Ann Dermatol.  2016 Apr;28(2):164-171. 10.5021/ad.2016.28.2.164.

Smoking and Hand Dermatitis in the United States Adult Population

• Lai YC
• Yew YW

• KMID: 2171372
• DOI: http://doi.org/10.5021/ad.2016.28.2.164

Abstract

BACKGROUND
Hand dermatitis is a common chronic relapsing skin disease resulting from a variety of causes, including endogenous predisposition and environmental exposures to irritants and allergens. Lifestyle factors such as smoking have been implicated in hand dermatitis.
OBJECTIVE
To evaluate the association between tobacco exposure and hand dermatitis using the 2003~2004 National Health and Nutrition Examination Survey (NHANES) database.
METHODS
Data were retrieved and analyzed from 1,301 participants, aged 20~59 years, from the 2003~2004 NHANES questionnaire study who completed health examination and blood tests. Diagnosis of hand dermatitis was based on standardized photographs of the dorsal and palmar views of the hands read by two dermatologists.
RESULTS
There were 38 diagnosed cases of active hand dermatitis out of the 1,301 study participants (2.9%). Heavy smokers (>15 g tobacco daily) were 5.11 times more likely to have active hand dermatitis (odds ratio [OR], 5.11; 95% confidence interval [CI], 1.39~18.88; p=0.014). Those with serum cotinine >3 ng/ml were also more likely to have active hand dermatitis, compared with those with serum cotinine ≤3 ng/ml (OR, 2.50; 95% CI, 1.26~4.95; p=0.007). After adjusting for confounding factors such as age, atopic diathesis, occupational groups, and physical activity, the association between tobacco exposure and active hand dermatitis remained significant.
CONCLUSION
Smoking has a significant association with the presence of active hand dermatitis. It is important to consider smoking cessation as part of management of hand dermatitis.

Keyword

Dermatitis; Eczema; Epidemiology; Smoking

MeSH Terms

Adult*
Allergens
Cotinine
Dermatitis*
Diagnosis
Disease Susceptibility
Eczema
Environmental Exposure
Epidemiology
Hand*
Hematologic Tests
Humans
Irritants
Life Style
Motor Activity
Nutrition Surveys
Occupational Groups
Skin Diseases
Smoke*
Smoking Cessation
Smoking*
Tobacco
United States*
Allergens
Cotinine
Irritants
Smoke

Reference

1. Thyssen JP, Johansen JD, Linneberg A, Menné T. The epidemiology of hand eczema in the general population--prevalence and main findings. Contact Dermatitis. 2010; 62:75–87.

2. Meding B, Swanbeck G. Prevalence of hand eczema in an industrial city. Br J Dermatol. 1987; 116:627–634.

3. Meding B. Epidemiology of hand eczema in an industrial city. Acta Derm Venereol Suppl (Stockh). 1990; 153:1–43.

4. Agner T, Andersen KE, Brandao FM, Bruynzeel DP, Bruze M, Frosch P, et al. EECDRG. Hand eczema severity and quality of life: a cross-sectional, multicentre study of hand eczema patients. Contact Dermatitis. 2008; 59:43–47.

5. de Jongh CM, Khrenova L, Verberk MM, Calkoen F, van Dijk FJ, Voss H, et al. Loss-of-function polymorphisms in the filaggrin gene are associated with an increased susceptibility to chronic irritant contact dermatitis: a case-control study. Br J Dermatol. 2008; 159:621–627.

6. Brown SJ, Cordell HJ. Are filaggrin mutations associated with hand eczema or contact allergy?--we do not know. Br J Dermatol. 2008; 158:1383–1384.

7. Thyssen JP, Carlsen BC, Menné T. Nickel sensitization, hand eczema, and loss-of-function mutations in the filaggrin gene. Dermatitis. 2008; 19:303–307.

8. Meding B, Swanbeck G. Predictive factors for hand eczema. Contact Dermatitis. 1990; 23:154–161.

9. Meding B, Lidén C, Berglind N. Self-diagnosed dermatitis in adults. Results from a population survey in Stockholm. Contact Dermatitis. 2001; 45:341–345.

10. Bryld LE, Hindsberger C, Kyvik KO, Agner T, Menné T. Risk factors influencing the development of hand eczema in a population-based twin sample. Br J Dermatol. 2003; 149:1214–1220.

11. Meding B, Järvholm B. Hand eczema in Swedish adults - changes in prevalence between 1983 and 1996. J Invest Dermatol. 2002; 118:719–723.

12. Lisby S, Baadsgaard O. Mechanisms of irritant contact dermatitis. In : Rycroft RJG, Menné T, Frosch PJ, Lepoittevin JP, editors. Textbook of contact dermatitis. 3rd ed. Berlin and Heidelberg: Springer Verlag;2001. p. 95–98.

13. Rustemeyer T, van Hoogstraten IMW, von Blomberg BME, Scheper RJ. Mechanisms in allergic contact dermatitis. In : Rycroft RJG, Menné T, Frosch PJ, Lepoittevin JP, editors. Textbook of contact dermatitis. 3rd ed. Berlin and Heidelberg: Springer Verlag;2001. p. 30–36.

14. La Vecchia C, Gallus S, Naldi L. Tobacco and skin disease. Dermatology. 2005; 211:81–83.

15. Miot HA, Bartoli Miot LD, Haddad GR. Association between discoid lupus erythematosus and cigarette smoking. Dermatology. 2005; 211:118–122.

16. O'Doherty CJ, MacIntyre C. Palmoplantar pustulosis and smoking. Br Med J (Clin Res Ed). 1985; 291:861–864.

17. Linneberg A, Nielsen NH, Menné T, Madsen F, Jørgensen T. Smoking might be a risk factor for contact allergy. J Allergy Clin Immunol. 2003; 111:980–984.

18. Dotterud LK, Smith-Sivertsen T. Allergic contact sensitization in the general adult population: a population-based study from Northern Norway. Contact Dermatitis. 2007; 56:10–15.

19. Karvonen J, Poikolainen K, Reunala T, Juvakoski T. Alcohol and smoking: risk factors for infectious eczematoid dermatitis? Acta Derm Venereol. 1992; 72:208–210.

20. Thomsen SF, Sørensen LT. Smoking and skin disease. Skin Therapy Lett. 2010; 15:4–7.

21. Meding B, Alderling M, Wrangsjö K. Tobacco smoking and hand eczema: a population-based study. Br J Dermatol. 2010; 163:752–756.

22. Anveden Berglind I, Alderling M, Meding B. Life-style factors and hand eczema. Br J Dermatol. 2011; 165:568–575.

23. Arrandale VH, Kudla I, Holness LD. Smoking and allergic contact dermatitis: causation or correlation? Occup Environ Med. 2014; 71:Suppl 1. A112.

24. Brans R, Skudlik C, Weisshaar E, Gediga K, Scheidt R, Wulfhorst B, et al. ROQ study group. Association between tobacco smoking and prognosis of occupational hand eczema: a prospective cohort study. Br J Dermatol. 2014; 171:1108–1115.

25. Kütting B, Uter W, Weistenhöfer W, Baumeister T, Drexler H. Does smoking have a significant impact on early irritant hand dermatitis in metal workers? Dermatology. 2011; 222:375–380.

26. Thyssen JP, Linneberg A, Menné T, Nielsen NH, Johansen JD. The effect of tobacco smoking and alcohol consumption on the prevalence of self-reported hand eczema: a cross-sectional population-based study. Br J Dermatol. 2010; 162:619–626.

27. Montnémery P, Nihlén U, Löfdahl CG, Nyberg P, Svensson A. Prevalence of hand eczema in an adult Swedish population and the relationship to risk occupation and smoking. Acta Derm Venereol. 2005; 85:429–432.

28. Edman B. Palmar eczema: a pathogenetic role for acetylsalicylic acid, contraceptives and smoking? Acta Derm Venereol. 1988; 68:402–407.

29. Meding B, Alderling M, Albin M, Brisman J, Wrangsjö K. Does tobacco smoking influence the occurrence of hand eczema? Br J Dermatol. 2009; 160:514–518.

30. Röhrl K, Stenberg B. Lifestyle factors and hand eczema in a Swedish adolescent population. Contact Dermatitis. 2010; 62:170–176.

31. Veien NK, Hattel T, Laurberg G. Hand eczema: causes, course, and prognosis I. Contact Dermatitis. 2008; 58:330–334.

32. Bø K, Thoresen M, Dalgard F. Smokers report more psoriasis, but not atopic dermatitis or hand eczema: results from a Norwegian population survey among adults. Dermatology. 2008; 216:40–45.

33. Berndt U, Hinnen U, Iliev D, Elsner P. Hand eczema in metalworker trainees--an analysis of risk factors. Contact Dermatitis. 2000; 43:327–332.

34. Lerbaek A, Kyvik KO, Ravn H, Menné T, Agner T. Incidence of hand eczema in a population-based twin cohort: genetic and environmental risk factors. Br J Dermatol. 2007; 157:552–557.

35. Anveden Berglind I, Alderling M, Meding B. Life-style factors and hand eczema. Br J Dermatol. 2011; 165:568–575.

36. Lukács J, Schliemann S, Elsner P. Association between smoking and hand dermatitis--a systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2015; 29:1280–1284.

37. Armitage AK, Dollery CT, George CF, Houseman TH, Lewis PJ, Turner DM. Absorption and metabolism of nicotine from cigarettes. Br Med J. 1975; 4:313–316.

38. Benowitz NL, Kuyt F, Jacob P 3rd, Jones RT, Osman AL. Cotinine disposition and effects. Clin Pharmacol Ther. 1983; 34:604–611.

39. Jacob P 3rd, Yu L, Wilson M, Benowitz NL. Selected ion monitoring method for determination of nicotine, cotinine and deuterium-labeled analogs: absence of an isotope effect in the clearance of (S)-nicotine-3',3'-d2 in humans. Biol Mass Spectrom. 1991; 20:247–252.

40. Benowitz NL, Hukkanen J, Jacob P 3rd. Nicotine chemistry, metabolism, kinetics and biomarkers. Handb Exp Pharmacol. 2009; (192):29–60.

41. Aicher A, Heeschen C, Mohaupt M, Cooke JP, Zeiher AM, Dimmeler S. Nicotine strongly activates dendritic cell-mediated adaptive immunity: potential role for progression of atherosclerotic lesions. Circulation. 2003; 107:604–611.

42. Grando SA, Horton RM, Pereira EF, Diethelm-Okita BM, George PM, Albuquerque EX, et al. A nicotinic acetylcholine receptor regulating cell adhesion and motility is expressed in human keratinocytes. J Invest Dermatol. 1995; 105:774–781.

43. Arnson Y, Shoenfeld Y, Amital H. Effects of tobacco smoke on immunity, inflammation and autoimmunity. J Autoimmun. 2010; 34:J258–J265.

44. Armstrong AW, Armstrong EJ, Fuller EN, Sockolov ME, Voyles SV. Smoking and pathogenesis of psoriasis: a review of oxidative, inflammatory and genetic mechanisms. Br J Dermatol. 2011; 165:1162–1168.

45. Rossi M, Pistelli F, Pesce M, Aquilini F, Franzoni F, Santoro G, et al. Impact of long-term exposure to cigarette smoking on skin microvascular function. Microvasc Res. 2014; 93:46–51.

46. Jensen JA, Goodson WH, Hopf HW, Hunt TK. Cigarette smoking decreases tissue oxygen. Arch Surg. 1991; 126:1131–1134.

47. Sørensen LT, Jørgensen S, Petersen LJ, Hemmingsen U, Bülow J, Loft S, et al. Acute effects of nicotine and smoking on blood flow, tissue oxygen, and aerobe metabolism of the skin and subcutis. J Surg Res. 2009; 152:224–230.

48. Ortiz A, Grando SA. Smoking and the skin. Int J Dermatol. 2012; 51:250–262.

49. Thyssen JP, Johansen JD, Menné T, Nielsen NH, Linneberg A. Effect of tobacco smoking and alcohol consumption on the prevalence of nickel sensitization and contact sensitization. Acta Derm Venereol. 2010; 90:27–33.

50. James WD, Berger TG, Elston DM. Contact dermatitis and drug eruptions. In : James WD, Berger TG, Elston DM, editors. Andrew's diseases of the skin: Clinical dermatology. 11th ed. London: Saunders/Elsevier;2011. p. 88–137.