Can Smoking Cigarettes Cause Acne?

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Smoking is bad for you. As often as this has been said, smoking causes hazards that extend well beyond lung cancer. Cigarette smoke can affect pretty much every organ system in the body in one way or the other, including the heart, blood vessels, lungs, eyes, mouth, reproductive tract, bones, bladder, and digestive organs.

One of the more surprising consequences is that it can either cause or lead to the worsening of acne, especially in adults.

A person with a cigarette in their hand
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"Smoker's Acne"

An increasing body of research has linked smoking to the onset of acne in adults. A study from the San Gallicano Dermatological Institute in Italy was among the first to suggest that smoking causes a specific type of acne known as atypical post-adolescent acne (APAA).

This is a non-inflammatory skin condition that has a disease pathway different from the more common inflammatory acne.

These findings point to what could be considered a new entity among smoking-related skin diseases that the researchers have dubbed "smoker's acne."

Cause and Symptoms

APAA breakouts do not appear as the red, inflamed pimples that we often associate with acne. Rather, non-inflammatory acne is associated with the blockage of pores and often appears as skin-colored bumps (comedones) and non-inflamed blackheads. APPA can occur anywhere on the body but is most apparent on the cheeks.

Researchers have found that smoking triggers two responses—increased sebum peroxidation and reduced vitamin E production—that together contribute to the onset of acne.

Sebum is the oily substance found in pores that can cause non-inflamed blackheads and comedones when the pores are blocked. Peroxidation is caused when free radicals oxidize sebum, changing its structure and allowing bacteria to thrive.

Vitamin E is an antioxidant that helps prevent free radicals from causing oxidation. The depletion of vitamin E further enables oxidation and, in turn, the promotion of APAA.

These findings were confirmed by a 2015 study from the Ohio State University College of Medicine in which hydrocarbon components in cigarette smoke were believed to be the culprit behind the development of APAA.

Incidence

According to the Italian research, smokers were four times more likely to have acne than non-smokers. Cigarette smokers were also at higher risk of non-inflammatory acne, including comedones and blackheads. Of the 1,046 people who participated in the study, three-quarters of those with non-inflammatory acne were smokers.

The number of cigarettes smoked didn't seem to have an effect on the severity of breakouts. However, people who had acne in their teen years were four times more likely to experience smoker's acne as an adult.

Among the non-smokers who had non-inflammatory acne, almost half were exposed to environmental risk factors as well. These included working in a steam-filled kitchen or being constantly exposed to smoke, both of which could have contributed in part to the development of acne.

Study Findings

According to the study conducted by the San Gallicano Dermatological Institute in Italy:

  • 42% of the smokers in the study had acne, compared to 10% of non-smokers.
  • 76% of those with non-inflammatory acne were smokers.
  • 91% of smokers with acne had the non-inflammatory form.
  • Among those with severe non-inflammatory acne, 81% were smokers.

Related Conditions

Acne inversa (hidradenitis suppurativa) is another skin condition that has been linked to smoking. It is a chronic disorder that can leave scars and is most common in middle-aged women who smoke.

While acne inversa looks similar to acne, it occurs in certain areas of the skin, specifically around apocrine glands that secrete sweat (as opposed to sebaceous glands that secrete sebum). Unlike APAA, acne inversa is inflammatory.

Acne inversa is not "acne" in the traditional sense of the word. Rather, it is the chronic inflammation of the apocrine glands that can cause acne-like bumps, mainly in the armpits, groin, thighs, or buttocks. The accumulation of pus can lead to an infection that may require drainage.

Acne inversa sometimes look similar to boils and may require treatment to avoid tissue injury and the formation of irreversible scarring.

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