How Smoking Accelerates Skin Aging

We all know the damage smoking does to the lungs and cardiovascular system, but do you know what it does to the health of your skin? The long-term effects may be much worse than you think.

Tobacco smoke contains a complex mixture of gaseous and particulate compounds, several of which may have the potential to exert physiologic and pharmacologic impacts. Various independent studies have shown that smoking has a degenerative effect on the skin.

Tobacco smoking induces oxidative stress, which has immunomodulatory effects by changing inflammatory cell function. It also causes the release of proteolytic enzymes; which in turn alters connective tissue turnover and degrades skin connective tissue. Collagen production and the deposition of mature collagen in the extracellular tissue is also significantly reduced.1 In essence, this activity accelerates the skin’s natural aging process.

Visible Effects of Tobacco Smoking
A study that examined the common features of smoker’s faces,2 found many stark similarites: lines or wrinkles on the face, typically radiating at right angles from the upper and lower lips or corners of the eyes, deep lines on the cheeks, or numerous shallow lines on the cheeks and lower jaw; a subtle gauntness of the facial features with prominence of the underlying bony contours; an atrophic, slightly pigmented grey appearance of the skin; and a plethoric, slightly orange, purple, and red complexion. These findings were shown to be independent of age, social class, exposure to sunlight, and recent changes in weight.

Additional features that are sometimes present in the faces of smokers are large open and closed comedones with furrows and nodules around the eye area. These are common characteristics of Favre-Racouchot syndrome (smoker’s comedones).3

The nails of smokers may show a yellow discoloration, and in heavy smokers who suddenly cease smoking (e.g., due to an abrupt illness), a sharp demarcation line develops between the yellow nail plate and the newly developed proximal pink nail (referred to as Harlequin nail or quitter’s nail).4

Yellow discoloration of the hair and beard can also be seen in smokers, particularly in gray-haired individuals (e.g., smoker’s moustache). Furthermore, smoking has been linked to premature graying and loss of hair, although the supporting evidence remains circumstantial.

Non-malignant changes in the oral mucosa of smokers are common and include gingival pigmentation (smoker’s melanosis), leukoplakia of the tongue (smoker’s tongue), and a gray-white keratinized palate with multiple red umbilicated papules that represent inflamed salivary glands (smoker’s palate/nicotine stomatitis).5

If the commonly known health risks associated with smoking don’t help prevent some smokers from lighting up, then hopefully the age-accelerating effects smoking has on the skin will.


1. Jorgensen LN, Kallehave F, Christensen E, et al. Less collagen production in smokers. Surgery 123(4):450-5 (1998 Apr).
2. Model D. Smoker’s face: an underrated clinical sign? Br Med J (Clin Res Ed) 291(6511):1760-2 (1985 Dec 21-28).
3. Keough GC, Laws RA, Elston DM. Favre-Racouchot syndrome: a case for smokers’ comedones. Arch Dermatol 133(6):796-7 (1997 Jun).
4. Verghese A, Krish G, Howe D, et al. The harlequin nail. A marker for smoking cessation. Chest 97(1):236-8 (1990 Jan).
5. Taybos G. Oral changes associated with tobacco use. Am J Med Sci 326(4):179-82 (2003 Oct).</p>