Does Smoking Have a Significant Impact on Early Irritant Hand Dermatitis in Metal Workers?

Abstract

Background: Although they know the long-term complications of smoking, many smokers require additional motivation for entering a smoking cessation programme. At the same time, smoking is considered a possible promoting factor for various skin diseases. Objective: The present study assesses the impact of smoking on occupational hand dermatitis in a high-risk population. Material and Methods: 1,355 metal workers, 97.3% of them shift workers, took part in a standardized interview and a dermatological examination of their hands. A subgroup of 1,020 males was willing to be followed-up for 1 year. Of those, 78.3% could be included in the final assessment. Results: Compared to the general German adult population the percentage of smokers was increased (41.7% at baseline). Probably due to self-selection bias and to a higher drop-out rate, the proportion of smokers was significantly lower at follow-up. Compared to nonsmokers, smokers had significantly higher score values for both erythematous lesions and vesicles. Conclusion: The present data might give additional support for occupational physicians or dermatologists to convince workers to quit smoking.

Tobacco smoking and hand eczema – is there an association?

“…Three studies found a statistically significant positive association between tobacco smoking and HE with respect to prevalence (27)(28)(29), and one found no clear association, but a slightly increased risk of HE in heavy smokers in one subgroup, along with a potential protective association in another subgroup (30). Three studies found no association between tobacco smoking and HE prevalence (31)(32)(33), but, in one of these, smoking was linked to severe eczema (32), and in another non-smoking was linked to more severe eczema (33).…”

“…Kütting et al (27) studied 1355 metalworkers, mostly males, and found statistically significantly higher scores for erythematous skin lesions on both hands in smokers than in non-smokers at baseline (p = 0.016). In a 1-year follow-up, which included 800 male metalworkers, significantly more smokers than non-smokers reported episodes of dyshidrotic HE (p = 0.027).…”

“…However, a protective effect of tobacco on HE prevalence was reported in only one study, and in a subpopulation of patients only (Table 1). Of the 15 studies examining HE prevalence in relation to smoking, in either occupational settings or in a population-based context (Tables 1 and 2), seven studies found a positive association (27)(28)(29)(34)(35)(36)(37) between HE prevalence and smoking, and in one of these studies a dose-response relationship between level of smoking and the 1-year prevalence of HE was found (37). One study (30) showed conflicting data: no significant association was found between smoking and the 1-year prevalence of HE in the total group, but, in one subgroup (hairdressers), heavy smoking was a risk factor for HE, whereas analysis of another subgroup (bakers) showed a protective effect of smoking.…”

“…The relationship between subclassification of HE and smoking was evaluated in five studies only (27,(42)(43)(44)(45); they found no significant association (42,45), a positive association with erythematous lesions and vesicles (27), a positive association with palmar eczema (43), or a positive association with combined irritant/allergic HE (44). However, HE is a heterogeneous disease: it may be that there are differences between the various subclasses of HE and factors such as smoking.…”

“…The studies were conducted differently: 10 were cross-sectional studies (29, 34-40, 43, 44), five were case-control studies (28,30,32,33,45), and five were cohort studies (9,27,31,41,42), complicating a direct comparison.…”