Smoking reduces blood flow in the body, which prevents oxygen from supplying important vitamins and nutrients to the skin. The impaired blood flow also causes toxic products to accumulate in the skin. In addition, research has shown that smoking causes a reduction in the production of collagen, which helps the skin maintain its elasticity. Exposure to smoke can also thin the skin and promote wrinkles and premature aging.

It is unclear why some people develop severe wrinkles due to smoking and others do not. However, research has shown that women and people with lighter skin have a higher risk of developing skin damage from smoking. The duration and amount of smoking may also contribute to the development of smoking-related skin damage.

Smokers may develop a condition referred to as “smoker’s face”. Some characteristics of smoker’s face include an increase in wrinkles (especially around the eyes and mouth), complexion that is slightly red or orange and gauntness (extreme leanness).

Skin conditions that have been associated with smoking include poor wound healing, psoriasis (a common, chronic condition marked by frequent episodes in which the skin becomes itchy and red and develops scales) and skin cancer.

Wrinkles and other skin damage caused by smoking may be treated in a variety of ways. These include over-the-counter topical creams, alpha-hydroxy acids (fruit acids that have the ability to keep moisture in the skin), dermabrasion (a procedure in which the physician “sands” the skin until a new layer of remodeled skin replaces the damaged tissue) and plastic surgery.

In addition to other negative health consequences, smoking can harm the skin. Smoking mainly affects the skin of the face and hands, particularly the mouth, eyes and fingernails. Although some of the effects of smoking are only cosmetic (e.g., wrinkles), others are more serious and potentially life-threatening (e.g., skin cancer).

Scientists do not fully understand why smoking causes skin damage. It is believed that smoking reduces the flow of blood to the skin. In turn, the skin is provided with decreased amounts of oxygen and nutrients, and toxic products begin to accumulate. Also, the skin continually regenerates. When old collagen is broken down and removed, new collagen is formed to replace it. Research has shown that smoking causes a reduction in the production of collagen. Smoking has also been shown to damage the elastin in the skin. Like collagen, elastin is a fiber responsible for the skin's elasticity and strength.

Matrix metalloproteinase (MMP, a group of zinc dependent enzymes that degrade various components of both normal and diseased connective tissue) is known to break down the skin’s collagen and elastic fibers, resulting in premature aging of the skin.  Research has indicated that smokers have a higher level of MMP than non-smokers. This research may provide insight as to why smokers tend to suffer from premature aging of the skin.

Although secondhand smoke has been linked to a number of harmful effects, such as lung cancer and heart disease, it is unclear whether it negatively affects the skin. It is also not fully understood why some patients develop severe wrinkles due to smoking and others do not.

Research has demonstrated that females are more susceptible to skin damage from smoking than men because the male hormone androgen results in a thicker dermis (lower layer of the skin). Though reduction in the female hormone estrogen causes skin dryness and cracking in women, research has shown that hormone replacement therapy does not counteract this effect.

People with lighter skin are also more likely to develop skin problems from smoking because darker skin is thicker and less prone to damage.

Other factors that may contribute to the development of smoking-related skin damage include:

• Length of smoking habit
• Quantity of cigarettes smoked
• Age and sex of patient
• Amount of sun exposure by patient
• General health status
• Family history and genetics
• Decreased hormone production in women

The length of time before changes in the skin may be observed varies among individuals. Changes in the skin due to smoking have been observed in young adults with only a 10-year smoking history. However, studies indicate that light smokers are far less likely to be wrinkled than heavy smokers.

The connection between smoking and wrinkles has been observed as early as 1856, but in 1985, an English physician named Dr. Douglas Model dubbed the term “smoker’s face” to describe the effects of premature aging commonly found in smokers.

Typical characteristics of smoker’s face include:

• Increase in wrinkles, especially around the eyes and mouth
• Complexion that is slightly red or orange
• Skin appearance that is ashen, pale or gray
• Puffiness
• Gauntness (extreme leanness)

Although the effects of smoking on the skin are still being researched, smoking has been linked with the development of several skin conditions, including:

• Wrinkles. Research has shown that smokers experience more premature wrinkling than nonsmokers. Although wrinkles are not usually a health issue, the cosmetic consequences may prompt some smokers to consider quitting.
  
  
• Poor wound healing. Smoking impairs the body’s ability to heal from wounds, particularly those that result from surgery. This is because the wound receives fewer nutrients from reduced blood flow to the area. Many patients are actually instructed to stop smoking prior to elective cosmetic surgery in order to improve the wound healing process.
  
  
• Hidradenitis suppurativa. Chronic disease marked by clogging of the apocrine glands (sweat glands found on certain parts of the body such as the axilla [armpits] and groin). Smoking may contribute to this condition by altering sweat gland activity. Additionally, toxic elements of tobacco may be excreted into the sweat.
  
  
• Palmoplantar pustulosis (PPP). Skin condition seen primarily in smokers. It is characterized by the development of tiny, fluid-filled blisters on the palms of the hand and the soles of the feet. The blisters usually fill with a small amount of pus, and then turn brown and scaly.
  
  
• Psoriasis. Common, chronic condition marked by frequent episodes where the skin becomes itchy and red and develops thick, dry, silvery scales. In addition to being a risk factor for psoriasis, some studies have shown that smoking worsens the severity of the condition. Although research has shown a connection between smoking and psoriasis, it is not as strong as the link between smoking and PPP.
  
  
• Skin cancer. Smokers are at a higher risk of developing squamous cell carcinoma (cancer that begins in the squamous cells, which are found in the tissue on the surface of the skin) of the skin than nonsmokers. Smokers have not been shown to have a higher risk of developing melanoma (malignant tumor of the pigment cells of the skin). However, if smokers do develop melanoma skin cancer, they are more likely to die from it than nonsmokers.
  
  
• Miscellaneous skin conditions. Smokers may develop yellow and brown stains on the fingers and nails or they may develop “smoker’s moustache”, which is a brown or yellow discoloration of the hairs of the moustache.

There are several products and treatment techniques that may reduce the wrinkles and other skin problems associated with smoking. Patients may be treated by a dermatologist (physician that specializes in the treatment of skin, hair and nails). Treatment techniques may include:

• Anti-wrinkle creams and lotions. There are a variety of non-prescription creams and lotions that are aimed at reducing wrinkles.
  
  
• Alfa-hydroxy acids. Fruit acids that have the ability to keep moisture in the skin and improve wrinkles.
  
  
• Topical retinoids. Substances chemically related to vitamin A that are used in the treatment and prevention of various skin problems.
  
  
• Bleaching creams. Non-prescription creams are available to treat areas of discolored skin.
  
  
• Skin peels. A procedure in which the top layer of skin is removed with a chemical solution. By removing the top layer, the skin regenerates and its appearance is often improved.
  
  
• Dermabrasion. This treatment may be used to treat wrinkles around the mouth. During dermabrasion, the patient’s skin is frozen with a numbing spray and a surgeon removes or “sands” the skin until a new layer of remodeled skin replaces the damaged tissue.
  
  
• Laser resurfacing. Another technique that may be used to treat wrinkles around the mouth. It involves changing the surface texture and appearance of the skin with the use of a powerful light beam.
  
  
• Plastic surgery. Procedures such as a browlift or facelift may reduce wrinkles in some patients.

Patients who suspect they may have developed more serious skin conditions related to smoking, such as skin cancer, should consult a physician. Individuals, especially smokers, should receive an annual skin screening with a dermatologist to monitor possible adverse impacts to the skin.

Although these treatments may help reduce the wrinkles and other cosmetic problems associated with smoking, the best way to prevent wrinkles and other harmful effects is to quit smoking. There are a variety of methods that can help with smoking cessation, such as substituting a smokeless version of nicotine for cigarettes, and acupuncture (ancient Chinese medical therapy that involves inserting fine needles into the body for therapeutic purposes). Patients should discuss their smoking cessation options with a physician. People with certain skin conditions may not be good candidates for the nicotine patch.

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to smoke exposure and skin:

1. What skin conditions am I at risk for as the result of smoking?
   
   
2. My spouse smokes. Does this affect my skin?
   
   
3. Are there steps I can take to prevent skin damage while continuing to smoke?
   
   
4. What are the treatment options for my smoking-related wrinkles?
   
   
5. Is it possible to reverse the skin discoloration I have experienced as a result of smoking?
   
   
6. Is skin damage as a result of smoking at least partially reversible?
   
   
7. If I quit smoking now am I still likely to develop wrinkles when I get older?
   
   
8. Can you recommend a smoking cessation method?
   
   
9. Am I at greater risk for skin cancers because I smoke?
   
   
10. As a smoker, do I require more frequent visits to the dermatologist? If so, how often should I schedule a screening?