Nicotine: does it have a role in the treatment of skin disease?

Epidemiological evidence suggests that, although smoking is detrimental in some skin diseases, it is of benefit in others such as pemphigus and Behcet disease. Evidence that nicotine is of therapeutic value in selected skin diseases is limited to case reports. There has been renewed interest in nicotinic acetylcholine receptor agonists, such as nicotine, after the discovery of a "nicotinic anti-inflammatory pathway". Nicotinic acetylcholine receptors exist in abundance in human skin, but it is unknown whether they exert an anti-inflammatory effect. Randomised controlled trials of nicotine preparations in those skin conditions that occur less often in smokers are necessary to establish the value of nicotine, if any, in the treatment of skin disease.