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Veteran cannabis users are quite familiar with the practice of passing a joint around

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If the affected areas extend around the vulval and perianal skin a figure-of-eight pattern can be seen The affected skin is ivory-white, and may contain areas of telangiectases and purpura As a result of friction the skin often breaks down to form a red raw surface Other features occasionally seen include hyperkeratosis, vesicles, bullae, and ulcers Atrophy is a common feature and sometimes there may be marked shrinkage of the vulva, especially the clitoris and labia minora, and the vaginal introitus

Competing interests The authors declare that they have no conflict of interest

Tobacco Endgame policies are a natural policy progression to regulate tobacco products in proportion to the harm they cause