Data to Date Points to Links Between Smoking and Hair Loss

It seems pretty clear, based on past studies, that smokers are at increased risk for hair loss. We’ve covered the topic in several articles

ARTICLE 1: Smoking and Balding

ARTICLE 2: Smoking and Balding: Why I Encourage My Patients to Quit

I was interested to read a nice systematic review by Kavadya and Mysore in the March/April issue of the International Journal of Trichology. The authors also sought to review the literature on the relationship between smoking and hair loss.

The authors point out there are several proposed mechanisms by which smoking and chemicals in smoke such as nicotine and others can contribute to hair loss. These mechanisms include: 1) Vasoconstrictor action by smoke metabolites 2) Retention of DNA adducts causing DNA damage 3) Oxidative stress and disequilibrium of antioxidant system and enhancing senescence mechanisms 4) Sustained microinflammation causing perifollicular fibrosis 5) Desensitization of nicotinic acetylcholine receptors and 6) Androgen-dependent hair thinning (reducing estradiol and increasing androgens)

Mosley and Gibbs, 1996

The Mosley and Gibbs study of 1996 often gets referenced when it comes to studies of smoking and hair loss. This was one of the very first reports that set out to meaningfully address the relationship between smoking and hair loss. The authors studied 606 patients (268 male and 338 female) age 30 and over who were visiting a surgical outpatient department over the three months of the study. Patients who were smokers had a nearly two fold greater risk for balding than non smokers (odds ratio 1.93 (95% confidence interval [CI]: 1.13–3.28). Interestingly, in that same study smokers were 4.4 times more likely to have greying of hair than non smokers implicating smoking in the greying of hair too.

Su and Chen 2007

An important study examining 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.

Studies 2008-2022

In addition to the Mosley and Gibbs and Su et al studies that are the first studies in this area, the authors of the current study remind us that there have been 6 or so additional studies that have highlighted an association between smoking and hair loss.

Gatherwright J, Liu MT, Gliniak C, Totonchi A, Guyuron B. The contribution of endogenous and exogenous factors to female alopecia: A study of identical twins. Plast Reconstr Surg. 2012;130:1219–26. [PubMed: 22878477]

Gatherwright J, Liu MT, Amirlak B, Gliniak C, Totonchi A, Guyuron B. The contribution of endogenous and exogenous factors to male alopecia: A study of identical twins. Plast Reconstr Surg. 2013;131:794e–801e.

Park SY, Oh SS, Lee WS. Relationship between androgenetic alopecia and cardiovascular risk factors according to BASP classification in Koreans. J Dermatol. 2016;43:1293–300. [PubMed: 27028221]

Fortes C, Mastroeni S, Mannooranparampil TJ, Ribuffo M. The combination of overweight and smoking increases the severity of androgenetic alopecia. Int J Dermatol. 2017;56:862–7. [PubMed: 28555720]

Vora RV, Kota RK, Singhal RR, Anjaneyan G. Clinical profile of androgenic alopecia and its association with cardiovascular risk factors. Indian J Dermatol. 2019;64:19–22. [PMCID: PMC6340244] [PubMed: 30745630]

Salem AS, Ibrahim HS, Abdelaziz HH, Elsaie ML. Implications of cigarette smoking on early-onset androgenetic alopecia: A cross-sectional study. J Cosmet Dermatol. 2021;20:1318–24. [PubMed: 32946667]

Conclusion

It’s clear that smoking impacts hair loss and does so potentially through a variety of different mechanism. Most studies suggest that smokers are at increased risk for earlier onset of hair loss and a more severe type. The authors of this systemic review point out that not all studies in the medical literature have shown a positive association between smoking and hair loss although the overwhelming majority of studies highlight this link.

REFERENCES

Kavadya T and Mysore V. Role of Smoking in Androgenetic Alopecia: A Systematic Review. Int J Trichology. 2022 Mar-Apr; 14(2): 41–48.

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.

Mosley JG and Gibbs AC. Premature grey hair and hair loss among smokers: a new opportunity for heatlh education? British Medical Journal 1996; 313: 1616.