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In today's vlog we explore the link between smoking and hair loss 👇🏻
We’re often told about the detrimental effects of smoking, but hair loss is something that is rarely touched upon. But is it something we should be worrying about?
In short, yes!
In this video we’re going to discuss some of the key research that has been done to investigate whether smoking can increase the risk of hair loss, and delve into some of the reasons behind this surprising link.
We’ll also be going over the key symptoms of hair loss in general, as well as specifically smoking-related hair loss, so you’re clued up on exactly what to look out for.
So without further ado, let’s get started!
In recent years, smoking rates have steadily fallen. As reported by the NHS (https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-smoking/statistics-on-smoking-england-2019/part-3-smoking-patterns-in-adults-copy), 19.8% of young adults were smokers in 2011, compared to 14.4% in 2019. The study also found that men are more likely than women to be smokers, which is an interesting point considering men are also much more prone to suffering with hair-loss.
- Circulatory issues
- Lung and breathing problems
- Fertility issues
There are a few well-reported side-effects of smoking, for example:
- Circulatory effects such as an increased likelihood of blood clots, high blood pressure and narrowing of the arteries
- Increased risk of many cancers, including stomach, kidney, throat and lung cancer
- Problems affecting the brain such as stroke and brain aneurysms
- Lung issues including COPD, asthma, emphysema and pneumonia, as well as increased frequency of coughs and colds
- Fertility issues such as a reduced sperm count
There are also a range of more aesthetic issues that come with smoking, for example skin problems like greying of the skin or developing a yellow tinge which can also effect the teeth and nails. Premature ageing is also a common battle for smokers, which can present itself as premature wrinkles, acne or psoriasis (https://www.stop-tobacco.ch/en/the-effects-of-smoking-on-health/premature-aging-of-the-skin).
And – you guessed it – hair loss.
So, what do we know about hair loss in general?
Well, it can be caused by a whole host of factors.
Hair loss in men can cause a variety of issues, but there are generally two main symptoms. Firstly, men may notice gradual thinning of hair on the top of the head, more commonly known as a receding hairline.
Alternatively, some men may get random, circular bald patches.
The most common cause of hair loss, which can cause either of these symptoms in men is hereditary balding. This type of hair loss tends to occur gradually (https://www.mayoclinic.org/diseases-conditions/hair-loss/symptoms-causes/syc-20372926).
And although there hasn’t been a great deal of research into whether smoking causes hair loss, there have been two notable studies that both came back with significant results, which are definitely worth considering.
The first of these studies, by R.M Trüeb (Trüeb, 2003) of the University Hospital of Zurich, found that balding due to cigarette usage was multifactorial, meaning that a variety or combination of different factors can lead to hair loss.
Let’s break this study down and take a look at the factors identified.
First of all, Trüeb proposed that hair loss due to smoking could be due to the effects cigarette smoke has on the microvasculature of the dermal hair papilla. The dermal papilla is essentially the structure that feeds a blood supply to the outer layer of the skin. They are present all over the body, but in the scalp, they have an extra responsibility – transporting oxygen and nutrients to the hair follicles to facilitate healthy hair growth. (https://www.hairtransplantmentor.com/dermal-papilla-dp/).
- Smoke affects the blood supply to hair follicles
- Oxygen and nutrients cannot be transported to the follicles
- Carbon dioxide causes this reduced blood flow
We’ve already touched upon the effects of smoking on circulation, and that is key here. The carbon dioxide in cigarette smoke reduces blood flow, including blood flow to the scalp and hair follicles, meaning they cannot receive the nutrients and oxygen required for healthy hair growth (https://ahealthyhair.com/does-smoking-cause-hair-loss/).
Hair growth will slow and potentially even cease altogether as a result.
The second factor to consider is that smoke genotoxicants can cause direct damage to the DNA of the hair follicle.
- Genotoxicants and alter DNA
- Smoking can cause this DNA change
- This can lead to disease
- As well as hair loss, when DNA alterations occur in the hair follicle
A genotoxicant is a substance that can cause direct damage to our DNA, or our genetic information.
Another study by Dr. Stephanie London supported these findings, concluding that smoking can cause a DNA change (also known as methylation), which essentially involves turning certain genes on and off and altering the genetic code.
This can wreak havoc on the body in a variety of ways, even causing serious diseases like cancer or cardiovascular disease (https://www.top-health-today.com/health-news/does-smoking-change-your-dna/).
Or, in the case of DNA alterations in the hair follicle, it can cause hair loss.
Trüeb’s study also found that hair loss can occur as a result of an imbalance in the follicular protease and antiprotease systems induced by smoking.
These protein-splitting enzymes are responsible for controlling tissue remodelling, so are absolutely vital during the hair growth cycle.
- Hair loss can be caused by an imbalance in follicular protease and antiprotease systems
- Smoking can cause this
- Protease is a protein-splitting enzyme, responsible for tissue remodelling
Worryingly, studies including one by (Kukkonen, et al., 2013) have shown that an imbalance in the protease and antiprotease systems can also lead to diseases such as chronic obstructive pulmonary disease (more commonly known as COPD) and emphysema (https://bmcpulmmed.biomedcentral.com/articles/10.1186/1471-2466-13-36).
Next, it was found that pro-oxidant effects of smoking lead to the release of pro-inflammatory cytokines, which results in follicular micro-inflammation and fibrosis. Ok, this one is a bit of a mouthful, but let’s break it down.
A pro-oxidant is a chemical that causes oxidative stress, which can in turn damage cells and tissues. A cytokine is a bracket term covering a number of substances secreted by cells in the immune system, which have an effect on other cells in the body. Fibrosis is a type of tissue damage that involves thickening and scarring, and micro-inflammation is swelling caused by microorganisms.
- A pro-oxidant causes oxidative stress
- This damages cells and tissues
- Cytokines are secreted by cells, and affect other cells in the body
- Fibrosis = tissue damage
- Micro-inflammation = swelling cause by microorganisms
- Smoking causes stress on the body’s cells, and in turn damages hair follicles
So, put simply, smoking causes a type of stress on the body’s cells, which leads to damage of the hair follicles, which can, as you would expect, result in hair loss or lack of hair growth.
Finally, smoking can result in ‘inhibition of the enzyme aromatase creating a relative hypo-oestrogenic state’. Another baffling bit of science to sum up this study with!
Hypoestrogenism refers to a lack of oestrogen in the body, which as previously mentioned is caused by an aromatase deficiency. Aromatase is also known as ‘oestrogen synthetase’ due to its role in producing oestrogens. Unfortunately, hair loss is a known side-effect of oestrogen deficiency.
- Smoking can lead to inhibition of aromatase
- Aromatase deficiency can lead to a lack of oestrogen in the body
- Hair-loss is a know side-effect of oestrogen deficiency
Unfortunately, the results of this study aren’t the only ways that smoking can result in hair-loss. There are also a number of indirect ways it can occur. Let’s discuss a few of these.
Firstly, smoking can lead to a weakened immune system, leaving us vulnerable to a variety of diseases.
Smoking cigarettes damages the antibodies and cells in our immune system that are responsible for attacking any pathogens entering our body. This leaves us extremely vulnerable to all sorts of illnesses that may present hair-loss as a symptom (https://www.livestrong.com/article/27919-cigarette-smoking-affect-immune-system/).
There is some good news though! This damage to the immune system can be counteracted – quitting smoking can both reverse the process and prevent further damage.
Another possible indirect cause of smoking-related hair-loss is stress.
- Telogen effluvium
- Alopecia areata
There are three types of hair loss associated with stress, as reported by Daniel K. Hall-Flavin (https://www.mayoclinic.org/healthy-lifestyle/stress-management/expert-answers/stress-and-hair-loss/faq-20057820):
- Telogen effluvium: This occurs when high stress levels push a large number of hair follicles into a ‘resting phase’. In time, the hairs affected will fall out suddenly and without warning.
- Trichotillomania: Trichotillomania is a psychological disorder in which sufferers have urges to pull their hair out as a way of dealing with negative emotions such as stress.
- Alopecia areata: Severe stress is thought to be a contributing factor to alopecia areata, a disease in which the body’s own immune system attacks the hair follicles and causes the hair to fall out.
But how does this relate to smoking, you may ask?
Well, for many smokers it’s a form of stress-relief, suggesting that smokers are often in a heightened state of stress or anxiety.
Ask any smoker you know and I’m sure they will tell you that cigarettes help them to calm down.
Smoking and stress:
- Cigarettes interfere with chemicals in the brain
- This causes the smoker to feel nervous or irritable when they have not had a cigarette
- The smoker associates having a cigarette with reduced stress
- But the smoking habit is likely to be causing this stress in the first place
The problem is that smoking is only a very temporary stress reliever, and may be causing the bulk of the stress itself (https://www.mentalhealth.org.uk/a-to-z/s/smoking-and-mental-health).
Cigarettes interfere with certain chemicals in the brain, which leads to a feeling of nervousness or irritability when the smoker has not had a cigarette for a length of time. This is nicotine withdrawal, which feels very similar to anxiety. When they do have a cigarette, therefore, those feelings are eased, leading to the smoker associating smoking with reduced feelings of stress.
The reality, however, is quite the opposite.
The cigarettes are what causes these stressful feelings in the first place,
so smoking to deal with them only leads to further stress in the long-run.
This heightened state of stress has the potential, therefore, to exacerbate the other physiological hair-loss inducing effects that smoking can cause.
Another indirect cause of hair-loss related to smoking is premature ageing.
As we’ve touched on already, smoking can cause symptoms such as wrinkles, gauntness and dry skin.
According to a 2009 study this ageing of the skin is thought to be caused by excess production of an enzyme that breaks down collagen – the protein responsible for providing the skin with strength and elasticity. Usually, this enzyme is useful, and serves to break down collagen so that new collagen can be formed however in smokers, too much collagen is destroyed (https://www.verywellmind.com/how-smoking-ages-skin-2223424).
Aside from the effects of the skin, collagen has other roles within our body – one of these being improving hair quality.
Collagen is responsible for moisturising the hair, promoting growth and regenerating follicles.
So, a lack of collagen caused by smoking can inevitably lead to poor hair health and even hair loss. (https://maneaddicts.com/how-collagen-affects-hair-according-to-experts/).
Lastly, smoking can deprive the body of essential vitamins, including vitamins A, C and D (which, by the way, are all ingredients in our supplements!) (https://www.livestrong.com/article/233579-smoking-and-vitamin-absorption/).
The vital one when it comes to hair loss is vitamin D.
This essential vitamin is responsible for the formation of new hair follicles, which help maintain the hair’s health and prevent it from falling out.
Vitamin D deficiency can also cause other symptoms like mood changes, muscle weakness and high blood-pressure (https://www.medicalnewstoday.com/articles/321673.php#symptoms).
So what are the main symptoms of smoking-related hair loss?
- Hair smells of smoke
- Dry/itchy scalp
- Brittle hair
- Yellowed skin or hair
- Fungal infections
Aside from obvious thinning of the hair and bald patches, there are a few symptoms to look out for which may be a precursor to smoking-related hair loss. These include (https://visihow.com/Stop_and_Reverse_Hair_Loss_Due_to_Smoking):
- Hair that smells of smoke
- Dry or itchy scalp
- Dandruff with grey flakes
- Brittle, straw-like hair
- Yellowed hair or scalp
- Thickening of the scalp due to inflammation
- Frequent fungal infections
But don’t lose hope yet! There is some good news – the second significant study in this area, found that people who smoked in the past but had since given up didn’t appear to be at an increased risk of baldness (https://www.nhs.uk/news/lifestyle-and-exercise/smoking-and-baldness/).
The main finding from this study was that there was a statistically significant correlation between moderate to severe androgenetic alopecia (this is one of the types of hair loss) and smoker status. This risk was increased by 13 times when baldness ran in the smoker’s family.
The NHS Knowledge service’s review of this particular study does note, however, that because the study comprised solely of Taiwanese men, the findings may not be directly applicable to those in other cultural groups, especially as ethnicity is thought to be linked to baldness (https://www.nhs.uk/news/lifestyle-and-exercise/smoking-and-baldness/).
So, to sum up, let’s go over what we’ve learnt about smoking and hair loss.
Firstly, there is some research to suggest that there is indeed a link between smoking and premature balding
There are several ways in which smoking can lead to increased hair loss. These include affecting the enzymes vital for healthy hair growth, damaging the circulatory system so oxygen and nutrients can’t reach the hair follicles, producing toxins that directly damage DNA, putting stress on the body’s cells and inducing oestrogen deficiency.
- Affecting enzymes vital for healthy hair growth
- Damaging the circulatory system so oxygen and nutrients can’t reach the hair follicles
- Producing toxins that can damage DNA
- Putting stress on the body’s cells
- Causing a lack of oestrogen, which can induce hair loss
There are also indirect ways in which smoking can lead to hair loss, such as by causing premature ageing or a weakened immune system which leaves you susceptible to illnesses.
Smokers are also more prone to being stressed due to the effect of cigarettes on the brain’s chemicals, which can be problematic as stress is known as a cause of hair loss.
- Premature ageing
- Weakened immune system
- Smokers generally more stressed
Some general signs of hair loss include gradual thinning of the hair and bald patches. There are also a variety of symptoms that can indicate or predict hair loss in smokers specifically, including hair that smells of smoke, weak, straw-like hair and thickening of the scalp.
And, finally, your risk of hair loss can be reduced by giving up smoking! If you would like more information on quitting smoking, visit your GP or find more information on the NHS website at www.nhs.co.uk/smokefree.
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Kukkonen, M. K. et al., 2013. Assosciation of genes of protease-antiprotease balance pathway to lung function and emphysema subtypes. BMC Pulmonary Medicine, Volume 13.
Su, L.-H. & Hsiu-Hsi Chen, T., 2007. Association of Androgenetic Alopecia With Smoking and Its Prevalence Among Asian Men. Arch Dermatol, 143(11), pp. 1401-1406.
Trüeb, R. M., 2003. Association between Smoking and Hair Loss: Another Opportunity for Health Education against Smoking?. Dermatology, 206(3), pp. 189-191.