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The differential diagnosis includes scleroderma and dyskeratosis congenita

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A 2020 New York seizure of 6,267 cartons of cigarettes required a long-term investigation, including court-authorized search warrants, wiretaps, grand jury subpoenas, and other investigative tools.[2] A Wellesley Island Station Anti-Smuggling Unit, with the help of US Border Patrol agents, seized more than 1 million cigarettes (worth more than $300,000) in April 2024.[3] A 2023 New York City raid seized more than 1,800 cartons of cigarettes and $155,000 in cash.[4] But even when successful, policing smuggling is costly and only prohibits a drop of water in the East River of smuggling activity

Nicotine obtained via smoking cigarettes or consuming heated tobacco products such as Terea Iqos