APPROACHES TO A PROPHYLAXIS OF SKIN AGING 307 the skin was not characterized as such. Of the 131 women without "cigarette skin," 113 (86•) have never smoked whereas only 18 (14•) of them have smoked. The group of 93 women with cigarette skin included 66 (71•) smokers and 27 (29•o) non-smokers. In other words, 66 (79•) of the 84 smokers were recognized from their skin ap- pearance, and 113 (80•) out of the 140 non-smokers had no signs of cigarette skin. In the case of the 27 non-smokers with "smoker's skin" one must consider constitutional factors separating this group of mostly elderly ladies from the real smokers. In contrast, most of the 18 smokers without smoker's skin had not yet reached the age of fifty. Therefore, their skin changes seem to have not progressed far enough to be noticed. The main differences between cigarette skin and light-damaged skin, which can be seen occasionally on the face after long and intensive ap- plication of sunlight, are in color and firmness. This follows from the different pathogenesis of these two types of skin da•nage. The primary reaction following chronic sunlight damage takes place in the blood- vessels adjacent to the epidermis. As a result, the parts of the con- nective tissue lying just under the epidermis degenerate, and finally the epidermis itself degenerates. What follows is a certain rigidity, sonne- tjmes intensified by a superficial elastoidosis. Deeper wrinkles are seldom found. Especially noticeable, however, is the color, which is irregularily brownish due to hyperpigmentation, but also has a reddish hue, due to the intact circulation in the deeper layers of the skin. In contrast to this, nicotine seems to have a much stronger effect upon the deeper blood vessels of the cutis. The constriction of vessels by nicotine is evident in the pale gray color of the face, caused by re- duced circulation and followed by a degeneration of the connective tissue in the deeper layers of the cutis. This degeneration results in deep wrinkles and loss of turgor. Since the relatively unaffected epidermis does not atrophy, it is easier to discern the changes in skin relief caused by the damage in the deeper layers of the cutis. These investigations have been limited thus far to women. It would appear that smoking has less or hardly any effect on the skin of men. With women the investigations should be limited to those be- tween the ages of 35 and 70. Women over 70, who have never smoked, are affected by other processes of degeneration, which result in a very similar morphological picture. These observations show that consump- tion of tobacco by younger women can produce the appearance of "se- nile" skin. Hardly any difference can be seen between the skin of a

3O8 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS forty year old smoker and a seventy year old non-smoker. This is even more apparent when neither subject has been extensively exposed to sunlight. The premature aging of women's facial skin is mainly the con- sequence of three basic factors: 1. The physiological process of aging of the entire integument, characterized by the folds resulting from habitual facial movements such as smiling and frowning. 2. Those chronic changes on the outermost skin layers which are caused by long exposure to sunlight. Such changes, as a rule, are not found on the skin of the rest of the body except on the neck, forearms, and hands. 3. Combined with the first two factors are those changes in the circulation and the quality of the deeper connective tissue which follow long years of smoking and which are mainly noticeable on the face and on the neck.