E -cigarettes and hair loss: Still a concern

E-cigarettes have the potential to accelerate androgenetic alopecia

Electronic cigarettes (or e-cigarettes) have become increasingly popular since they first arrived to the world scene in 2004. Nowadays nearly 4 % of adults in the US use them.

A e-cigarettes is a battery operated device that typically emits vaporized nicotine to the user. Doses of nicotine delivered to the user range from very low (even zero) to very high. They provide the user with a similar sensation to regular cigarettes without the tobacco smoke. There are many forms of e-cigarettes including those that resemble a classic cigarette as well as a pen, pipe and cigar. E-cigarette use is increasingly popular in adolescents, many of whom have never smoked regular (tobacco) cigarettes. In fact, a great deal of marketing efforts go into targetting younger age groups.

E-cigarettes are not without risk. In 2016, FDA clamped down on sellers of e-cigarettes and brought forth tougher rules on how they are sold and marketed. In the same year, the surgeon general stated formally that e-cigarette user is a significant public health concern.

E-cigarettes and Hair Loss

For many years, researchers have been trying to figure out whether smoking speeds up the process of genetic balding. The studies have been somewhat inconsistent but point to the possibility that smoking accelerates the process of male balding.

An important study examing the relationship between smoking and hair loss was a 2007 study by the Taiwanese group of Dr. Su and Dr Chen.  These researchers examined 740 patients between the ages of 40 and 91 over a 2 month period.  They found that smokers generally had worse androgenetic alopecia compared to non-smokers. In fact, smokers had nearly a two-fold increased risk of having moderate or severe genetic hair loss compared to non-smokers. In addition, the early development of male balding was more likely in smokers.

It’s not clear if e-cigarettes bring about the same risk for the hair follicle as traditional tobacco cigarretes. It’s certainly possible the risk is different but no one knows yet for sure. It has been proposed be that smoking is damaging to the tiny blood vessels and the there are toxic substances in cigarette smoke that damage the cells in the hair follicles. It's also possible that smoking causes inflammation which speeds up the process of genetic hair loss. Some of the toxic substances in traditional cigarettes may be absent in e-cigarettes. But what is not absent in most e-cigarettes is the nicotine component. It’s likely that nicotine affects blood flow and affects inflammation in hair follicles.

In addition to the effects on blood flow, there is no getting around the fact that nicotine is found in hair of individuals who use nicotine. In fact, one way to monitor in clinical studies how well a person is stopping smoking is to measure the nicotine content of their hair.

Nicotine may also promote inflammation. In 2000, a study performed in rats showed clearly that this is the case. Rats exposed to nicotine were showed to have chronic inflammation and fibrosis (scarring) in the skin and effects were seen around hair follicles as well.


There is still alot of unknowns when it comes to the effects of e-cigarettes on the hair and more good studies are needed. It is quite likely that nicotine affects hair in a negative way and that use of e-cigarettes may accelerate the process of balding in those who have a genetic predisposition.


 Su LH and Chen T H-H. Association of Androgenetic Alopecia with Smoking and Its Prevalance Among Asian Men. Archives of Dermatology 2007 143; 1401-1406.

Inaloz H et al. Teratogenic effects of nicotine on rat skin. Clin Exp Obstet Gynecol 2000; 27: 241-3

Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Whistler office at 604.283.1887

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