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But the primary concern is the risk of ochronosis, a rare but challenging condition where long-term overuse paradoxically causes darkening of the skin, says Francesa Lewis, MD, a board-certified dermatologist in Delray Beach, Florida

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That could have a tremendous impact on health. Smoking rates in the United States have decreased over time, but cigarette smoking remains the leading cause of preventable disease and death, according to the US Centers for Disease Control and Prevention