected hairpin vessels in 57.1% of the lesions. However, these vessels were rather large, prominent, and focusable than the chain and grouped hairpin vessels in the lesion-free labial mucosa.
In this study, targetoid brown round areas were significantly higher in smokers (37.8% vs. 19.5%, P: 0.010) than nonsmokers. While the center of these dermoscopic structures was brown, there was a white ring surrounding it. We think that these structures are improving microulceration. However, there was no significant difference between the two groups in terms of newly developed microulcerations. We think that the white dots and honeycomb appearance found in our study are different variants of hyperkeratosis. However, it was significant that hyperkeratosis and white dots were higher among smokers. Hyperkeratotic structures were sometimes linear.
There was no significant difference between the groups in terms of yellowish white streaks (30.5% vs. 26.8%, P: 604). We conclude that these structures are cicatricial structures secondary to trauma. These structures, which are generally linear, can be multiple and rarely in starburst pattern.
| Conclusion|| |
In this study, the effect of smoking on vascular and nonvascular structures such as microcirculation of labial mucosa was evaluated dermoscopically. In this study, we think that structures such as hemorrhagic dot, matchstick hairpin vessels, and microaneursym, which are significantly higher in smokers, may be caused by microcirculation disorders. In addition, we believe that the possibility of smoking to make similar changes in other tissue and organ microcirculation should be considered in patients with these structures.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]