Does Smoking Cigarettes Cause Acne?

Cigarette smoking can cause certain types of acne. It is associated with a non-inflammatory form of acne called atypical post-adolescent acne (APAA), or simply "smoker's acne." It is also linked to an acne-like condition known as acne inversa, which can irreversible damage.

Chemicals in tobacco smoke can damage the skin in the same way they do other organs of the body. They can also change the composition and density of skin oils, known as sebum, leading to clogged pores and the outbreak of blackheads and whiteheads.

This article explains how smoking and acne are linked. It also explores whether e-cigarettes (vaping) can contribute to acne outbreaks.

Symptoms of Smoker's Acne

Researchers at the San Gallicano Dermatological Institute in Italy were among the first to suggest that smoking causes a specific type of acne known as atypical post-adolescent acne (APAA). The condition is popularly known as "smoker's acne" due to its close association with cigarettes.

APAA is a non-inflammatory form of acne that doesn't cause the redness, warmth, and swelling of inflammatory forms like cystic acne, nodular acne, and acne vulgaris (the most common form of acne).

Rather than producing inflamed pimples, APAA causes small, non-inflamed skin bumps known as comedones. Comedones form when sebum and dead skin cells block oil-producing glands in the skin known as sebaceous glands.

There are two types of comedones that can occur with smoker's acne:

• Closed comedones: Also known as whiteheads, these occur when the blockage remains below the surface of the skin, causing flesh-colored or whitish bumps.
• Open comedones: Also known as blackheads, these occur when the blockage is exposed to air and begins to darken due to oxidation (a chemical reaction triggered by oxygen).

With smoker's acne, the outbreak of comedones can give the skin a rough, patchy texture.

While APAA can affect the chin, forehead, nose, and even the back, the lips—where comedones commonly occur—are usually not affected.

Causes of Smoker's Acne

Researchers have found that two interconnected factors contribute to the development of APAA.

The first is something called sebum peroxidation. This is when unstable molecules known as free radicals attack fatty acids in sebum, causing the oil to break down and become thicker and stickier. This can lead to blocked pores and comedones.

The second factor is decreased vitamin E production. Vitamin E is an antioxidant that prevents free radicals from causing peroxidation. Cigarette smoke depletes vitamin E from the blood and, by doing so, increases the risk of sebum peroxidation by free radicals.

These findings are supported by a 2015 study from the Ohio State University in which hydrocarbons (a type of free radical found in cigarette smoke) were believed to be the culprit behind APAA.

Smoking and Other Forms of Acne

Although APAA is strongly linked to cigarette smoking, it is unclear if smoking is directly linked to acne vulgaris and other more common forms of acne. Claims that it does so remain controversial.

While older studies have suggested that smoking can aggravate acne, it is unclear if acne is made "worse" by acne or if smokers simply have worse skin due to the long-term effects of smoking.

A 2020 review of studies found conflicting evidence as to whether smoking and acne are linked, with some studies reporting a direct correlation and others finding no correlation at all. Further research is needed.

Acne Inversa

Acne inversa, also known as hidradenitis suppurativa, is an inflammatory skin condition that is most definitely linked to smoking. It causes large pus-filled nodules that can burst open and leave visible scars. Middle-aged female smokers are most commonly affected.

Acne inversa is not "acne" in the traditional sense of the word. While it looks similar to acne vulgaris, it affects the apocrine glands that secrete sweat rather than the sebaceous glands that secrete sebum. The acne-like bumps are also larger and occur mainly in the armpits, groin, thighs, or buttocks

While the cause of acne inversa is known, smoking appears to be one of the main triggering factors for the disease.

Does Vaping Cause Acne?

Like smoking, vaping can cause serious health concerns. But compared to cigarette smoke, vaping produces far fewer hydrocarbons and theoretically poses less of a risk of acne,

This doesn't mean that vaping poses no risks. E-cigarettes contain a substance called propylene glycol that can severely dehydrate the skin and mouth. Nicotine in e-cigarettes has the same effect.

While there is no clear connection between vaping and acne, skin dehydration will invariably increase sebum production in order to keep the skin well moisturized. With the increased production of sebum comes an increased risk of acne.

Vaping can affect the skin in other ways. The heated e-cigarette vapors are known to cause mouth lesions, burn injuries, and contact dermatitis (an itchy rash caused by skin irritants).

There is also evidence that nicotine used in most e-cigarettes can cause premature skin aging.

Summary

Cigarette smoking can lead to a non-inflammatory form of acne called atypical post-adolescent acne (APAA), or simply "smoker's acne." Smoking can also cause an inflammatory skin condition known as acne inversa that can lead to irreversible scarring.

It is unclear if vaping has any direct association with acne. Even so, many e-cigarettes contain nicotine and other chemicals that are known to be damaging to the skin.