Nicotine staining of the hair and nails.

CLINICAL CHALLENGE Patients are not always forthcoming about their tobacco use. Smoking and other forms of tobacco use have serious health consequences, and many dermatologic diseases and treatments are negatively affected by tobacco exposure. When a patient does not disclose their full tobacco history, the dermatologist can miss a valuable opportunity to counsel the patient on tobacco cessation. In addition, tobacco use assessment and tobacco cessation intervention are clinical quality measures for physicians to report for stage-1 meaningful use according to Medicare and Medicaid; therefore an accurate tobacco use history is needed for documentation in the electronic medical record.