The Effects of Smoking on the Skin (The Full Article)
Long-term smoking can have a detrimental effect on your skin. While cosmetic changes such as premature wrinkles and skin discolouration are not life-threatening, these cutaneous (meaning affecting the skin) manifestations can provide a powerful motivation for some to quit smoking. This may be particularly true for those who took up smoking because of they felt it was "glamorous", only to discover that the reality is taking them even further away from the movie star image that they aspire to. Developing wrinkles is a natural part of the aging process but smoking effectively accelerates aging and makes the smoker appear years older than they actually are. Premature wrinkles, with dry, greyish skin drawn across sunken cheeks may all be part of the gaunt visage of the chronic smoker. There can be other, more serious, consequences for smokers, including the increased risk of some types of skin cancer and a thinning of the skin.
As early as the mid-nineteenth century, it was observed that heavy smoking could cause visible changes in a person's complexion. This included premature wrinkling and a loss of elasticity in the skin, giving the smoker a rough, haggard appearance, and a slightly reddened or orange complexion. There was, however, little effort to back this up with scientific research.
That was until 1985, when Dr. Douglas Model published an article in the British Medical Journal in which he coined the term "smoker's face". (1.) In this article, Model discussed how roughly half of the long-term smokers studied, having smoked for ten years or more, came to exhibit the same facial characteristics as a result of the damage caused by smoking. These characteristics were typical of long-term smokers and could be observed regardless of the age of the smoker, their weight, or the degree of their exposure to the sun.
"Smoker's face" occurs because toxins involved in the smoking process create a series of noticeable changes in skin complexion and colour. As the chemicals from cigarettes are absorbed into the bloodstream, they constrict the blood vessels, including the tiny capillaries located near the surface of the skin. The increased carbon monoxide produced by smoking reduces the amount of oxygen that is then circulated to areas of the skin. This means that even less oxygen and nutrients reach the skin through the constricted blood vessels. Combined with this is the capacity of direct exposure to cigarette smoke to irritate and dry-out skin. In the smoker's case, their skin's moisture levels may already be reduced because of the diuretic effect that nicotine has on the body.
The symptoms of "Smoker's face" include a number of distinct characteristics. Prominent lines and wrinkles are usually noticeable emanating from the corners of the eyes ("crow's feet"), even extending on to the cheek. The cheeks themselves may appear sunken. Other wrinkle lines become etched perpendicular to the lips, with shallow lines forming on the cheeks and lower jaw. Some male smokers may also develop a distinctive feature referred to as "cobblestone wrinkles", which are wrinkles that run down the back of the neck. The underlying bone structure of the face becomes more visible under drawn, taunt skin that has lost its elasticity. The skin may take on a dry, tough and leathery appearance. A mottled, slightly reddened, orange and purple complexion may occur because of inadequate oxygenation of the blood, similar to what occurs during cyanosis. On other occasions, the smoker's complexion may develop a grey, unnatural pallor because it is more atrophied than a non-smoker's skin.
Other factors such as stress, insomnia, pollution, and the sun's ultra violet (UV) rays can have a negative effect on the condition of the skin and may predispose the smoker to some of the characteristics attributed to "smoker's face". Free radicals, which are molecules of oxygen with unpaired electrons, can also damage the skin by attacking healthy cells and damaging skin tissue. Because smoking contains a dense population of free radicals, it increases the number of damaging free radicals present in the body. Smoking can also reduce the body's store of Vitamin A, which is used in the body's repair process.
Smoking can impede the regenerative properties of the skin. In 1977, L. H. Mosely and F. Finseth published an article that examined how smoking impaired the wound healing capabilities of the hand because of the resulting reduction in blood flow it caused. (2.) Other studies have since back up these findings, factoring in the percentage reduction in blood flow caused by smoking induced vasoconstriction and recording its duration.
It is well established that smoking reduces the skin's ability to regenerate, slowing the rate at which wounds heal and increasing the chances of scarring, especially with regard to post-surgical flaps and grafts. This is why patients are told not to smoke well in advance of them undergoing surgery. It is perhaps ironic that smoking, a major reason why someone may require a facelift, actually reduces the chances of this surgical procedure being successful by compromising the blood supply to neighbouring tissue. Some cosmetic surgeons even take measurements of nicotine levels in patient's blood prior to performing facelifts because of this contingency. Smoking will also hinder the chances of a skin graft being successful because the grafted skin needs to generate new blood vessel buds soon after being attached or it will die create scar tissue. The constriction of the blood vessels near the surface of the skin reduces the amount of oxygen available and affects the removal of dead cells and toxins.
Another consequence of smoking is that it upsets the process the body uses to restore skin by reducing the amount of the protein collagen present in the skin. Collagen produces new, healthy skin and is the connective tissue that constitutes about 80% of normal skin. When someone smokes, they effectively diminish the amount of nutrients stored in the skin, meaning that less collagen is available to repair damage. The key to the renewal process is the enzyme Matrix Metalloproteinase-1 (MMP-1), which breaks down fibrous collagen, old skin and elastic tissue. Before the body can make new skin, it needs to break down the old and this is achieved by MMP-1 destroying the fibres that form collagen. The problem for smokers is that smoking activates more of this enzyme than is normally present in non-smokers, creating a shortage of collagen. (3.) Without sufficient collagen for renewal, the skin gradually loses its elasticity, becoming dry and wrinkly.
The concentration of MMP-1 in smoker's skin was the subject of a study headed by Professor Antony Young and his colleagues at Guy's, Kings and St Thomas' School of Medicine in London. Their tests found that considerably more MMP-1 genetic material was present in the buttock skin of smokers when compared to that of non-smokers.
In another study, Akimichi Morita and researchers at Nagoya City University Medical School added drops of smoke solution to dishes of human fibroblasts, the skin cells that produce collagen. The smoke was sucked from cigarettes and pumped through saline solution. After only one day, those cells exposed to cigarette smoke produced considerably more MMP, and up to 40% less collagen, than normal skin cells would. The more concentrated smoke was introduced to the skin cells in this way, the more the production of collagen was affected. With less collagen available, the result was an increase in those symptoms associated with the aging of the skin.
Other research suggests that smoking may actually cause skin to become thinner. A study undertaken by scientists at The Twin Research Unit at St. Thomas' Hospital in London, headed by Dr. Tim Spector, studied 50 sets of identical twins, which were divided into long-term smokers and non-smokers. Ultrasound was used to gauge the inner-arm skin thickness of the twins and the results were compared. The Twin Research Unit discovered that those subjects who smoked had skin around 25%, and even up to 40%, thinner than their non-smoking siblings. The skin of the twin who smoked also exhibited the usual smoker's characteristics of being less supple and more wrinkled.
There is also evidence that smoking can damage DNA, which in turn has a deleterious effect on the skin. Dr Jan Bavinck, from the Leiden University Medical Center in the Netherlands, examined a sample of 580 people with various types of skin cancer and looked at the number of them who smoked. (4.) Squamous Cell Carcinoma is a common type of skin cancer usually caused by prolonged exposure to sunlight and which is more typical amongst older, pale-skinned, fair-haired people. Tumours for this type of cancer often start as small lumps or patches of skin that can spread if left untreated. Although quite an aggressive form of cancer, it has a high success rate when treated, usually involving surgery.
Dr Bavinck discovered that people who currently smoked around 11 to 20 cigarettes a day were over three times more likely to develop squamous cell carcinoma. After establishing smoking is an independent risk factor, the degree of risk was correspondingly acknowledged to increase the more people smoked. For smokers who smoked less than this amount, the risk of developing the cancer was reduced but was still twice the normal rate. The research team theorized that this was due to the damage smoking caused to the DNA in skin tissue, which then produced abnormal cell growth.
Smoking reduces the amount of oxygen being carried in the blood and those people with spinal cord injuries (SCI) who also smoke have been shown to have a greater incidence of pressure sores and have a slower recovery time from these sores. (5.) People with spinal cord injuries need to shift their body weight constantly to prevent developing pressure sores caused by lying on the same area of skin. This is so oxygenated blood can carry nutrients to the skin and remove waste products so that the skin remains healthy. Smoking, and especially the nicotine in cigarettes, decreases the blood flow to the extremities by constricting the blood vessels. The carbon monoxide produced by smoking also hinders oxygen from being incorporated in the bloodstream. As a result, less oxygenated blood and nutrients are transported to the skin, and the volumes of waste product removed from the skin become reduced. This is the reason why smokers with SCIs are more likely to develop skin conditions such as pressure sores.
The documented material available on this subject can leave little doubt that long-term smoking damages the skin. Whether the consequence is that it makes the smoker look older than they are, makes them more susceptible to certain types of skin cancer, or that it interferes with the skin’s ability to repair itself, the fact remains that smoking offers nothing beneficial to a person's skin. As with most other smoking related maladies, the best way to prevent developing "smoker's face" is to stop smoking before it becomes established. The longer someone smokes, the worse the damage to your skin will be, and the more pronounced the telltale symptoms of "smoker's face" become.
Some younger smokers who ignore the more deadly consequences of smoking may be more likely to listen to the warning that smoking will make them less attractive. This is certainly not the face being portrayed in the tobacco industry adverts that feature the young and the beautiful. It is sad that young people sometimes start smoking in order to look more mature, without realising that in later life it can have the unwanted consequence of making look 10 or 20 years older than they actually are.
(1.) Model, D. 'Smoker's face: An underrated clinical sign?' British Medical Journal, 1985. 291:1760-1762.
(2.) Mosely LH, Finseth F, 'Cigarette smoking: impairment of digital blood flow and wound healing in the hand.' Hand 1977. Jun; 9(2): 97-101.
(3.) Lahmann, C., J. Bergemann et al., 'Matrix Metalloproteinase-1 and Skin Aging in Smokers', The Lancet, 2001. 24:935-936.
(4.) J.N. Bouwes Bavinck, MD, et al.; 'Relation Between Smoking and Skin Cancer'; Leiden University Medical Center, Leiden, the Netherlands. Vol. 19, No. 1, (January) 2001, pp. 231-238.
(5.) Lamid S, El Ghatit AZ. 'Smoking, spasticity and pressure sores in spinal cord injured patients.' American Journal of Physical Medicine, 1983. 62:6; pp. 300-306.