Smoker’s Mustache Revisited: Upper Lip Hair Yellow Discoloration Associated With Tobacco

Yellow hair discoloration (xanthotrichia) has been observed in several settings. Indeed, acquired xanthotrichia, in addition to environmental and occupational causes, can be observed secondary to either iatrogenic, topical, or systemic exposure to systemic drugs and certain systemic conditions: most commonly essential fatty acid deficiencies, protein deficiency, or vitamin B12 deficiency. Smoker’s mustache refers to the acquired yellow discoloration of previously white hair on the cutaneous upper lip of men. These individuals are typically elderly and have a history of smoking either cigarettes, cigars, or pipes of several years’ duration. The asymptomatic dyschromia often originates centrally, affecting the hair overlying the philtrum and expanding laterally. The condition is asymptomatic, and affected individuals are either unaware of the color change or not concerned with their altered appearance. Yellow to brown discoloration of the thumbnails, fingernails, or both (such as nicotine sign and/or harlequin nails) may be an accompanying clinical stigma to the smoker’s mustache and a clue to the diagnosis. Management options include smoking cessation or hair removal of the discolored hair, or both; however, patients usually elect to continue smoking, maintain their facial hair, and continue to display their distinctive yellow smoker’s mustache.