The effects of smoking on acne are controversial; the risk of it aggravating acne in adult women seems plausible.
Several studies have investigated the link between acne and smoking with conflicting results. Some studies have shown that tobacco protects against or alleviates acne, which is thought to stem from its anti-inflammatory effect. This effect was particularly noticeable on severe acne and in heavy smokers. However, other studies have reached opposite conclusions.
A careful examination of these studies reveals that the protective effects have generally been described in adolescents, and the aggravating effects in adult women.
Smokers’ acne is described: as predominantly comedogenic acne (black heads) and cystic acne present on the cheeks of female adult smokers. There is no proven correlation with the degree of smoking. Excessive smoking is therefore partly to blame for cystic acne in adult women.
The mode of action of smoking upon acne is not known, however, it may have an anti-inflammatory role or it may promote blockage of the pilosebaceous follicles. These are merely hypotheses.
For cystic acne on the cheeks in adult women, it is important to think about the responsibility of smoking. It would not be wise to advise adolescents to smoke to improve their acne. On the other hand, encouraging women to cut down on or stop smoking is sound advice and has the advantage of being politically correct.