This article explains how smoking affects the skin and helps lay the groundwork for an acne outbreak. It also looks at other skin-related complications of cigarette smoking and whether vaping has the same effect.

“Smoker’s Acne”

An increasing body of research has linked smoking to the onset of acne in adults. A study from the San Gallicano Dermatological Institute in Italy was among the first to suggest that smoking causes a specific type of acne known as atypical post-adolescent acne (APAA).

This is a non-inflammatory form of acne that has a different disease pathway from the more common inflammatory acne.

These findings point to what some researchers have dubbed “smoker’s acne.”

What Smoker’s Acne Looks Like

APAA breakouts do not appear as the red, inflamed pimples typically associated with acne. Rather, it is characterized by the blockage of pores and the appearance of the following:

Closed comedones: Better known as whiteheads, these look like small pimples without the redness. Non-inflamed open comedones: Also called blackheads, these are open spots on the skin that get clogged with oil and dead skin cells, causing dark specks.

Smoker’s acne can occur anywhere on the body, not just around the mouth.

Causes

Researchers have found that smoking triggers two responses that together contribute to the onset of APAA.

The first is an increase in sebum peroxidation. Sebum is the oily substance found in pores that causes comedones whenever a pore is blocked. Peroxidation occurs when unstable molecules known as free radicals attack fatty acids (such as those found in sebum). The deterioration of fatty acids provides bacteria with the perfect host environment to thrive.

The second response is decreased vitamin E production. Vitamin E is an antioxidant that prevents free radicals from causing peroxidation. Cigarette smoke decreases vitamin E by degrading the fatty acids that transport the micronutrient throughout the body. This allows free radicals to reap further havoc on sebum in skin pores.

These findings were confirmed by a 2015 study from the Ohio State University in which hydrocarbons (a type of free radical) found in cigarette smoke were believed to be the culprit behind APAA.

Incidence

According to the Italian research, smokers are four times more likely to have acne than non-smokers. Cigarette smokers are also at higher risk of non-inflammatory acne. Of the 1,046 people participating in the study, three-quarters of those with non-inflammatory acne were smokers.

The number of cigarettes smoked didn’t seem to have any effect on the severity of breakouts. However, people who had acne in their teen years were four times more likely to experience smoker’s acne as an adult.

Here are some more specifics about what researchers found:

42% of the smokers had acne, compared to 10% of non-smokers. 76% of those with non-inflammatory acne were smokers. 91% of smokers with acne had the non-inflammatory form. 81% of those with severe non-inflammatory acne were smokers.

Acne inversa (hidradenitis suppurativa) is another skin condition that has been linked to smoking. It is a chronic disorder that can leave visible scars, most commonly in middle-aged female smokers.

While acne inversa looks similar to “regular” acne, it only occurs in certain areas of the skin, specifically around apocrine glands that secrete sweat (as opposed to sebaceous glands that secrete sebum). Unlike APAA, acne inversa is inflammatory.

Acne inversa is not “acne” in the traditional sense of the word. Rather, it is a condition in which the chronic inflammation of the apocrine glands causes acne-like bumps, mainly in the armpits, groin, thighs, or buttocks. The accumulation of pus in pores can lead to infection, resulting in tissue injury and irreversible scarring if not treated appropriately.

Does Vaping Cause Acne?

Like smoking, vaping can cause serious health concerns. But, compared to cigarette smoke, vaping produces far fewer hydrocarbons and theoretically poses less risk insofar as acne is concerned.

This doesn’t mean that vaping poses no risks. E-cigarettes contain a substance called propylene glycol that is known to cause dehydration of the tissues of the mouth and skin. Nicotine in e-cigarettes has the same effect.

While there is no clear connection between vaping and acne, skin dehydration will almost invariably increase sebum production as the body works to keep the skin moisturized. Increased sebum production, in turn, is linked to an increased risk of acne vulgaris—the most common form of acne—particularly in people with acne-prone skin.

And, although vaping is not associated with scarring the same way that acne can be, it can cause oral lesions, burn injuries, and a red, itchy rash called contact dermatitis caused by exposure to certain chemicals in heated e-cigarette vapors. There is also evidence that nicotine used in most e-cigarettes causes abnormal skin changes that can lead to premature skin aging.

Summary

Cigarette smoking can lead to a non-inflammatory form of acne called atypical post-adolescent acne (APAA), or simply “smoker’s acne.” Smoking can also cause an inflammatory condition called acne inversa that can lead to irreversible scarring. Studies suggest that smokers are four times more likely to have acne than non-smokers.

It is unclear if vaping has any direct association with acne. Even so, the dehydrating effect of chemicals in e-cigarettes can lead to increased sebum production which can, in turn, increase the risk of acne.

A Word From Verywell

If you’ve been trying to quit and have not succeeded, don’t give up. According to the Centers for Disease Control and Prevention, it takes an average of eight to 11 quit attempts before a person can permanently kick the habit. For some smokers, it can take up to 30.

So if you haven’t succeeded in quitting, try again. Under the Affordable Care Act, you may be entitled to full coverage of smoking cessation aids to help you in your attempts. Check the terms of your policy or call your insurer to understand what benefits are available to you.