Atopic dermatitis: disease characteristics and comorbidities in smoking and non‐smoking patients from the TREATgermany registry

Abstract

Background Atopic dermatitis (AD) is a chronic inflammatory skin disease with a multifactorial genesis including genetic predispositions and environmental risk and trigger factors. One of the latter possibly is smoking, indicated by an increased prevalence of AD in adults and children that are actively or passively exposed to cigarette smoke. Objectives In this study, AD characteristics and its atopic comorbidities are compared in smoking and non‐smoking AD patients. Methods TREATgermany is a non‐interventional clinical registry which includes patients with moderate to severe AD in Germany. Baseline data of patients included in TREATgermany from inception in June 2016 to April 2020 in 39 sites across Germany was analysed comparing AD disease characteristics and comorbidities in smokers vs. non‐smokers. Results Of 921 patients, 908 (male: 58.7%) with a mean age of 41.9 ± 14.4 reported their smoking status. The objective Scoring of Atopic Dermatitis (oSCORAD) did not differ between smokers (n = 352; 38.8%) and non‐smokers, however, lesions’ intensity of oozing/crusts and excoriations as well as patient global assessment scores (PGA) of AD severity were higher in smoking as opposed to non‐smoking patients. Smokers reported a lower number of weeks with well‐controlled AD and more severe pruritus than non‐smokers. Total IgE levels were more elevated in smokers and they displayed a younger age at the initial diagnosis of bronchial asthma. After adjustment for potential confounders, the increased intensity of oozing/crusts, the reduced number of weeks with well‐controlled AD and the greater pruritus remained different in smokers compared to non‐smokers. In addition, smoking patients with adult‐onset AD showed a 2.5 times higher chance of involvement of the feet. Conclusions German registry data indicate that AD patients who smoke have a higher disease burden with a different distribution pattern of lesions in adult‐onset AD.

European guideline (EuroGuiDerm) on atopic eczema – part II: non‐systemic treatments and treatment recommendations for special AE patient populations

“…The results of a recent registry study of 908 patients with atopic eczema suggest that the intensity of lesions and the Patient Global Assessment Score (PGA) were higher in smoking patients ( n = 352) than in non‐smoking patients (n = 556). However, physician‐assessed disease severity (oSCORAD and EASI scores) did not differ between smokers and non‐smokers in this study 160 …”

“…However, physician-assessed disease severity (oSCORAD and EASI scores) did not differ between smokers and non-smokers in this study. 160…”

Atopic dermatitis: Correlation of distinct risk factors with age of onset in adulthood compared to childhood

“…2 Conversely, an US study did not find differences between adult-and childhood-onset AD depending on the current smoking status. 15 Generally, passive and active smoking have been associated with an increased prevalence of AD, 56 active smoking also with both self-reported 61,62 and physician-assessed 8,62 AD severity. Besides biological effects, this might potentially be ascribed to a worse health behavior because of a higher psychological burden 6,63 in severe AD.…”

Predicting acute radiation dermatitis in breast cancer: a prospective cohort study

“…Although few studies have directly investigated the mechanism by which smoking causes ARD, it has been shown that smoking induces a pro-inflammatory response, oxidative stress, and skin microvascular dysfunction [ 31 , 32 ]. Among patients with atopic dermatitis, smokers showed more pruritus, more exudation, and/or crusting than non-smokers [ 33 ]. In hemodialysis patients with uremic pruritus and elevated serum interleukin (IL)-31 levels, smoking is associated with moderate to severe pruritus [ 34 , 35 ].…”