Impact of Smoking in Cutaneous Lupus Erythematosus

Abstract

To investigate cigarette smoking in cutaneous lupus erythematosus (CLE). Prospective longitudinal cohort study. Urban cutaneous autoimmune disease clinic. 218 volunteers presenting between 1/5/2007 and 7/30/2010 with CLE. Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) scores for disease severity and response to treatment. Skindex 29-3 to assess patient quality of life (QoL). Lupus current smokers had higher median CLASI scores (9.5) than never (7.0) and past (6.0) smokers (p = 0.017). Current smokers had higher median scores on all Skindex 29-3 subsets. Current smokers on hydroxychloroquine had higher quinacrine use than non-smokers (p = 0.041). 2–7 months post-enrollment, current smokers (median CLASI change -3) treated with only antimalarials improved more than never (+1) and past (0) smokers (p = 0.02). ≥ 8 months post-enrollment, current smokers (CLASI change +3.5) treated with antimalarials plus at least one additional immunomodulator improved less than never (−1.5) and past (0) smokers (p = 0.04). Current smokers with lupus had worse disease, worse quality of life, and were more often treated with hydroxychloroquine plus quinacrine than non-smokers. Never and past smokers showed greater improvement when treated with antimalarials plus at least one additional immunomodulator. Current smokers had greater improvement when treated with only antimalarials.