Acne and Smoking in Women

Smoking woman. Portrait in soft yellow and blue tint.

Women who smoke tend to get non-inflammatory blemishes like whiteheads and blackheads.

Dermatologists often notice that mature women who have acne also tend to smoke. This article won’t tell you that you shouldn’t smoke (even though we really think you shouldn’t) but rather what women need to know to keep acne under control if they choose to smoke.

What’s Different About Acne in Women Who Smoke?

Acne is usually considered to be an inflammatory disorder. In women who smoke, researchers at the San Gallicano Hospital in Rome have discovered, acne-related blemishes tend to have a non-inflammatory character.

Women who smoke tend to get whiteheads and blackheads instead of pimples, papules, nodules, and cysts. These non-inflammatory blemishes can still leave scars when they heal, and women who smoke also can develop scars on previously clear skin.

Why should smoking cause acne?

It turns out that the skin is sensitive to nicotine. The keratinocytes (the cells that make collagen to keep skin flexible) and the fibroblasts (that repair broken skin) have nicotine receptors. When these cells come in contact with nicotine, they are stimulated. They release more collagen and add new layers to the skin, so that pores become tight. In turn, tight pores keep sebum inside. It hardens and forms whiteheads. The outermost end of a whitehead can oxidize as it is exposed to air and become a blackhead.

Nicotine also has an effect on the small blood vessels that bring oxygen and nutrients to the skin. It causes these blood vessels to constrict. This makes it harder for the immune system to send white blood cells to release inflammation-causing chemicals in the skin, so that red, peeling, itchy, and irritated acne is less likely. However, the skin is also less able to get rid of the skin oils that get stuck inside pores and less able to repair nicks and scratches.

Using a nicotine patch, incidentally, has the same effect on the skin. Both smoking and nicotine from other sources perpetuate the condition known as “smoker’s face.”

If You Aren’t Going to Stop Smoking, What Should You Do?

There are acne treatments that work well for smokers, and acne treatments that don’t.

Basic skin cleansing goes a long way in treating acne in women who smoke. Any kind of cleanser that contains polyethylene beads or corundum crystals will help break up the hardened skin oils that plug pores. Rub the cleanser over your face and rinse—these products need mechanical action to work for opening pores.

Microdermabrasion cloths and microdermabrasion creams can also be helpful for treating acne in women who smoke. These products wear away tight skin that causes fine wrinkles and that keeps pores from draining. You may be able to see subtle differences in your skin the first or second time you use products of this type, although full benefits take several months.

Red light treatments are helpful treating blemishes in smoker’s skin. They help shrink the oil-producing glands at the base of pores. Blue light and combination light treatments are not as useful, because acne in smokers’ skin usually is not caused by overgrowth of acne bacteria. It can also be helpful to use skin creams that contain green tea extract or the form of vitamin C known as ascorbyl palmitate.

Perhaps more than any other group, smokers benefit from using skin care creams that contain vitamin E. Also perhaps more than any other groups, smokers are likely to run into unexpected side effects from taking nutritional supplements that contain vitamin E.

In smokers, the skin is usually depleted of vitamin E. Using a cream that contains vitamin E (which may be labeled as alpha-tocopheryl rather than alpha-tocopherol) restores the free radical fighters the skin needs to control inflammation. Taking vitamin E supplements, however, drastically increases the production of sebum—in some people, as much as 3000%—and in some smokers can cause blackheads and whiteheads to multiply.

Acne Treatments that Aren’t As Helpful for Women Who Smoke

There are other common treatments for acne that are not as helpful for women who smoke. Exfoliants and skin peels, for instance, can actually make smoker’s face worse.

The way an exfoliant or skin peel treats acne is by using an acid to loosen up the “glue” that keeps old or dead skin cells stuck to the surface. Removing dead skin by the use of microdermabrasion cloths or microdermabrasion creams gets rid of dead skin in ways that open up pores.

Treating skin with alpha- or beta-hydroxy acids such as glycolic acid or salicyclic acid, however, not only lifts dead skin but also stimulates the growth of collagen underneath the skin. In smokers, this excessive production of collagen is part of the problem. Exfoliants leave the skin red longer for smokers than for non-smokers because circulation is impaired, and they stimulate the production of collagen that can make the skin even thicker.

Skin care products that contain the B vitamin nicotinamide are also problematic for smokers. The skin respond to nicotinamide in the same way it responds to nicotine. Some smokers develop rosacea when they use skin creams that contain nicotinamide.

And moisturizers may be helpful or harmful.

Most smokers have skin that tends to dry out. The right moisturizers keep the skin from flaking or peeling and give it a depth of color that no makeup can replace. The wrong moisturizers can make skin problems even worse.

Women who smoke should use moisturizers that are made with oil in water. The first-listed ingredient on the bottle will be water (or aqua), and the second listed ingredient will be a silicone or an ingredient ending in -yl. Women who smoke need to avoid moisturizers that are made with alcohol in water. In these products, the first-listed ingredient on the bottle will also be water (or aqua), but the second- or third-listed ingredient will end in -ol. Alcohol dries out the skin and makes smoker’s acne even worse.

If you don’t use makeup, there is an even better moisturizer than any product you can buy. It’s water itself. A splash of water on your face temporarily leaves your skin 500% moister than when it’s dry. Hydrating your face with clean water and patting it dry several times a day—if you don’t use makeup—can be one of the best ways to keep your skin bright and flexible.

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