Trüeb Ralph M
Dermatology. 2003;206(3):189-91. doi: 10.1159/000068894.
Besides being the single most preventable cause of significant morbidity and an important cause of death in the general population, tobacco smoking has been associated with adverse effects on the skin. Smoke-induced premature skin ageing has attracted the attention of the medical community, while only recently an observational study has indicated a significant relationship between smoking and baldness. The mechanisms by which smoking causes hair loss are multifactorial and are probably related to effects of cigarette smoke on the microvasculature of the dermal hair papilla, smoke genotoxicants causing damage to DNA of the hair follicle, smoke-induced imbalance in the follicular protease/antiprotease systems controlling tissue remodeling during the hair growth cycle, pro-oxidant effects of smoking leading to the release of pro-inflammatory cytokines resulting in follicular micro-inflammation and fibrosis and finally increased hydroxylation of oestradiol as well as inhibition of the enzyme aromatase creating a relative hypo-oestrogenic state. In view of the psychological impact of androgenetic alopecia on affected men and women, increasing public awareness of the association between smoking and hair loss offers an opportunity for health education against smoking that may be more effective than the link between smoking and facial wrinkles or grey hair, since the latter can be effectively counteracted by current aesthetic dermatologic procedures, while treatment options for androgenetic alopecia are limited.
吸烟不仅是普通人群中最可预防的导致严重发病的单一原因，也是一个重要的死亡原因，还会对皮肤产生不良影响。烟雾导致的皮肤过早老化已引起医学界的关注，而直到最近一项观察性研究才表明吸烟与脱发之间存在显著关联。吸烟导致脱发的机制是多因素的，可能与香烟烟雾对真皮毛乳头微血管的影响、烟雾中的遗传毒性物质对毛囊DNA的损伤、烟雾引起的毛囊蛋白酶/抗蛋白酶系统失衡（该系统在毛发生长周期中控制组织重塑）、吸烟的促氧化作用导致促炎细胞因子释放，进而引起毛囊微炎症和纤维化，以及最终雌二醇羟基化增加和芳香化酶受抑制导致相对低雌激素状态有关。鉴于雄激素性脱发对受影响的男性和女性的心理影响，提高公众对吸烟与脱发之间关联的认识为开展反对吸烟的健康教育提供了一个机会，这可能比吸烟与面部皱纹或白发之间的联系更有效，因为后者可通过当前的美容皮肤科手术有效抵消，而雄激素性脱发的治疗选择有限。
