Yes. Smoking can affect scleroderma, especially systemic sclerosis, by narrowing blood vessels and reducing blood flow to the fingers and toes. This may worsen Raynaud’s attacks and contribute to circulation problems. Smoking also harms the lungs, which matters because systemic sclerosis can affect breathing. Research does not show consistently that smoking makes every part of scleroderma worse, but quitting is an important step for protecting circulation and overall health.
Which type of scleroderma is affected by smoking?
Scleroderma is a group of conditions involving changes in the skin and connective tissue. Two main forms are localised scleroderma and systemic sclerosis. Localised scleroderma mainly affects the skin and sometimes the tissues beneath it. Systemic sclerosis can affect the skin, blood vessels and internal organs, including the lungs and digestive system.
The distinction matters because the clearest concerns about smoking relate to circulation and organ health in people with systemic sclerosis. According to the NHS guide to scleroderma, systemic sclerosis can affect blood circulation and internal organs as well as the skin. Smoking can add to these health concerns, although the degree of risk depends on the person's condition and other health factors.
How does smoking affect blood circulation in scleroderma?
One of the main concerns is the effect of tobacco smoke on blood vessels. Smoking can cause blood vessels to narrow, reducing the amount of blood reaching the body's extremities. This is particularly relevant to systemic sclerosis because the condition can affect the small blood vessels supplying the fingers and toes.
Raynaud's phenomenon is common in people with systemic sclerosis. It occurs when blood vessels narrow temporarily, often in response to cold temperatures or emotional stress. The fingers or toes may become pale or blue, feel unusually cold, or develop numbness, tingling or discomfort before their colour returns as circulation improves.
Guy's and St Thomas' NHS Foundation Trust explains that tobacco smoke constricts blood vessels and decreases blood flow to the fingertips. For someone whose circulation is already affected by systemic sclerosis, smoking may make Raynaud's symptoms more difficult to manage.
Can smoking increase the risk of finger ulcers?
Reduced blood flow can make it harder for the skin and tissues around the fingertips to remain healthy. People with systemic sclerosis may develop digital ulcers, which are sores on the fingers or toes. These sores can be painful and may take time to heal, particularly when circulation is poor.
A study of 101 people with systemic sclerosis, published in Arthritis & Rheumatism and indexed by the US National Library of Medicine's PubMed database, found that current smokers were more likely than people who had never smoked to have experienced certain serious digital blood-flow complications. The study was relatively small, so its results should not be treated as an exact prediction of an individual's risk. Nevertheless, the findings support avoiding smoking when blood vessels are already vulnerable.
Seek medical assessment if a finger or toe develops a persistent sore, worsening pain, or a lasting change in colour or temperature. These changes may indicate a circulation problem that needs prompt attention.
Can smoking make systemic sclerosis progress faster?
The relationship between smoking and the overall progression of systemic sclerosis is more complicated than its effect on blood vessels. Research has examined whether smoking is linked to changes in skin thickness, lung function, digestive symptoms and other organ complications. The findings are not entirely consistent, and smoking does not affect every person with systemic sclerosis in the same way.
A review published in Cellular Immunology and available through the National Library of Medicine's PubMed database found that research on smoking and systemic sclerosis had produced conflicting results. Differences in study design, patient groups and how smoking exposure was measured make the relationship difficult to establish. In particular, the evidence does not justify claiming that smoking inevitably causes every form of the disease to become more severe.
More recent research adds detail to this picture. A 2024 analysis of 12,314 patients in the European Scleroderma Trials and Research cohort, published in RMD Open, a BMJ journal, found associations between smoking and certain progression outcomes in some groups of patients. The findings varied according to factors including sex and antibody status. Because this was an observational study, it cannot prove that smoking directly caused those outcomes, nor does it mean that the same risks apply to everyone with systemic sclerosis.
The practical conclusion is that smoking should be avoided, but it is not possible to predict an individual's disease course from smoking history alone. A rheumatology team considers symptoms, medical history, examination findings and changes over time when assessing how systemic sclerosis is affecting the body.
Does smoking affect the lungs in people with scleroderma?
Yes, smoking is an important concern for lung health. Systemic sclerosis can affect the lungs, including through interstitial lung disease, in which lung tissue becomes inflamed or scarred, and pulmonary hypertension, which involves increased pressure in the blood vessels of the lungs. Cigarette smoking can also harm the respiratory system independently of scleroderma.
Research involving people with systemic sclerosis has linked smoking with less favourable respiratory outcomes. This is one reason clinicians encourage patients to stop smoking, even when they have not been diagnosed with a lung complication. Quitting cannot guarantee that lung problems will be prevented or reversed, but it removes continued exposure to tobacco smoke and supports broader respiratory health.
Contact your healthcare professional if you develop new or worsening breathlessness, a persistent cough, or a noticeable decline in your ability to carry out normal activities. These symptoms can have several causes and should be assessed rather than automatically attributed to smoking or scleroderma.
Can smoking cause scleroderma in the first place?
Smoking has not been established as a direct cause of scleroderma. The exact causes of the condition remain unclear, and researchers continue to investigate the roles of immune-system activity, genetic factors and environmental exposures. Although smoking has been studied as a possible risk factor, the available evidence does not establish that it causes systemic sclerosis.
It is therefore important to distinguish between two questions: whether smoking causes someone to develop scleroderma and whether smoking can worsen certain health problems in someone who already has it. Evidence for a direct cause remains uncertain, while the concerns about blood-vessel narrowing and the established harms of smoking to the lungs support stopping tobacco use.
What are the benefits of quitting smoking with scleroderma?
Quitting smoking is a useful health step for people with systemic sclerosis, particularly when circulation or breathing is a concern. It may help reduce the severity of Raynaud's symptoms and prevents further exposure to tobacco smoke. It is not a cure for scleroderma, and any existing skin, blood-vessel or organ damage may need separate medical care.
A study of 606 people with systemic sclerosis, indexed by the US National Library of Medicine's PubMed database, reported that smoking was associated with poorer vascular, gastrointestinal and respiratory outcomes. The researchers also found that smoking cessation appeared beneficial for some outcomes, including Raynaud's severity. These observational findings support quitting but do not guarantee a particular improvement for every individual.
Stopping can be difficult, particularly if smoking has become part of a daily routine or is used to cope with stress. Support from a healthcare professional can make the process more manageable. A doctor or pharmacist can discuss behavioural support, nicotine-replacement products or prescription medicines and help identify suitable options based on your medical history and current treatment.
Practical steps to help you stop smoking
- Discuss a quitting plan: Ask your doctor or rheumatology team about available support and the options that may suit you.
- Choose a quit date: Set a realistic date and plan for situations that usually prompt you to smoke.
- Consider professional support: A pharmacist, smoking-cessation service or trained counsellor can help you manage cravings and reduce the chance of returning to smoking.
- Protect your circulation: Keep your hands and feet warm, particularly in cold weather, and follow any circulation-related advice from your healthcare team.
- Keep attending routine reviews: Continue recommended monitoring for lung and other organ complications, whether or not you have stopped smoking.
If you have tried to quit before, another attempt can still be worthwhile. You do not need to wait until your scleroderma symptoms worsen to seek help. Tell your healthcare professional if you smoke or have recently quit so that this information can be considered as part of your ongoing care.
When should you speak to your healthcare professional?
Discuss smoking cessation with your healthcare team if you have scleroderma, even if your symptoms are currently stable. It is particularly important to seek assessment if Raynaud's symptoms are becoming more troublesome, sores are developing on your fingers or toes, or you notice new or worsening breathing difficulties. A clinician can review these changes alongside your medical history, examination and previous test results.
Overall, smoking can affect scleroderma-related health, particularly circulation and lung health. The evidence does not show that it makes every aspect of the disease worse in every person, but there are clear reasons to avoid tobacco. Getting help to quit is a practical step toward protecting your health while continuing the monitoring and treatment recommended for your condition.