If the health risks aren’t enough to make you quit smoking, consider this: smoking has been found to be more responsible for aging the skin than sun damage (Baumann-cited, Daniel et. al., 1971). A recent German study also demonstrated that smoking is linked to acne, as about 40.8% of smokers exhibited acne, compared to 25.2% of non-smokers, amongst a population of 896 citizens.
Are any number of cigarettes safe?
No. It has been found by Daniel et. al. that even individuals who smoke less than a half a pack daily are still more likely than non-smokers to be conspicuously wrinkled (Baumann-cited). The study further found those who smoke more than 50 packs per year are 4.7 times as likely to be wrinkled than non-smokers, and if these individuals acquire sun exposure, they are several times more likely than that to be wrinkled (Baumann-cited, Kadunce et. al., 1991). With regards to acne, the study from Munich strongly indicated that the risk of acne increased as the number of cigarettes consumed per day increased.
If I quit smoking years ago, am I still more likely to have facial wrinkling now?
Unfortunately, yes. A 2002 study in the International Journal of Dermatology found that a higher degree of microscopic superficial wrinkling was noted in individuals 20-39 who smoked than in non-smokers. The same study found that older individuals who smoked between 11 and 19 years were 1.75 times more likely than non-smokers of the same age, sex, and social status to exhibit noticeable skin wrinkling. However, those who smoked more than 19 years were 2.93 times more likely than non-smokers from the same demographic to exhibit conspicuous skin wrinkling. Therefore, the effects of smoking on the skin only worsen with time. The only way to be damage-free is to never smoke at all; the next best policy is to quit as soon as possible.
Are smoking wrinkles limited to the face?
No. Although “smoker’s mouth” and facial wrinkles are commonly noted, a 2007 study in the Archives of Dermatology found that smokers were more likely than non-smokers to exhibit deep body wrinkles as well. In the study, two dermatology residents and one medical student examined photographs of 82 people ranging in 22-91 years old (average age: 56), and assigned a wrinkling score (0, none; 8, severe), without knowledge of which individuals smoked and which did not. As such, smoking does not only affect the face.
How does cigarette smoking cause wrinkling?
Three primary factors seem to be at play, although there are probably several others. One is that cigarette smoking has been found to activate matrix metalloproteinases, enzymes which degrade collagen and elastin fibers (Baumann-cited, Lahmann et. al.). Matrix metalloproteinase activation causes the skin of smokers to prematurely wrinkle, sag, and become more transparent.
A second factor is that smoking has been shown to decrease capillary and arteriolar blood flow in the skin, which may very well damage connective tissue components that are important to maintaining the integrity of the skin (Grady and Ernster, 2002). Baumann notes that the lack of blood flow slows the rate of wound healing, and therefore patients should be advised to stop smoking prior to any surgery, including a cosmetic surgery or procedure, for which adequate blood flow is required for proper outcome.
A third factor is that smoking increases oxidation activity and vitamin A levels, which are both antioxidants. Vitamin A has also been found to increase collagen levels. A study in the American Journal of Clinical Nutrition found that supplementation with 1000 mg vitamin E partially ameliorated the higher peroxidase levels, but high levels of vitamin A have been found to be toxic, so additional supplementation is not generally recommended (ask your doctor).
Are some demographics more susceptible to cigarette-induced skin damage than others?
Yes. It has been found that white people are affected more than black people, and women are more affected than men (Baumann-cited, Boyd et. al.). Further, hormone replacement therapy does not reduce the risk of facial wrinkling for women who smoke (Baumann-cited, Castelo-Branco et. al.). However, age, weight change, and social status do not play a role in the degree to which cigarette smoking ages the skin (Baumann-cited, Boyd et. al.) In addition, it must be noted that signs of aging and acne can vary even amongst individuals of the same age and gender with the same smoking history and habit. Genetics must play a role to some degree, although smokers as a whole, regardless of pack-years or frequency, exhibit greater conspicuous skin wrinkling than non-smokers.
Smoking visibly damages the skin, even when small amounts are smoked over short periods. Smoking seems to affect the skin by increasing matrix metalloproteinase expression, decreasing blood flow to the skin, and decreasing vitamin A levels. Any smokers who are concerned with their appearance should stop smoking as soon as possible, if not for their skin, than definitely for their overall health and well-being.
Please note: For this blog entry, all studies that are called “Baumann-cited” are from Chapter 4 of my favorite book, Dr. Leslie Baumann’s 2002 Cosmetic Dermatology, which contains an extremely thorough analysis of how cigarette smoking affects the skin.