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Tobacco smoke inflicts widespread damage on the skin, accelerating aging, impairing wound healing, and worsening inflammatory skin conditions such as psoriasis and hidradenitis suppurativa.
Skin and hair are subjected to various harmful environmental agents, including tobacco smoke. Comprising thousands of substances, tobacco smoke inflicts damage on the skin, with nicotine itself also being detrimental.
Beyond its established connections to cancer, and lung and heart diseases, smoking is implicated in early skin aging, impeded wound healing, and heightened infection risks, in addition to various skin conditions such as psoriasis, hidradenitis suppurativa, and cutaneous lupus erythematosus. It has been observed that smokers generally suffer more severely from most inflammatory skin diseases, including acne, than non-smokers, and these conditions are often more challenging to treat effectively in smokers.
Tobacco smoke induces oxidative stress, leading to inadequate oxygen supply to the skin, tissue ischemia, and occlusion of blood vessels. It diminishes innate and host immune responses and triggers the production of metallo-proteinase MMP-1, an enzyme that breaks down collagen.
Although nicotine replacement is less harmful to the skin than smoking, nicotine itself causes vasoconstriction, inhibits inflammation, delays wound healing, and contributes to skin aging.
The temporary adverse effects of tobacco smoking on the skin and mucosa include:
Over time, the appearance of a 40-year-old heavy smoker's skin can resemble that of a 70-year-old non-smoker:
The exact mechanisms through which smoking accelerates aging of facial skin are speculative but may include:
Smoking hampers wound healing, affecting skin injuries and surgical wounds, elevating the risk of infection, failure of grafts or flaps, tissue death, and blood clot formation. The underlying mechanisms include vasoconstriction and reduced oxygen delivery, delayed keratinocyte migration, diminished collagen synthesis, and slowed new blood vessel growth within wounds.
Smoking aggravates the development and persistence of leg ulcers, especially arterial and diabetic foot ulcers, and calciphylaxis. It is linked to a higher likelihood or severity of:
Cigarette smoking doubles the risk of squamous cell carcinoma of the skin compared to non-smokers and increases the risk of oral leukoplakia (precancer) and oral cancer; 75% of oral and lip cancer cases occur in smokers. Smoking does not appear to elevate the risk of basal cell carcinoma.
Cessation of smoking reduces the metastasis risk from lip cancer by two to threefold.
Palmoplantar pustulosis, a chronic and disabling dermatosis characterised by pustules, erythema, and scaling on the palms and soles, predominantly affects middle-aged women, most of whom are smokers. The condition's mechanism involves nicotine interacting with acetylcholine receptors in sweat glands and ducts, altering their structure and causing inflammation.
Cessation of smoking leads to gradual improvement, and many patients may eventually see their pustules clear.
Studies have shown that smokers typically exhibit more extensive and severe psoriasis than non-smokers. Patients with chronic plaque psoriasis tend to smoke more than those without the condition. Obesity or metabolic syndrome and quality of life issues complicate this research.
The mechanism is believed to involve smoking-induced inflammatory mediators and the promotion of keratinocyte proliferation, with nicotine binding to dendritic cells, T-cells, and keratinocytes.
Most patients with hidradenitis suppurativa (HS) are smokers, experiencing a greater disease burden than non-smokers. HS's pathogenesis is linked to nicotine/acetylcholine-induced follicular occlusion, follicular rupture, and immune dysregulation, with smokers responding poorly to current treatments.
Some inflammatory diseases appear less common or severe in smokers than in non-smokers, including:
However, smoking is not recommended as a treatment due to its adverse effects and addiction risk.
For those seeking to quit smoking, various support options are available, including telephone support, consultations with family doctors, nicotine replacement therapies, and prescription medications such as varenicline (Champix) or bupropion (Zyban). Vaping or e-cigarettes are also options, though they carry their own health concerns. A multi-faceted approach is often most effective, with devices such as carbon monoxide breath metres aiding in treatment guidance.
The cutaneous effects of smoking cessation can vary, with nicotine-containing patches, gum, lozenges, nasal spray, inhalers, and e-cigarettes potentially beneficial or detrimental to skin health. Cutaneous side effects from these treatments may impact patient adherence.
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