Smokers Much Less Likely to get Rosacea

Written by on May 21, 2012 in in the news, research with 22 Comments


Yes you read correctly, some recent research conducted in the UK has found that smoking is associated with a substantially reduced risk of developing rosacea.

The study was epidemiological which means that it used statistics to match the incidence of rosacea in smokers and non-smokers in a random grouping of individuals.

Why Are Smokers Much Less Likely to get Rosacea?

Typically an epidemiological study can’t say why such associations exist, only prove their existence. It is the task of further research to establish the reason and any subsequent implications for treatment etc.

Other Nicotine and Rosacea Research

We learnt in 2008 from some NRS funded research that “The activation of nicotine receptors appeared to be associated with a significant increase in intracellular calcium, and also stimulated two major signaling proteins that may trigger a cascade of biochemical reactions associated with rosacea.”

So there will certainly be some debate about what the statically significant reduction in rosacea is smokers in the UK really means.

Other Results in This Study

  • Rosacea has been diagnosed in the UK in 1.65 / 1000 person-years. By my calculation this would translate to around 13% of the population of the UK having rosacea by the time they reach the life expectancy of 80 years.
  • Rosacea was diagnosed in 80% of cases after the sufferer was 30 years of age.
  • Ocular Rosacea was found in 21% of cases of rosacea.
  • Alcohol consumption was associated with a marginal risk increase.

As the study was funded by Galderma perhaps the incidence results would be the most interesting outcomes for them.

Latest Abstract

A Study on the Epidemiology of Rosacea in the UK.

Br J Dermatol. 2012 May 5, Spoendlin J, Voegel JJ, Jick SS, Meier CR.

Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Switzerland Hospital Pharmacy, University Hospital Basel, Switzerland Galderma Research & Development, Sophia Antipolis, France Boston Collaborative Drug Surveillance Program, Boston University, Lexington, MA, USA.

Background: Rosacea is a chronic facial skin disease of unclear origin. Epidemiological data are scarce and controversial with reported prevalences ranging from 0.09% to 22%. To our knowledge, incidence rates have not been quantified before.

Objectives: In this observational study we quantified incidence rates of diagnosed rosacea in the UK and described demographic characteristics and the prevalence of ocular symptoms in rosacea patients. We compared life-style factors such as smoking and alcohol consumption between rosacea patients and controls.

Methods: Using the UK-based General Practice Research Database, we identified patients with an incident diagnosis of rosacea between 1995 and 2009 and matched them (1:1) to rosacea-free control patients. We assessed person-time of all patients at risk and assessed incidence rates of rosacea, stratified by age, sex, year of the diagnosis, and region.

Results: We identified 60,042 rosacea cases and 60,042 controls (61.5% women). The overall incidence rate for diagnosed rosacea in the UK was 1.65 / 1,000 person-years.

Rosacea was diagnosed in some 80% of cases after the age of 30 years. Ocular symptoms were recorded in 20.8% of cases at the index date. We observed a significantly reduced relative risk of developing rosacea among current smokers (odds ratio 0.64, 95% CI 0.62-0.67). Alcohol consumption was associated with a marginal risk increase.

Conclusions: We quantified incidence rates and characteristics of rosacea patients diagnosed in clinical practice in a large epidemiological study using primary care data from the UK. Smoking was associated with a substantially reduced risk of developing rosacea.

Not Time to Take up Smoking

Despite the strong result from this statistical research, I doubt whether any doctor would recommend that you take up rosacea to reduce your chances of getting rosacea.

In fact you will probably find the opposite, that the health risks associated with smoking will see doctors advising smokers to give up altogether.

Any Smokers Out There?

Have you noticed a reduction in rosacea symptoms when you were a smoker ?

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About the Author: David Pascoe started the Rosacea Support Group in October 1998. .

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22 Reader Comments

  1. Rose says:

    I have found the opposite to be true, myself. My skin was so much worse when I smoked. The healthier my body is, the better my rosacea is.

    • judy says:

      So did your rosacea cleared up when you stopped smoking?
      i am 38 years old, i’ve been having rosacea since I started smoking. I think that was the case. But I see all my friends who used to smoke never had that condition problem, only me 🙁

  2. GJ says:

    Hey David. It’s been a long time.

    It’s fun to play around with these sorts of findings..because it’s epidemiology and we can. Say we think there’s something meaningful – a lesson – here:
    We might say that smokers tend to be less obese and obesity is inflammatory.

    Say we don’t think there’s anything meaningful here:
    We might say that smokers don’t care much about their health and are unlikely to visit their GP… But when they do visit their GP they are often dying. On those occasions they will not be complaining about pustules and ruddiness about the cheeks but about dying. The GP will be apt to diagnose ‘dying’ and not ‘dying with concomitant rosacea.’

    From personal experience, the skin of smokers comes in two types: either dead looking or highly florid with lots of broken vessels. The first (I guess) is a result of hypoxia and the second, a result of the body’s response to hypoxia (new vessel growth). Neither are great looks.

  3. MsLux says:

    Nonsense. Smoking wrecks your skin and makes rosacea much worse. The title is very misleading!

  4. DDD says:

    Wow this was painful to read. A. the “activation of nicotine receptors stimulates protein….. which causes rosacea”? This doesn’t support your article and then you just followed up that citing with a statement that made no sense.

    In addition their ratios just don’t make any sense to me.

  5. PTas says:

    I gave up smoking -unsuccessfully- three (3) years ago. I was a smoker for at least ten (10) years, with no rosacea symptoms. I first i saw a red face during my two (2) non smoking years! I am currently a smoker (again), with no rosacea improvement during this year. So my conclusion is this:

    Somehow, my body had developed a way to adapt my smoking habbit and discard those cancer cells produced by it. When I quit, my body had an overplus of immune cells than triggered my rosacea (I’m not a doctor, I’ m just making an assumption).

    So my advice is this. If you are not a smoker, DONT START SMOKING! If you are, try a more gradual reduction of smoking cause as far as I can tell, no sharp change is a good change for your body, even if this change aims to improve your health.

  6. coniston says:

    I stopped smoking 20 years ago without every having rosacea. Became healthy and walked my dog 3 times a day .But wondered why my eyes were always red I was tested for dry eyes which I did have 13 years ago. Seborreic derm and rosacea with pustules nearly 3 years . Wondering if the dry eyes were the start. Recently saw a new eye consultant 10 days ago recommended omega 3 and flaxseed, will it help all 3 if they are caused by inflamtion.

  7. DaveM81 says:

    This article reinforces a strong, long-held belief of mine.

    My own rosacea symptoms began severely, overnight, 6-9 months after I gave up smoking. I always suspected, at first just a gut feeling, that the two were somehow linked.

    This is not the first medical research article I have seen confirming my suspicions.

    I suffer from ‘type II’ rosacea symptoms – P&P’s ONLY. My own theory is that these are caused or aggravated by the presence of demodex mites. Where smoking fits in to the puzzle is, that cigarette smoke contains, among many other things, BENZENE. Benzene is known to kill demodex mites. Therefore, I suspect that smoking kept me free from mites. Once the effect of smoking finally made their way out of systems, the mites were free to return – hence the beginning of my symptoms just a few months after quitting.

    Many people don’t seem to want to accept this finding, but as far as I can see, more knowledge can only help in the quest against rosacea. I’m not advocating smoking – I haven’t returned to the habit myself in spite of my theory, and the extreme despair rosacea has caused me. But there is nothing to be gained in denying the link.

  8. plumage says:

    I can see a reason why this works. Smoking causes constriction of the vascular system- that is what causes people to lose the circulation in their extremities after continuous smoking. But let’s be frank smoking will kill you (a 50% chance) so don’t go there. I’d rather keep my rosacea than wreck my health.

  9. MsLux says:

    This is waffle. Many folks with rosacea have circulation problems and Raynauds, smoking exacerbates this beyond belief. Posting articles like this is slightly daft. What is the point exactly? Much if the worst rosacea I’ve seen was on smokers. I don’t care. I’d rather articles on cosmetic treatments, medical advances and laser etc. This is bad science.

  10. DaveM81 says:

    It isn’t waffle MsLux, these are actual, factual findings.

    No one is suggesting smoking as a rosacea treatment. It is important to fully investigate any findings, to improve the presently very poor level of understanding of rosacea in medicine.

  11. MsLux says:

    The words ‘appeared’ and ‘may’ are highly significant red flags. There is a huge difference between causative and associated. There are also a thousand different ways a piece of research might be referenced and interpreted. Research of this nature often directly contradicts other research as there are multiple additional factors such as race, diet, gender, age, socio economic status, medical history etc. I know people are desperate but this smacks of bad science and tabloid presentation. Folks who aren’t familiar with decoding and analysising the subtelues of these kinds of studies ate often mislead with false hope.

  12. MsLux says:

    *please excuse typos on previous post*

  13. verogaj says:

    Reading this forum, I find this news! For 15 years I suffer from rosacea, pregnancy of my last child 15 years ago … and I quit smoking!
    I can not believe … but me, if I can say that is true … in the 3rd month of my face was embararazo all full of beans and red, and thought it was hormonal … and still kept thinking. fat .. but besides 8kg, also quit me rosacea brought!
    It is also true, if someone serves, that decreasing the sugar and carbohydrates, 2 months ago my rosacea is better … I’m doing a macrobiotic diet and eliminated sugar and flour.

  14. witchnellie68 says:

    Well, isn’t that typical?
    I gave up smoking 5 years ago, partly for health but mainly to spite the (UK)taxman. I’d always flushed but never more than that. About a year after giving up my skin started to worsen – I actually decided it was part of the detox, as was the hacking cough 6 months before. It eventually became clear there was more to it than that; so I’ve been on Metrosa gel for a year now, which has eliminated the pustules but I’ve got a permanently ‘sunburnt’ look. Oh, the temptation…

  15. DaveM81 says:

    I know what you mean, Witchnellie!

    I gave up smoking in an attempt to preserve my health – and for that reason only. It would be massively ironic if giving up was indeed the trigger for my symptoms, because had I known in advance of the nightmare to come, I most likely would never have bothered quitting! And if I knew for certain that smoking again would rid me of my symptoms, I’d probably do it. Rosacea isn’t a minor annoyance to me, it’s been a life-changing nightmare.

    But I don’t know for certain. I only have a theory. And a belief that there must, surely, be another way.

  16. Steve says:

    The most obvious explanation is hat nicotine is an insecticide and Rosacea is caused by demodex mites.

  17. DaveM81 says:

    Similar to my theory Steve, which is that the benzene present in the smoke killed the mites, thereby keeping me, as a smoker, free from rosacea symptoms. Do you have a source that states nicotine is an insecticide?

    Best wishes


    • Sheldon says:

      Wow. This is fascinating. I suffered with acne for years, but after giving up smoking last year I developed a red rashy face and began flushing. I was working abroad so I blamed it on the humidity, and I had made some dietary changes during my health kick which I assumed had played a part. I smoked again back in the UK, ate a bit of everything, moved to the countryside and vowed to live healthily. I had no face rash, no puffy eyes, just the odd chin spot at that time of the month.

      I gave up again, changed my diet, cut out alcohol and processed food, did exercise and stopped wearing make up. That was 10 weeks ago, and my face is worse than it’s ever been. Red, rashy, blotchy, cysts, whiteheads… I haven’t been diagnosed with rosacea (I haven’t been to the doctors) but have all the symptoms. My mum has suffered for years, she had her most recent bout of laser surgery a few months ago. A sensible response to this would be “Hey! Look at the the gene link, the detox process, the dietary changes, the environmental factors, turning 30… those things have given you that horrible face!” I know that.

      But I also have the ‘gut feeling’ that smoking is related. The only other time I gave up was for 2 months in 2007 when I also developed a big red face, but also lived in a hot country. Funny that I have extensively traveled for 10 years and tan beautifully as a smoker. I know that this is a controversial idea, but it is one that does NOT advocate smoking; I shall continue living healthily and I would never smoke again. How sad that the pursuit of clean insides should result in such unpleasant outsides! I’m with you Dave, there’s something in it!

  18. exsmoker says:

    I have read davem81 posts hear with great interest.
    I quit smoking after 30 years or more in Jan 2013.
    After about a year off smoking I started to notice the skin on my forehead and cheeks get progressively worse and this in turn stressed me out.
    I went to my doctor and he said it was Seborrheic dermatitis.
    I had a small touch of this for years on and off, but it was always easily contained.
    I then started to get hot flushes and couldn’t stand to be in a hot room and found even drinking alcohol made me feel hot.
    After about 3 months of trying various creams and potions with nothing clearing it up, the stress of it all eventually caused me to have an anxiety attack which I had to go on medication to get over!!
    I then went to a dermatologist who said I had rosacea.
    So basically I went from a 49 year old smoker with no health issues to an anxiety ridden rosacea faced wreck!
    I didn’t initially put quitting smoking and my rosacea and anxiety together until I began to search the internet.
    I’m now convinced that quitting smoking caused my rosacea and that my rosacea caused my stress which brought on my anxiety.
    If I knew then what I know now I can say with 100% certainty that I wouldn’t have quit smoking.
    I currently undergoing IPL treatment to see if that can sort my skin out and if that doesn’t work I’ll seriously consider starting smoking again as life is just torture with this damn affliction.
    I would love to know if anyone has quit smoking, developed rosacea, started smoking again and had the rosacea clear up?

    • Kelly L. says:

      Hi exsmoker, I also was a two pack a day smoker for thirty years, quitting in October 2013, however I started “vaping” instead. About three months later, my symptoms started, begining with “dry eye”. Went to all kinds of doctors, and a dermatologist said I had ocular rosacea. What a nightmare. Almost all my eyelashes have fallen out, and some of my eyebrows, and now my entire face is afflicted as well. I was 49 when I quit, which DID stop me from life-long gum disease, so I got braces, which I should have done when I was young. Now its almost two years later and I still have it. I thought maybe it was the PG/VG ratio in my “e-cigs, and after trying to adjust that, still no change. Right after I quit smoking all kinds of stressful situations arose (kitty died unexpectedly, Mother in law died, and then last summer my 28 year old daughter was in a car accident and is now a quadraplegic, so my stress will never end). Sometimes it drives me so crazy, I want to go back to smoking, but my orthodontist warned me my teeth will start “dropping” and of course the gum disease will come back, requiring antibiotics, again, which I also suspect has something to do with this-decades of antibiotics. Now my vision is getting worse. What a choice, this nightmare or back to smoking with all those health risks. What is IPL treatment? THANK YOU for sharing your story, sounds so much like me. Was so happy to stumble across this site, and see Im not alone! I wish you luck and hope to hear from you!

  19. exsmoker says:

    Hi Kelly,
    Sorry to hear about you skin issues and the other stresses you have suffered.
    I agree our stories do indeed appear very similar.
    IPL is a laser treatment which is good but not a cure and the affects only last for so long.
    I started that this time last year roughly and had 4 sessions over 4 months which did improve the redness on my face somewhat but the constant flushing and burning sensation remained.
    I went back to my dermatologist and was prescribed an oral antifungal which made no difference and then was prescribed oral antibiotics which again made no difference.
    After putting up with this condition for 2 years I finally had enough last November and went back smoking as I reckoned I didn’t have this problem as a smoker and it had destroyed my quality of life and was starting to lead me into depression.
    After 2 months back smoking my skin has certainly improved and the flushing/ burning sensation has also greatly eased.
    My symptoms didn’t start appearing until 6mths to a year after I quit so I expect it will take that long for my skin to return to normal.
    I was a 20 a day smoker but now I just smoke 6 or 7 a day.
    I just quit and never tried vaping so perhaps it’s not the vaping that caused your issue but simply the quitting smoking?
    I feeling & looking a lot better now that I have done in the last 2 years, so while I’m regret having to go back smoking I consciously chose quality over quantity (if that turns out to be the case) as I just couldn’t continue the way I was going.
    I’m by no means advocating smoking as a cure for rosacea, all I can say is I didn’t have it as a smoker, quit and got it quite badly, started smoking and it’s getting better daily.
    There is definitely a link there and it really needs to be investigated because maybe there is a cure there that doesn’t involve having to smoke!
    I also use a tea tree oil/witch hazel face wash and toner now along with a nightly moisturiser and still apply Nizoral cream (as recommended by Derm) most nights before I go to bed.
    I hope to be able to stop the Nizoral in a few months once the improvements continue.
    Hope this is of some help to you and I wish you the best of luck for the future.

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