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The tobacco and bettle nut combination burns mucosa and soft tissue which leads to ulcerations

Clin Transplant 18(6):672675 Forstermann U, Munzel T (2006) Endothelial nitric oxide synthase in vascular disease: from marvel to menace

Slightly more common in people with psoriasis , patients with psoriasis show geographic tongue at a rate of about 10%, compared to 2.5% in matched controls

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That adds avoidable strain. Resistance training can raise testosterone and lower cortisol over weeks, but nicotine exposure is linked with lower testosterone and higher cortisol, which undermines muscle growth and repair