Supervisor Elham AbolFateh
Editor in Chief Mohamed Wadie

What Are Skin Changes Induced by Smoking" Dr. Badran Answers

Thu 26 May 2022 | 10:52 PM

Smoking negatively affects almost every organ of your body, and this includes the largest organ: your skin.

The skin is an organ exposed to cigarette smoke both directly through contact with environmental smoke and indirectly in the form of the toxic substances that pass into the bloodstream from the inhaled smoke. It is not surprising, therefore, that smoking affects the skin in many different ways, most of which are harmful.

The various health effects of smoking are well known, but the effect of smoking on skin is less studied. The mechanisms responsible for effects of smoking on skin are not completely recognized.

How Does Smoking Damage the Skin?

Such skin damage induced by tobacco has been related to oxidative stress, impaired collagen biosynthesis, and activation of matrix metalloproteinases. In addition, tobacco smoking air pollutants activate toxicity induced by several environmental contaminants, which may play a role in already known premature skin-aging effects.

Skin and hair are exposed to various environmental noxious agents, including tobacco smoke. Tobacco smoke consists of thousands of substances that damage the skin, and nicotine itself is harmful.

Tobacco smoke causes oxidative stress so that insufficient oxygen is supplied to the skin resulting in tissue ischaemia and blood vessel occlusion. It reduces innate and host immune responses, and induces metallo-proteinase MMP-1, an enzyme that specifically degrades collagen.

The nicotine in cigarettes causes narrowing of the blood vessels in the skin; this means the skin will not be getting all of the vital nutrients that it needs in order to function properly. Nicotine delays wound healing and accelerates skin ageing. Smoking decreases the flow of oxygen to the skin by as much as 30 percent.

Smoking creates an abundance of free radicals that can cause cellular damage and depletes essential vitamins and minerals in the body including the skin. Tobacco smoking is an independent risk factor for cutaneous squamous cell carcinoma.

Tobacco-induced Contact Dermatitis

Tobacco and tobacco smoke are strongly associated with various skin conditions, among which contact dermatitis is of prime importance. The aetiological and clinical aspects vary according to the different tobacco production and processing steps. Contact dermatitis is frequent in tobacco harvesters, curers and cigar makers, whereas it rarely affects smokers and, only exceptionally, cigarette packaging workers. The skin sites involved also vary, according to whether the exposure is occupational or non-occupational. Tobacco contact irritation is far more frequent than contact allergy.

Tobacco Aggravates Eczema

Children are at a higher risk of developing an atopic eczema when exposed to environmental tobacco smoke. Smoking during pregnancy increases the risk of eczema in the baby. Smokers have a higher prevalence of atopic dermatitis.

Tobacco is an irritant and pollutant that, similarly to pollution, penetrates atopic skin, which tends to have a permeable barrier. This triggers the inflammatory immune response responsible for atopic eczema. Smoking may cause an increased frequency of hand eczema, particularly in high-risk occupations.

Smoking and Ageing Skin

Tobacco smoking has unpleasant temporary cutaneous and mucosal effects: temporary yellowing of fingers and fingernails, discoloured teeth and black hairy tongue.

Longer term, the gaunt skin of a 40-year-old heavy smoker resembles that of non-smoking 70-year-old: facial wrinkles and furrows (e.g., crows’ feet at lateral canthus and vertical ear crease) .

Smoking also worsen the scores for upper eyelid skin redundancy, lower lid bags, malar bags, nasolabial folds, upper lip wrinkles, lower lip vermillion wrinkles and slack jawline,

Smoking also causes uneven skin colouring( greyish, yellow with prominent blood vessels ) and dry, coarse skin.

It is not certain exactly how smoking causes early ageing of the facial skin. Theories include: heat from the cigarette directly burning the skin, changes in the elastic fibres of the skin, narrowing of blood vessels (vasoconstriction), which reduces blood supply to the skin and can cause changes in skin elastic fibres and loss of collagen and moisture of the skin. Smoking also increases the production of free radicals and lowers levels of vitamin A in the skin.

People who smoke may be more likely to develop dark spots on their faces as well. One study found that people who smoked had higher levels of melanin in their skin compared to those who didn't smoke.

Smoking and Wound Healing

The toxic components of cigarette smoke, in particular nicotine, carbon monoxide, and hydrogen cyanide, interfere with the processes involved in wound repair.

Smoking delays wound healing, including skin injuries and surgical wounds. It increases the risk of wound infection, graft or flap failure, death of tissue and blood clot formation. The reasons for this are: vascoconstriction and lack of oxygen reaching skin cells, delayed migration of keratinocytes ( keratinocytes play an essential role in protection, as they form a tight barrier that prevents foreign substances from entering the body and function as immunomodulators following skin injuries.), decreased collagen synthesis and delayed growth of new blood vessels within the wound.

Smoking severely reduces the tissue perfusion and is one of aggravating factors for arterial leg ulcers. Smoking contributes to the development and persistence of diabetic foot ulcers.

Calciphylaxis is a rare disorder of systemic arterial calcification causing ischemia and necrosis in localized areas of the fat and skin. Smoking contributes to the development of calciphylaxis.

Smoking and Skin Infections

Smoking is associated with a greater likelihood or severity of bacterial wound infections and viral infections in the skin.

Smokers are more prone to oral infections than are non-smokers. Cigarette smoke can also modulate Candida albicans activities that promote oral candidiasis.

Less Collagen Production in Smokers

Collagen is a hard, insoluble, and fibrous protein that makes up around 30% of the protein found in the human body. It is found in the bones, muscles, tendons, teeth, skin, the cornea and lens of the eye. Collagen is the chief protein in connective tissue.

Collagen makes up 70% of the protein within our skin. Collagen is found in the dermis, or middle layer, of skin that gives it its fullness, plumpness, strength, and elasticity. It also plays a role in replacing and restoring dead skin cells.

Habitual factors that damage the production of collagen include smoking and high sugar consumption.

With age, the body produces less collagen, the structural integrity of the skin declines and wrinkles form. Smoking accelerates the aging process of skin, contributing to wrinkles. Heavy smokers are nearly five times more likely to be wrinkled than non-smokers. Smoking creates collagen-destroying enzymes and diminishes collagen production.


Smoking is associated with an increased risk of developing psoriasis, particularly the pustular forms, and this association is particularly significant in women; smoking reduces the response to psoriasis treatment; smokers and ex-smokers have a higher risk of developing severe psoriasis than nonsmokers, and this risk is directly related to the intensity of the habit (number of cigarettes smoked per day) and cumulative consumption (pack-years, calculated by multiplying the number of packs smoked per day by the number of years the person has smoked).

Palmoplantar Pustulosis

Palmoplantar pustulosis (PPP) is a rare, recurrent inflammatory disorder. Affected inpiduals develop small to large sterile blisters filled with a yellow turbid liquid (pustules) on the palms of the hands and/or soles of the feet. The pustules may be painful and cause a burning feeling.

Several authors have found a significant association between smoking and the development of PPP. A large multicenter study found that 80% of patients with PPP were current smokers at the time of disease onset, compared to only 36% of the controls. The relative risk of PPP in smokers compared to nonsmokers was 7.2. Moreover, 90% of these patients are women, and women smokers are 74 times more likely to develop PPP than nonsmoking women of the same age. Smoking cessation appears to be associated with an improvement in PPP.