It is no new fact that chronic smoking can affect human health in more than one negative way. Carcinogens detected in smoke can increase the risk of premature aging, chronic illnesses, cancer, and can even cause premature death.

When we talk about how smoking can affect skin, the list is a long one. Intake of nicotine from smoking can trigger psoriasis, hidradenitis suppurativa, chronic dermatoses, alopecia, lupus erythematosus, polymorphous light eruption, skin cancer and tobacco-associated oral lesions which could be pre-cancerous. The least it can do is premature aging , trigger skin inflammation and cause acne, and delay wound healing.

What is nicotine?

One of the alkaloid contained in tobacco is called nicotine that is easily absorbed into the respiratory tract, skin and intestinal mucosa. It is metabolised through the liver to active metabolites. It is quite addictive. It can react with different nicotinic acetylcholine receptors located in the brain, adrenal medulla, skin and inflammatory cells like monocytes and dendritic cells. Nicotine can pass into the human body through smoke inhalation, ingestion, intranasal spray, transdermal patch, topical cream, or enema.

In the skin, it increases keratinocyte(skin cell) adhesion and upward migration of epidermal cells. It not only leads to increased keratinocytosis but also modifies the cell structure over long term.

It does have a gender association. Women who smoke are at higher risk of morbidity or mortality when compared to men who chronically smoke.

What are the dermal effects of smoking?

Pre mature ageing:

Smoking is an absolute risk factor for wrinkles and premature skin ageing. This negative influence on the skin was discovered more than 150 years ago. The pathogenesis is a multifactorial one for smoke induced ageing. Smoking can affect reticular dermis by decreasing the number of elastic fibres. It can lead to the activation of metalloproteinase which can cause degradation of collagen, elastic fibres and proteoglycans. Smoking can also reduce the level of active form of the transforming growth factor β (TGF-β1) and down-regulate their receptors causing dysfunctions of tissue remodelling and repairing. An in vivo study showed that mice treated with intracutaneous or topical tobacco smoke can have a decreased level of type I collagen.

A “Smoker’s face” presents with some characteristic features such as prominent wrinkles, prominence of underlying bony contours and grey-coloured, atrophic complexion of the skin. Ageing is correlated with pack-years of smoking and number of cigarettes smoked per day. Studies confirmed the association especially with more than 40 packs smoked per year.

Delayed wound healing:

By reducing the activity of fibroblasts, it reduces their migration to site of wound and delays the healing process. It can also lead to wound dehiscence, increased chance of infection at the site of wound. Pre surgery and post operation recovery it is best to avoid smoking to avoid post operative complications.

Alopecia:

Smoking is an undeniable risk factor for androgenic alopecia among men. Studies showed that smoking over 20 cigarettes per day can be associated with developing moderate to severe androgenic alopecia

Nicotine can cause microcirculation dysfunctions among hair papilla. Cigarette smoke is a source of substances which can cause DNA mutation. Studies revealed that smoking can affect the balance between proteases and antiproteases. Moreover, it can increase pro-inflammatory cytokine concentration in anagen hair which can lead to follicular microinflammation and fibrosis. Thus, leading to alopecia.

Other skin diseases it can trigger

Smoking can trigger psoriasis and chronic dermatoses. In certain studies it has proven to be a risk factor for skin cancers like squamous cell carcinoma and keratoacanthoma, and certain anogenital cancers.

There is no debate about if smoking has a negative impact on human health or not . What remains important is that for good health it is best to stay away from a habit like smoking which can be highly addictive and is a risk factor for multiple diseases.

On that note it is wise to say, one of the best things for a healthy skin is to quit smoking and use a good sunscreen.