SAN ANTONIO — In the opinion of Heather Goff, MD, MPH, encouraging patients to quit smoking is one of the most impactful and modifiable interventions one can make for patients.

“Smoking has a direct relationship with skin health and overall health,” Goff, associate professor of dermatology at UT Southwestern Medical Center, Dallas, said at the Society of Dermatology Physician Associates (SDPA) 23^rd Annual Fall Dermatology Conference. Helping a patient quit smoking, she said, is “one of the best things I can do for someone.”

During a wide-ranging presentation on lifestyle in skin health and disease, Goff — the SDPA conference medical director — cited study after study that implicates smoking as a risk factor for early morbidity and mortality. The evidence included a 20-year prospective study, which found that not smoking and strong social support were the two most significant predictors of successful aging. 

In a larger, more recent prospective multicohort study, lifestyle predictors associated with the greatest number of disease-free years included a BMI less than 25 and at least two of the following: never smoking, physical activity, and moderate alcohol consumption — defined as fewer than six standard servings per week for women and fewer than seven standard servings per week for men. 

If Goff smells cigarette smoke when she walks into the exam room, she’ll ask the patient whether they smoke. If the patient replies yes, her next question is, “Have you thought about quitting? Do you want to quit?”

“If someone is in the pre-contemplation stage (defined as current smokers who are not planning to quit within the next 6 months) and I start talking too much about quitting, they’ll probably go outside and smoke a cigarette in the parking lot,” Goff noted. “So, I just drop it. I’ll tell them, ‘If you ever change your mind, let me know; we can help.’ Then I move on to whatever else brought them in.”

To her knowledge, at least two patients in the last 5 years have successfully quit smoking after these conversations, including a patient who came to see her for hidradenitis suppurativa and acne keloidalis nuchae. 

Goff highlighted five progressive stages of behavior change in smoking cessation based on a reference guide  from the American Lung Association: 

• Precontemplation: Current smokers who are not planning to quit within the next 6 months.
• Contemplation: Current smokers who are considering quitting within the next 6 months and have not made a quit attempt in the past year.
• Preparation: Current smokers who have made a quit attempt in the past year and are planning to quit within the next 30 days.
• Action: Individuals who are not currently smoking and have quit within the past 6 months (recent quitters).
• Maintenance: Individuals who are not currently smoking and have maintained abstinence for more than 6 months but less than 5 years (former smokers).

According to Goff, studies have demonstrated that the more times someone has tried to quit smoking, the greater their likelihood of eventually succeeding. “It’s like they try and try, and eventually they succeed, maybe because they just get tired of trying to quit,” she said.

Authors of a recent clinical practice paper on tobacco addiction found that the most effective first-line treatments for smoking cessation include varenicline, nicotine replacement therapy paired with behavioral counseling, and bupropion. They estimated that the number needed to treat for one person to achieve and maintain long-term tobacco abstinence with these treatments ranges from eight to 20.

“So even if it feels like those one, two, or three conversations about quitting smoking aren’t making a difference,” they’re not meaningless, Goff said. “What we say does have an impact.”

In an interview at the meeting, Kristen M. Grippe, a certified physician associate who directs the PA program at Gannon University, Erie, Pennsylvania, said that — in her view — counseling patients on smoking cessation has seldom been a priority for dermatology providers. “I feel like we’ve been taught that’s primary care’s job, but I do it all the time,” Grippe said. 

Neither Goff nor Grippe had disclosures to report. 

Doug Brunk is a San Diego-based medical journalist.