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In 2022, oral nicotine products, as a new product category, exceeded ENDS to become the fourth-largest tobacco product category in the rank of market shares

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These include: Increase in certain enzymes known as matrix metalloproteinases which promote breakdown of collagen and elastic fibres in the skin Increase in atoms or molecules known as free radicals that accumulate causing physiological decline in the skins structure and function Phototoxicity of tobacco smoke smoke becomes more toxic under the influence of ultraviolet radiation Vasoconstriction (narrowing of blood vessels) reduces blood flow to the skin and can cause subsequent changes to elastin and collagen in the connective tissue

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Nicotine can also cross the blood-brain barrier, which results in neurotoxic effects