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Does Smoking Cause Acne?

About 20% of American adults smoke. Vastly larger percentages of adults smoke in other countries where people aren’t exposed to anti-smoking rules and regulations each and every day every time they  go out in public. About 20% of American adults have acne—but they aren’t always the same people who smoke. And some countries that have high rates of smoking don’t have high rates of smoking.

So, is it really possible that smoking causes acne? Could quitting smoking put an end to acne? Nothing in this article is intended to encourage you to smoke or to discourage from stopping smoking. We just want to provide a fair and balanced overview of the relationship between smoking and the world’s most common skin problem.

Smoking and Acne Inversa
There is a known relationship between smoking and acne inversa.

A Typical Pitch For Acne Products For Smokers

Internet marketers are always finding new market niches for acne products. The latest target for Internet marketers interested in selling acne products is selling skin care aids to smokers.

A typical pitch for a program for treating acne in smokers begins with the undisputed fact that many adults like to smoke. Cigarette smoke contains carbon dioxide, carbon monoxide, and a variety of free radical-inducing chemicals, as well as a number of substances that are toxic to tissues all over the body1. Menthol cigarettes are even more irritating than non-menthylated tobacco products.

Inhaling cigarette smoke creates a swoosh of toxic chemicals and tar that adhere to your lungs, your mouth, your nose, and your throat. The heart beats harder to force blood through blood vessels that tighten up in response to nicotine. Blood flow is redirected to the vital organs at the body’s core and away from the skin. Blood vessels in the skin are less able to deliver oxygen and nutrients and less able to remove skin irritants—so shouldn’t this all cause acne?

The Truth About Smoking And Acne

Oddly enough, reducing circulation to the skin, while it’s not a good thing, does not necessarily make acne worse. Acne is not caused by a deficiency of nutrients of oxygen. Non-inflammatory acne such as blackheads and whiteheads is caused by an accumulation and hardening of sebum in the neck of pores. Inflammatory acne is caused by the skin’s misdirected attempts to kill acne bacteria with inflammation; the bacteria release decoy chemicals known as chemotaxins that cause the inflammation triggers to attack healthy skin cells instead. Arguably, since most of the worst aspects of acne are the result of the skin’s hyperactivity, depriving the skin of oxygen and nutrients might, ironically, reduce the severity of acne.

Various studies have found that acne is more common among smokers than among non-smokers, especially among teens and young adults, but that hardly means that smoking causes acne2. After all, 100% of smokers don’t get acne. There is a known relationship, however, between smoking and a form of acne known as acne inversa.

What Is Acne Inversa?

Acne inversa is a form of the disease we haven’t discussed on the site before. This form of acne is called “inversa” because the blockage of the pore occurs from the top down rather than from the bottom up. The underlying cause of acne inversa is the too-rapid growth of skin at the very top of a hair follicle. The skin grows so fast and sheds so fast that it occludes the mouth of the pore. The sebum inside is not exposed to the air so it does not harden and it does oxidize and turn black, forming a blackhead. Pores may become inflamed and cause pimples, but they do not usually form cysts.

Also, acne inversa forms on what dermatologists call intertriginous skin, where two patches of skin touch each other. This kind of acne breaks out under the arms, between the cheeks of the buttocks, and in personal areas one usually does not associate with acne3, such as under the foreskin in men and in the vagina of women.

Who Gets Acne Inversa?

In most of the world, from 0.3% to 4% of the population4 has acne inversa. It can start as as early as age 12 and continue throughout life. It’s about 2-1/2 times more common in women than in men, and it is far more common in smokers and in people who are obese (and whose folds of skin are more difficult to keep clean). Men who get acne inversa usually have pimples around the anus and women who get acne inversa usually get it in the armpits. The one thing that most people who have acne inversa have in common is a history of smoking.

Smoking And Acne Inversa

German researchers found5 that 87% of people who had acne inversa, at least in their study of 100 people, smoked cigarettes. Most of these smokers smoked about a pack (20 cigarettes) a day, men on average 24 cigarettes a day, women on average 21 cigarettes a day. Most of them started smoking before they developed acne inversa, on average 12 years before the onset of the disease.

Acne bacteria were present in the pimples and whiteheads caused by acne inversa, but only in small numbers. Researchers conclude that acne inversa does not result from an infection, and that plug of sebum at the top of the pore in acne inversa only traps the small number of bacteria that are normally present in a pore.

Acne inversa, however, turns out to be the only form of acne that is affected by nicotine. It turns out that nicotine stimulates certain skin cells6 in much the same way that it stimulates the brain, and it helps those skin cells avoid a process known as apoptosis, or cellular suicide. Smoking may kill tissues in the lungs, but it makes certain skin cells in the buttocks, arm pits, and genitals essentially immortal—clogging pores in inconvenient places until the constant stimulation with nicotine is stopped.

If you have the everyday form of acne known as acne vulgaris or even if you have rosacea, keloidal acne, or acne fulminans, stopping smoking may not make a big difference in your complexion. But if you have acne inversa, stopping smoking may be what you need to do7 to get rid of the condition for good.


  1. Martins-Green M., Adhami N., Frankos M., Valdez M., Goodwin B., Lyubovitsky J., Dhall S., Garcia M., Egiebor I., Martinez B., Green H.W., Havel C., Yu L., Liles S., Matt G., Destaillats H., Sleiman M., Gundel L.A., Benowitz N., Jacob P. 3rd., Hovell M., Winickoff J.P., Curras-Collazo M. Cigarette Smoke Toxins Deposited on Surfaces: Implications for Human Health. PLoS One. 2014.
  2. Capitanio B., Sinagra J.L., Ottaviani M., Bordignon V., Amantea A., Picardo M. Acne and smoking. DermatoEndocrinology. 2009;1(3):129-35.
  3. Wollina U., Koch A., Heinig B., Kittner T., Nowak A. Acne inversa (Hidradenitis suppurativa): A review with a focus on pathogenesis and treatment. Indian Dermatology Online Journal. 2013;4(1):2-11.
  4. Calao M., Wilson J.L., Spelman L., Billot L., Rubel D., Watts A.D., Jemec G.B.E. Hidradenitis Suppurativa (HS) prevalence, demographics and management pathways in Australia: A population-based cross-sectional study. PLoS One. 2018.
  5. Cesko E., Korber A., Dissemond J. Smoking and obesity are associated factors in acne inversa: results of a retrospective investigation in 100 patients. European Journal of Dermatology. 2009;19(5):490-3.
  6. Lim Z.V., Oon H.H. Management of Hidradenitis Suppurativa in Patients with Metabolic Comorbidities. Annals of Dermatology. 2016;28(2):147-51.
  7. König A., Lehmann C., Rompel R., Happle R. Cigarette smoking as a triggering factor of hidradenitis suppurativa. Dermatology. 1999;198(3):261-4.
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