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JULIE: Currently around 25 to 30 farmers are producing cigar wrapper tobacco in North Carolina

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This provides an additional indirect mechanism linking smoking to worsening acne beyond the direct skin effects What the research on smoking and acne actually shows A key piece of research establishing the smoking-acne connection is a 2009 study by Capitanio et al., published in the Journal of Investigative Dermatology , which examined acne patterns in a large cohort of adults and found a specific association between smoking and non-inflammatory acne characterised by comedones and congestion rather than the inflamed papules and pustules of classic inflammatory acne