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.
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.