Does Smoking Cause Acne: What Does The Science Say?

There are few substances as harmful and widely abused as cigarettes. The list of negative health effects of smoking is as long as California. But does smoking also cause acne? Evidence to date is conflicting, and smoking seems to have both positive and negative effects on acne.

Conflicting findings from epidemiological studies

Epidemiological studies compare the rates of acne between different groups, such as smokers vs. non-smokers. The results from these studies are all over the map. Some show strong correlation between acne and smoking (smokers have more acne). But other studies show opposite results, that smokers have less acne.

Inconclusive results like this suggest there’s no link between smoking and acne, or that smoking has both positive and negative effects on the skin.

Indirect effects of smoking on acne

Because we have no direct evidence on how smoking affects acne, we have to look at indirect ways. These include.

  • Smoking reduces inflammatory response in the skin. Because smoking dials down the immune system in the skin it slows wound healing. Paradoxically this can actually be good for acne, because acne patients have excessively strong immune response to acne-causing bacteria.
  • Smoking reduces vitamin E in the skin. Vitamin E is the most important antioxidant in the skin. It protects the skin from sunlight, pollution and other forms of damage. When exposed to such damage sebum in the skin oxidizes (goes bad), and this can trigger acne. One study found that compared to non-smokers smokers had lower levels of vitamin E and higher levels of damaged (oxidized) sebum.
  • Smoking can contribute to hormonal acne. Smoking has been linked to increase in acne causing hormones. Several studies have shown that smoking causes insulin resistance and increases blood sugar levels. Studies have also shown that smoking increases free testosterone. Both of these effects can aggravate hormonal acne.

Italian researchers have found that non-inflammatory acne is more common in smokers whereas smokers have less inflammatory acne. This, combined with immune dampening effect of smoking, suggest that smoking may be good for some types of acne. But this is more speculation than fact as the data is not good enough to draw strong conclusions.

Conclusion

Does smoking cause acne? At this time we can’t say either way. Smoking appears to have both beneficial and harmful effects on the skin. On the positive side it dials down the overactive immune system in acne-prone skin. On the negative side smoking depletes vitamin E and increases sebum oxidation in the skin, and this makes the skin more prone to breakouts. Smoking also increases insulin and testosterone levels, both of which contribute to hormonal acne.

Whether the net effect is helpful or harmful to acne probably varies from person to person. But given all the proven, negative effects of smoking it would be foolish to consider it as treatment for acne.

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About Me

Hi, I am Acne Einstein(a.k.a. Seppo Puusa). I'm a bit of a science nerd who is also passionate about health. I enjoy digging through medical journals for acne treatment gems I can share here. You can read more about my journey through acne and how I eventually ended up creating this.

5 thoughts on “Does Smoking Cause Acne: What Does The Science Say?

  1. Hello,

    I just wanted to leave a reply to let people know – YES, smoking does aggravate and/or cause hormonal acne! Here is my testimony below:

    My entire life, up until 4 years ago, I had perfectly clear skin to the point where I didn’t need to wear any sort of foundation. Then, during these last four years, I struggled with severe cystic acne that was extremely painful, hideous, embarrassing, and stressful. I am an actress and a model, so you can imagine how important a clear complexion is to me and how it can affect my career. Not even the best makeup artists could conceal the enormous sub-dermal zits that were erupting all over my chin, cheeks, and jawline – not to mention all the scars that were left behind from previous eruptions. I saw my dermatologist multiple times, and each time he would prescribe me something new to try because the last prescription we tried wasn’t working. Cream after cream, gel after gel, face wash after face wash, pill after pill… nothing was working. It finally came to the point where Accutane was my only remaining option. For an uninsured patient like me, Accutane can cost upwards of $5000 – and I don’t have that kind of money (most people don’t).

    Feeling defeated, I felt like there was no hope left for me – no possible chance that I would ever have a clear complexion again. Then a little over a month ago, I finally got up the courage and strength to quit smoking. During the first couple of weeks after quitting, my face erupted with acne worse than ever before. I almost gave up and went back to smoking, thinking it was actually helping suppress the severity of the breakouts. But then after researching what your body goes through after quitting, I realized that the severe breakout could entirely be related to the detoxification process that my body was going through. I am SO glad I waited it out. It has been exactly 5 weeks since I quit smoking, and as of today, my face is virtually 100% clear – with the exception of the leftover scars. Not a single new zit on my face! After noticing this, I did the math – I had perfectly clear skin until 4 years ago, and 4 years ago was when I started smoking. It all makes perfect sense. Funny thing is, I asked my dermatologist if smoking cigarettes could be causing or contributing to my acne – and he said NO, that smoking would cause wrinkles, but shouldn’t have any affect on acne. I will be giving him a call to tell him my testimony, so that he can advise current and future patients who suffer from acne that are smokers to quit!

    Now I just have to work on these scars… but at least no more new ones will be forming anytime soon, because I have no intention of picking up cigarettes ever again!

    I hope you found my story helpful. Thanks for reading, and good luck – if you’re a smoker suffering from acne, QUIT NOW! The quitting struggle is difficult at first, but it’s entirely worth it in the end to have clear skin – and not to mention confidence – again!

    – Sarah

  2. I agree. I had the most perfect, flawless skin, until I was 18 years old- then I started smoking, and black heads, white heads and pimples festered on my face making it there new home. I tried the pill, $100 skin treatments, and the best of EVERY kind of face wash and foundation. Eventually I have now quit smoking as I am CONVINCED acne and smoking is linked. A recent study also proved that 80% of smokers have acne.

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