Influence of Smoking on Disease Severity and Antimalarial Therapy in Cutaneous Lupus Erythematosus: Analysis of 1002 Patients from the EUSCLE Database.

British Journal of Dermatology

PubMedID: 24673427

Kuhn A, Sigges J, Biazar C, Ruland V, Patsinakidis N, Landmann A, Amler S, Bonsmann G, The EUSCLE Co-Authors. Influence of Smoking on Disease Severity and Antimalarial Therapy in Cutaneous Lupus Erythematosus: Analysis of 1002 Patients from the EUSCLE Database. Br J Dermatol. 2014;171(3):571-9.
BACKGROUND
In the last years, it has been controversially discussed in the literature if smoking is associated with the activity of cutaneous lupus erythematosus (CLE) and the efficacy of antimalarial agents.

OBJECTIVES
To investigate the influence of smoking on disease severity and antimalarial treatment in patients with CLE using the Core Set Questionnaire of the European Society of Cutaneous Lupus Erythematosus (EUSCLE).

METHODS
A total of 1002 patients (768 female, 234 male) with different CLE subtypes were included in this cross-sectional study, which was performed in 14 different countries. Smoking behaviour was assessed by the EUSCLE Core Set Questionnaire and statistically analysed using an SPSS database. The results were correlated with the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI) and the efficacy of antimalarial treatment.

RESULTS
A high percentage (87.2%) of the 499 CLE patients, who have ever smoked, had already smoked by the date of their first diagnosis. Patients with intermittent CLE smoked significantly more often than patients with subacute CLE (p<0.05) and chronic CLE (p<0.05). The total CLASI activity and damage score of CLE patients was 6.6 ± 7.1 and 2.6 ± 4.3, respectively, and was higher in patients who have ever smoked than in non-smokers. Antimalarial treatment was successful in 84.3% of cases, with a significantly higher efficacy in non-smokers than in patients who have ever smoked (p<0.05). The total CLASI activity score was lower in CLE patients treated with antimalarials at the time point of the evaluation compared to untreated patients.

CONCLUSION
This multicentre analysis of 1002 CLE patients assessed by the EUSCLE Core Set Questionnaire statistically confirms that smoking influences CLE disease severity and the efficacy of antimalarial treatment. This article is protected by copyright. All rights reserved.