Acne and smoking

Figures & data

Figure 1 Mild APAA.

Figure 2 Moderate APAA.

Figure 3 Severe APAA.

Figure 4 (A) Acne is more frequent among smokers. (B) APAA is more frequent among smokers, CPAA among non smokers. (C) among patients who had post-adolescent acne, smokers have a higher probability to be affected by current acne (p = 0.0042; OR: 4.05; CI 95%: 2.6–6.3).

Figure 5 Amounts of vitamin E in the sebum of smokers is significantly lower than in healthy controls (p = 0.02). Ctr, healthy non smokers; AS, acne-smokers; Ctr-S, healthy smokers.

Figure 6 Amounts of squalene in the sebum of smokers (AS, Ctr-S) is halved compared to that present in the sebum of non smokers (Ctr) (A). In parallel with this reduction a relative increase of squalene peroxide is seen (B) (p < 0.05). Ctr, healthy non smokers; AS, acne-smokers; Ctr-S, healthy smokers.

Figure 7 Smokers affected by acne show a significant increase in sebum excretion in comparison with non smokers, affected or not affected by acne (p = 0.04). Ctr, healthy non smokers; AS, acne-smokers; Ctr-S, healthy smokers.

Figure 8 Hematoxylin-eosin 4x; (A) patient A, 30-year-old: open comedone; presence of inflammatory infiltrate and absence of elastosis; (B) patient B, 36-year-old: closed comedone, scarce inflammatory infiltrate and considerable elastosis.

Table 1 Classification criteria

Atypical Post-Adolescent Acne (APAA)	Mild-Moderate APAA (mAPAA) (Fig. 1)	Severe APAA (sAPAA, Smoker’s acne) (Figs. 2 and 3)
Papules-pustules and nodules (predominantly inflammatory lesions).	Large closed comedonals, small cyst-like comedonals, open with large dimension inflammatory lesions scarce or absent.	Like the moderate form, but the presence of cysts of the dimension > 3mm.
Mainly located on the jaws, on the mandibule and the neck.	Localized on the face, but affecting more the malar region and the forehead, with concentrations on small areas of the face.	Localized on the face but affecting the malar region and the forehead, spread over the whole face sometimes confluent.
Normal skin.	Possible normal skin/possible enlarged pore diameter and icepick scars.	Pallid skin, thick of greyish color, enlarged pore diameter, icepick scars.

Table 2 Post-adolescent acne and smoking

	Smokers	Non smokers	Total
Number of patients	277	723	1000
Acne*	155	70	185
APAA	105	33	138
mAPAA	96	31	127
sAPAA	9	2	11
CPAA	10	37	47
Healthy	162	653	815

*OR: 6.622; ci 95%: 4.7–9.3. APAA, atypical post-adolescent acne, CPAA, classical post-adolescent acne, m, mild to moderate, s, severe.

Table 3 Additional factors possibly associated with post-adolescent acne

	n
UV Lamps (>12/year)	2
Occupational factors	3
Passive smoking	2
Hyperseborrea	9
Total	16