Abstract
INTRODUCTION: It is well-established that smoking adversely affects the skin. This study aimed to compare skin properties, skin care product usage patterns, and the status of minimally invasive cosmetic procedures and self-evaluated skin quality in active smokers, ex-smokers, and non-smokers. METHODS: This cross-sectional study was conducted in Department of Dermatology, Faculty of Medicine, Ordu University, Türkiye in 2024, with participants aged 18-65 years. Data were collected through a validated self-administered questionnaire. Categorical data were analyzed using chi-squared or Fisher's exact tests. Intergroup differences were examined using one-way analysis of variance with post hoc Bonferroni tests. Correlations between smoking duration, daily cigarette consumption, and total skin quality scores were assessed using Pearson and Spearman correlation analyses and modeled with linear regression. Receiver Operating Characteristic (ROC) analysis was used to assess the skin quality score's ability to distinguish smokers from non-smokers. Logistic regression analysis was conducted to examine the association between smoking and skin quality. Structural Equation Modeling (SEM) was used to explore the relationships between smoking, age, gender, and skin quality. RESULTS: The study included 286 men and 393 women. Active smokers had worse skin quality, with more wrinkles, spots, and pigmentation (p<0.001). E-cigarette users showed poorer skin in the forehead, around the eyes, mustache, mouth, neck, and back (p=0.007-0.034). Hookah use was linked to worse skin and more spots on the back (p=0.004 and 0.009). Average skin quality scores were 25.47 for active smokers, 27.35 for ex-smokers, and 32.1 for non-smokers. Skin quality declined as smoking duration and daily cigarette count increased (p=0.00). Active smokers more frequently received neurotoxin injections and mesotherapy for skin spots (p=0.006 and 0.026). CONCLUSIONS: This study confirms the detrimental effects of smoking - including e-cigarette and hookah use - on skin. These findings may serve as motivation for smoking cessation efforts.