For smoking, consistent evidence from multiple systematic reviews points in the same direction: it is an independent, probably causal risk factor for wrinkles, loss of elasticity and impaired wound healing. For alcohol there are associative signals, but they are still too limited to quantify the impact. Anyone wanting to slow skin ageing stands to gain the most by quitting smoking.
Smoking is one of the most thoroughly studied external factors that age the skin, and multiple studies point in the same direction. A systematic review and meta-analysis identified smoking as one of seven major risk factors for skin ageing, alongside age, sex, ethnicity, air pollution, diet and sun exposure1. Smoking independently contributes to wrinkles and loss of elasticity, separate from all those other factors.
The mechanism behind smoking-related skin ageing runs largely through oxidative stress and inflammation. Tobacco smoke stimulates reactive oxygen species (aggressive molecules that damage cells and proteins) in the skin, triggering inflammatory processes that break down skin tissue2,3,4. In addition, smoking impairs wound healing, which also affects skin quality and recovery over the long term5. Together with UV radiation, smoking is considered one of the most significant external accelerators of skin ageing.
The consequences of smoking are not limited to wrinkles. There are also broader negative effects on skin diseases and on how well the skin responds to treatments6. Although the studies do not always express the magnitude in hard numbers, the effect is described as clinically meaningful. Causality is assessed as probable on the basis of the consistent pattern across multiple studies.
For alcohol, the picture is considerably less developed in the available research. Alcohol consumption is briefly mentioned in one review as a lifestyle factor that contributes to extrinsic skin ageing3, but mechanisms are not described in detail and the precise contribution cannot be quantified on the basis of these sources. The association has therefore been noted, but the evidence is thin and sits at a very different level from the evidence for smoking.
In practical terms, the advice on smoking is clear: consistent evidence from multiple studies shows that quitting smoking is the most direct modifiable step to slow further skin ageing. For alcohol, sufficient data are currently lacking to make firm statements about the size of the effect and the mechanism through which it operates.
Based on multiple systematic reviews and narrative reviews (PMID 34764376, 28705280, 39604792, 27720464, 33921444, 32681870). For smoking there is consistent evidence from multiple studies; for alcohol the support is limited to one mention as a lifestyle factor without any mechanistic elaboration.