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Theories include: Heat from the cigarette directly burning the skin Changes in the elastic fibres of the skin (elastosis ) Narrowing of blood vessels (vasoconstriction), which reduces blood supply to the skin and can cause changes in skin elastic fibres and loss of collagen Reducing vitamin A levels and moisture of the skin

It is difficult to perform good studies on the effect of condoms on disease transmission, because its unethical to ask one group of test subjects not to use condoms, and possibly not realistic to expect another group to use condoms consistently and correctly

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