Premature aging of the skin

We all know that smoking is bad for our health, but fewer people realize that it is also an enemy of the skin. Women in particular experience premature aging of the skin thanks to smoking. Let’s take a look at the aesthetic damage that may be caused.

The link between skin aging and smoking

Skin aging and its link to smoking has been the subject of many clinical studies. More recently, in vivo and in vitro biochemical studies have shown that tobacco is an independent cause of skin aging, especially in women, with effects proportional to the amount of tobacco smoked. The primary signs of this premature aging are wrinkles and changes in the elasticity of the dermis, both of which were demonstrated in classic clinical studies. In 1971, a study on 1104 participants flagged up the existence of a definitive link between facial wrinkles and smoking. It showed that wrinkles on the outside of the eyelid (crow’s feet) were deeper and broader on smokers than on non-smokers and that heavy smokers (people who smoked more than 10 cigarettes a day or who had been smoking for more than 15 years) had the most pronounced wrinkles. (1) Then, in 1985, Model defined “the smoker’s face”. What did it look like? Deep lines on the cheeks, fine lines or wrinkles coming off the lips and from the corners of each eye, a bony face with protruding cheekbones, a gaunt look, and shriveled and grayish skin. (2) More recently, in 1995, Ernster’s study on 1136 smokers showed a relative risk of developing moderate to severe wrinkles of 2.3 for men who smoked and 3.1 for women who smoked, compared to non-smokers. (3) A study carried out on 407 Korean participants in 2003 also demonstrated a clear link between how many wrinkles a person had and whether or not they smoked (odds ratio of 2.8 for 30 packets a year, 5.5 for 50 packets a year, and 3.7 for women). (4) Recent in vivo and in vitro biochemical studies confirmed that smoking leads to skin aging. (5) A computer-assisted silicone modeling technique used on 350 participants also revealed a relative risk of 2.72 for the appearance of moderate to severe wrinkles in smokers compared to non-smokers. Heavy smokers (people who smoked more than 50 packets a year) were 4.7 times more likely to have wrinkles than non-smokers, regardless of the amount of sun exposure.  

Smoking and sunbathing tend to exert a combined effect on skin aging, particularly for women. The study carried out on 407 Korean subjects came up with an odds ratio for developing wrinkles of 2.20 for smoking alone, 4.19 for exposure to the sun alone, and 10.78 for the two combined. Another factor that influences skin aging is estrogen. Specifically, estrogen slows down skin aging and partially determines the collagen level of the dermis. The natural decrease in estrogen that occurs over time contributes to the aging of the skin. However, nicotine prompts a premature reduction in estrogen levels which can cause the skin to age faster.      

How skin aging due to smoking occurs

Many factors are involved in the appearance of fine lines and skin aging. Tobacco smoke when combined with UVA and UVB rays may have a phototoxic effect. Smoking also decreases the amount of water in the outermost layer of the skin which could explain why smokers experience dryness. The fibers of the connective tissue are also affected by smoking, which leads to a reduction in collagen production. Toxic products contained in tobacco wear away the fundamental structures of the dermis. One of their main actions is to accelerate the rate at which the elastic fibers that give the skin its suppleness are destroyed. In addition, cigarette smoke is one of the biggest external sources of free radicals. These are responsible for preventing enough oxygen from reaching cells, which causes alterations in collagen fibers and elastin. Breathing in cigarette smoke constricts the blood vessels, which reduces the level of oxygen and essential nutrients in the tissues of the skin. This means that the skin wrinkles up more easily and becomes fragile. Recent in vivo studies have begun to reveal the molecular mechanisms which explain why premature skin aging is linked to smoking. High levels of MMP-1 enzymes are present deep in the dermis of smokers, where they cause collagen and elastin fibers to deteriorate. Studies suggest that it is hexane, a chemical product contained in cigarette smoke, that causes the MMP-1 enzymes to react in the fibroplasts. (6) Smoking causes abnormal elasticity of the dermis, which is comparable to the effect produced by prolonged sun exposure.

Other forms of aesthetic damage

Smoking produces other effects on the skin. We have known since the 1960s that smoking causes scar tissue to form more slowly, and the main cause of this is undoubtedly the reduced blood supply to the skin. This reduces the amount of oxygen and nutrients that reaches a wound, which in turn lengthens the time it takes to heal. The decrease in collagen production prompted by smoking is probably another explanation for the slow formation of scar tissue. Since smoking reduces the blood flow to the damaged skin, it also increases the risks of post-operative infections. Breast cancer operations on female smokers have demonstrated how scar tissue can become infected, necrosis can occur, and the skin can become very fragile (epidermolysis).  Because of the problems related to scar tissue formation, some plastic surgeons ask their patients to stop smoking before they undergo their operation. Other dermatological problems related to smoking include acne, for which a link has been established between the number of cigarettes smoked per day and the prevalence of the condition. Yellowing of the skin, fingers, nails, and also the teeth, is caused by smoking, while there seems to be a strong link between psoriasis and smoking, especially among women. Yes, smoking even affects your hair, as smokers experience earlier hair-loss and graying than non-smokers.  

When a person stops smoking, the skin quite quickly recovers some elasticity and loses its grayish color. Act now, and quit smoking to save your skin!

References

(1) Daniell HW, Smoker’s wrinkles. A study in the epidemiology of « crow’s feet », Ann Intern Med, 1971

(2) Model D, Smoker’s face : Who are the smokers ?, Br Med J 1985

(3) Ernster VL, Grady D, Miike R et al, Facial wrinkling in men and women, by smoking status. Am J Public Health, 1995

(4) Kennedy C, Baqtiaens MT, Bajdik CD et al, Leiden Skin Cancer Study. Effect of smoking and sun on the aging skin, J Invest Dermatol 2001

(5) Par exxemple :Yin L, Morita A, Tsuji T, Skin aging induced by ultraviolet exposure and tobacco smoking : evidence from epidemiological and molecular studies. Photodermatol Photoimmunol Photomed 2001; 17:178-83; Lahmann C, Bergemann J, Harrison G, Young AR, Matrix metalloproteinase-1 and skin ageing in smokers. Lancet 2001; 24, 357:935-6

(6) A Morita, K Torii, A Maeda, Y Yamaguchi, Molecular basis of tobacco smoke-induced premature skin aging, Journal of Investigative Dermatology Symposium Proceedings (2009) 14, 53–55; doi:10.1038/jidsymp.2009.13

  • Patel BD, Loo WJ, Tasker AD, Screaton NJ, Burrows NP, Silverman EK, Lomas DA, Smoking related COPD and facial wrinkling: is there a common susceptibility? Thorax. 2006 Jul;61(7):568-571. Epub 2006 Jun 14.
  • Freiman A, Bird G, Metelitsa AI, Barankin B, Lauzon GJ. J Cutan, Cutaneous effects of smoking. Med Surg. 2004 Nov-Dec;8(6):415-23.
  • Leonardi-Bee J, Ellison T, Bath-Hextall F. Smoking and the Risk of Nonmelanoma Skin Cancer: Systematic Review and Meta-analysisSmoking and the Risk of Nonmelanoma Skin Cancer. Arch Dermatol. 2012 Jun 1:1-8. doi: 10.1001/archdermatol.2012.1374.
  • Ortiz A, Grando SA. Smoking and the skin. Int J Dermatol. 2012 Mar;51(3):250-62. doi: 10.1111/j.1365-4632.2011.05205.x.
  • Morita A. Tobacco smoke causes premature skin aging. J Dermatol Sci. 2007 Dec;48(3):169-75. Epub 2007 Oct 24. Review.
  • CM Seitz, RW Strack, DL Wyrik, Cigarette Smoking and Facial Wrinkles: A Review of the Literature- Journal of Smoking, Cessation, 2012 - Cambridge Univ Press
  • A Dupati, Yolanda R Helfrich, Effect of cigarette smoking on skin aging- Expert Review of Dermatology, 2009
  • MA Farage, KW Miller, P Elsner, H. I. Maibach, Intrinsic and extrinsic factors in skin ageing: a review, International journal of Cosmetic Science, volume 30, issue 2, 2008
  • WB Grant - On the roles of solar ultraviolet irradiance and smoking on the diagnosis of second cancers after diagnosis of melanoma, Dermato-Endocrinology, 2012
  • A Morita, K Torii, A Maeda, Y Yamaguchi, Molecular basis of tobacco smoke-induced premature skin aging, Journal of Investigative Dermatology Symposium Proceedings (2009) 14, 53–55; doi:10.1038/jidsymp.2009.13
  • A Morita - Tobacco smoke causes premature skin aging- Journal of dermatological science, 2007 - Elsevier

Author: Anne-Sophie Glover-Bondeau / September 2012

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