You’ve undoubtedly heard at least some of the studies on smoking and cancer, and lung and brain damage, weakened immune system, yellow skin and nails, mutated DNA, and pregnancy complications. And you’ve probably heard plenty of warnings about wrinkles and smoking. Smoking as little as a pack per week (approximately 50 packs a year) ups your chances of being wrinkled by 4.7 times (Annals of Internal Medicine). But could smoking also be responsible for a condition that many of us associate with youth?
To add to the list of side effects, smoking is often linked with acne outbreaks. Interestingly though, there are some studies that state the obvious. So what’s the relationship between smoking and acne?
Is there a Correlation between Smoking and Acne?
In a study of females ages 25-50, research showed that smokers were far more likely to develop acne than non-smokers, with probability being around 41.5% for female smokers (115 out of 277 test subjects) and 9.7% for female non-smokers (70 out of 723 test subjects). Specifically, these smokers were more likely to have non-inflammatory acne, which features many micro- and macro-medones (earlier stages of pores blockage) but few scarring and inflamed pustules.
It was also found that those who smoked 15 or more cigarettes a day were more likely to have more serious forms of acne (British Journal of Dermatology). Some scholars now believe that this non-inflammatory strain of acne — found mostly in smokers — is becoming a defining character of smokers and is starting to be called “smoker’s acne.”
Another study demonstrated a strong relationship between smoking frequency and acne, with smoking 0-10 cigarettes per day having a 39.8% likelihood of acne, while 11-20 cigarettes per day had a 44% prevalence in smokers. Non-smokers were also found to have less acne than smokers, and men were more likely to develop it than women. However, the researchers did not measure the severity of each subject’s acne (The British Journal of Dermatology).
How Might Smoking Contribute to Acne?
Some scholars theorize that it clogs pores, though this claim is still hotly contested in the medical field, as there is much conflicting evidence about smoking’s relationship to acne. An Italian study pointed to cigarette smoke’s causing sebum peroxidation (sebum oxidation and breakdown) coupled with decrease in Vitamin E as possible culprits. However, smokers tended to over-excrete sebum by three times the normal amount. Smokers’ sebum also had reduced levels of the antioxidant a-tocopherol, which reaches the skin via sebum excretion (Dermato-Endocrinology).
Lipid peroxidation (fat breakdown) was also pegged in skin degradation, as it damages fats that can keep skin soft and hydrated. Similarly, skin cells (keratinocytes) have special receptors that adhere to nicotine. If smoking becomes excessive, this can cause hyperkeratinization, where dead cells that would usually escape onto the skin’s surface are confined within a follicle or pore (Journal of Dermatological Treatment).
With the combination of damaged sebum, over-excretion, lipid damage, hyperkeratinzation and environmental factors, it makes sense that smokers might be more prone to acne. However, there isn’t conclusive evidence.
What about Studies that Say the Opposite, that Smoker Have Less Acne?
Researchers conducted a 20 year study that looked at smoking and acne in over 27,000 young males, specifically comparing severe acne – including scarring, excessive lesions and pustules, and emotional upset — with mild to moderate acne, which is defined as being less widespread and not quite as painful. They found that those who smoked 1-10 cigarettes a day were less prone to severe acne than those who smoked 11-20 per day. Non-smokers were also more susceptible to severe acne than regular smokers, according to Klaz et al.’s study.
The researchers clarified, however, that their study did not feature females, had a limited age group, and did not factor in many hormonal/external factors, and therefore their results are not absolute. They also noted that some of the ingredients that may benefit acne can be found in safer forms, like nicotine patches and gum, but these do not justify smoking.
And some studies have shown inflammatory conditions like rosacea and severe acne to be more prevalent in non-smokers, though this relationship is not yet understood or conformed.
A study by Firooz et.al was not able to find a correlation between acne and cigarette smoking in their study of 350 acne sufferers and 350 others who had different skin ailments. They did note that the wide age gaps (ages 15-40), coupled with environmental and genetic factors, might have altered their findings (BMC Dermatology). Several other studies have published similar results, but each acknowledges flaws and discrepancies in the sample size.
Bottom Line
It’s no secret that smoking is terrible for your health, being one of the most preventable causes of death in recent decades. Aside from cancers and organ damage, smoking can complicate pregnancies, impair breathing, yellow skin and nails, as wella s damage skin with wrinkles, discoloration, oxidative stress, and even acne. There are numerous contradictory studies that either find no correlation between smoking and acne, say that it is mostly prevalent in heavy smokers, or that smoking of any kind can induce smoker’s acne, a non-inflammatory strain of acne commonly found in those who both smoke and are exposed to tobaccos smoke.