We all know that smoking is bad for our lungs, but did you know that it’s also bad for your skin?
Smoking increases skin wrinkling and aging, increases your risk of skin cancer particularly squamous cell carcinoma, and impairs wound healing. Smoking also worsens a lot of skin conditions, including psoriasis and hidradenitis suppurativa which causes painful boils in your armpits, groin, under the breasts, and buttocks.
Let’s dig into the details.
Do you want to look older than you are? Then smoke cigarettes. Smoking causes wrinkles. No, it doesn’t matter if you’re young — one study looking at 350 current or past smokers compared to non-smokers showed that microscopic wrinkles were already apparent in 20-39 year olds who smoked (Koh J S et al). The more that you smoke, the worse your wrinkles will be (Kadunce DP et al; Ernster VL et al; Chung JH et al; Helfrich YR et al). Why would this be? Well, smoking increases matrix metalloproteinases, proteins in your skin that break down collagen so that your skin isn’t as thick or firm looking. Smoking also prevents your body from making a molecule called TGF-beta that would otherwise stimulate your body to make more collagen to replace what you’ve lost (Hu et al). Fortunately, if you are a smoker, these changes may to some extent be reversible, as at least one study has shown that past smokers had less facial wrinkling than current smokers (Koh et al).
Another change that tends to come with the wrinkles are really big blackheads and cysts, often on the sides of the cheeks near the eyes. The fancy term for this is called Favre Racouchet syndrome, or nodular elastosis with cysts and comedones. I encourage those of you who can to google it — if you’re looking for smooth, even skin tone as you age, this is NOT it. Are there treatments that can help if you’ve got it? Sure, tretinoin cream may help clear those plugged pores, but it’s unlikely to resolve completely.
Smoking also increases your risk of skin cancer. Smoking has clearly been associated with increased risk of the second most common type of skin cancer, called squamous cell carcinoma (SCC). A systematic review and meta-analysis from 2012 showed at least 1.52 increased odds of getting SCC if you’re a smoker (Leonardi-Bee et al). SCC is usually very treatable, but this type of skin cancer is one that can spread to other areas of the body, especially if it’s untreated, or if yours has certain risk factors such as located on the lips or the ear, if it’s a large size (> 2 cm), deeply invasive, or if it has aggressive features under the microscope.
How does smoking increase your skin cancer risk? Likely by a few ways (Hu et al). First of all, the cigarette compounds themselves make something called reactive oxygen species, and these then can damage DNA and our proteins, causing mutations that can lead to skin cancer and also prevent our body from being able to fix the DNA damage. Smoking also constricts blood vessels, and when the blood flow goes back to normal, even more reactive oxygen species form. So, you end up getting even more DNA damage and damage to your proteins. Smoking also causes skin cells to enlarge and replicate more rapidly. Eating a lot of blueberries or antioxidant containing foods may theoretically help reduce at least the reactive oxygen species from smoking, but wouldn’t you rather avoid the damage to begin with.
Increased reactive oxygen species may also play into making you look older, too (Hu et al).
Smoking also makes it harder for your skin heal. Are you generally prone to injuries, or do you have a surgery coming up? Then I strongly encourage you to stop smoking, or at least cut back. Smokers are more likely to develop infections, are slower to heal, and are more likely to have healing wounds come apart, something called wound dehiscence.
Why is this? For a few reasons. To heal properly, you need blood flow to supply the area with nutrients and cells to actually repair the wound. Smoking decreases blood flow by causing your blood vessels to narrow, or constrict, and makes your blood vessels more prone to blockage, or what’s called occlusion (yes, just like with how smoking can increase your risk of heart attacks by blocking the vessels that provide blood to your heart!) (Jensen et al; Wennmalm et al). Smoking negatively affects your immune response, increasing your risk of infection, particularly if you also have diabetes (Sumpio et al; Kalra et al; Delbridge et al — Ref 97-99 from Hu et al). To heal properly, you need cells called fibroblasts to make collagen. Unfortunately, smoking both prevents fibroblasts from replicating (so you don’t have enough to heal the wound successfully), and it also reduces your body’s ability to make collagen (Ref 92 Hu et al)
If you stop smoking, you’ll have the blood flow that you need to provide nutrients and cells to the area to fight off infection, to heal the wound, and your body will be able to make collagen to heal the site as it needs to.
We’re not going to dive very deep into this, but please understand that smoking makes other skin conditions worse, including psoriasis and a condition called hidradenitis suppurative, where you get painful, draining bumps in the armpits, groin and under the breasts, worse. Further, smoking decreases how effective some skin therapies work.
What about vaping? Does this cause similar problems? I was not able to find any articles specifically looking at this, but I would venture to guess that it still would negatively affect your skin because nicotine can still generate reactive oxygen species, damage your DNA, and affect your blood flow.
Was this enough to convince you to stop smoking? Or vaping? I know it’s hard to kick the habit, but if you want to optimize your skin’s beauty, lower your risk of skin cancer, and optimize outcomes if you have some of these other skin disorders, then I definitely encourage you to quit. Your skin will thank you. It will make your heart and your lungs happy too!
References
Chung JH et al. Cutaneous photo damage in Koreans: influence of sex, sun exposure, smoking and skin color. Arch Dermatol. 2001; 137 (8): 1043-1051.
Delbridge L et al. Factors associated with development of foot lesions in the diabetic. Surgery. 1983; 93 (1 Pt 1): 78-82.
Ernster VL et al. Facial wrinkling in men and women, by smoking status. Am J Public Heal. 1995: 85(1): 78-82.
Helfrich YR et al. Effect of smoking on aging of photoprotected skin: evidence gathered using a new photo-numeric scale. Arch Dermatol 2007; 143 (3): 397-402.
Hu S et al. Holistic dermatology: an evidence-based review of modifiable lifestyle factor associations with dermatologic disorders. JAAD 2022; 86: 868-77.
Jensen JA et al. Cigarette smoking decreases tissue oxygen. Arch Surg. 1991; 126: 1131-1134.
Kadunce DP et al. Cigarette smoking: risk factor for premature facial wrinkling. Ann Intern Med 1991; 114 (1): 840-844.
Kalra R et al. Effects of cigarette smoke on immune response: chronic exposure to cigarette smoke impairs antigen-mediated signaling in T cells and depletes IP3-sensitive Ca (2+) stores. J Pharmacol Exp There 2000; 293 (1): 166-171.
Koh JS et al. Cigarette smoking associated with premature facial wrinkling: image analysis of facial skin replicas. International Journal of Dermatology 2022; 41: 21-27.
Leonardi-Bee J et al. Smoking and the risk of non melanoma skin cancer: systematic review and meta-analysis. Arch Dermatol 2012; 148 (8): 939-46.
Sumpio BE et al. Vascular evaluation and arterial reconstruction of the diabetic foot. Clin Podiatr Med Surg 2003; 20 (4): 689-708.
Wennmalm A et al. Nicotine inhibits vascular prostacyclin but not platelet thromboxane formation. Gen Pharmacol. 1983; 14: 289-91.