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Cigarette smoke induces proinflammatory cytokine release by activation of NF-B and posttranslational modifications of histone deacetylase in macrophages

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10,13,66 The outcome is the lack of estradiol and/or agonist SERM actions, which account for the dramatic loss in skin health parameters such as collagen and elastin causing atrophy, wrinkles, poor wound healing/barrier function/hydration