Brans R1, Skudlik C, Weisshaar E, Gediga K, Scheidt R, Wulfhorst B, Elsner P, Schönfeld M, John SM, Diepgen TL; for the ROQ study group.
Hand eczema (HE) is a very common occupational skin disease. Tobacco smoking is known to be associated with adverse cutaneous effects. However, its influence on the prognosis of occupational HE has not been studied yet.
To evaluate relations between smoking status, severity and prognosis of occupational HE in patients taking part in an interdisciplinary tertiary individual prevention programme (TIP).
In a prospective multi-centre cohort study 1,608 patients with occupational HE taking part in TIP were recruited and followed-up for 3 years. The clinical and self-reported outcome data of smokers and non-smokers was compared.
Non-smokers and smokers were equally distributed. During TIP the average self-reported daily cigarette consumption and the severity of HE decreased significantly (p < 0.001). However, at all time-points HE was significantly more severe in smokers than in non-smokers. This association was not dependent on the self-reported number of cigarettes smoked per day. Smokers had significantly more days of absence from work due to occupational HE than non-smokers in the year before TIP (p = 0.001) and in the year afterwards (p = 0.023). After TIP smokers reported significantly more often that they had to give up their occupation (p = 0.021) than non-smokers.
The severity of occupational HE is increased in smokers. Tobacco smoking is associated with a higher number of days of absence from work and with not staying in the workforce due to occupational HE. Thus, smoking confers a worse prognosis and interferes with the outcome of prevention programmes.