The Ethical Role of Dermatologists in Smoking Cessation Counseling

Smoking has been associated with increased disease severity, poorer treatment response, and adverse outcomes in several dermatologic conditions, including hidradenitis suppurativa (HS), psoriasis, cutaneous lupus erythematosus, and chronic wounds. Although smoking cessation counseling is traditionally viewed as the responsibility of primary care clinicians, dermatologists frequently encounter patients whose skin disease may be influenced by tobacco use. This raises an important ethical question: when does counseling regarding lifestyle behaviors fall within the scope of dermatologic practice? Herein, we discuss the ethical justification for dermatologists to engage in smoking cessation counseling through the principles of beneficence, autonomy, and justice. Beneficence supports counseling when tobacco use is relevant to disease severity, treatment response, procedural outcomes, or prevention. At the same time, counseling must respect patient autonomy and avoid approaches that may contribute to emotional distress, perceived judgment, or damage to the therapeutic alliance. Justice further requires recognition of the social and structural barriers that can make smoking cessation difficult for many patients. More broadly, smoking serves as a model for addressing other modifiable health behaviors that may affect skin health, including obesity, alcohol use, and vaccination status. Dermatologists are not obligated to comprehensively manage all lifestyle factors; however, they have an ethical/professional responsibility to discuss behaviors that have meaningful implications for patient outcomes.