title: Association of cigarette smoking but not alcohol consumption with cutaneous lupus erythematosus.
abstract: OBJECTIVE
  To ascertain whether smoking or alcohol consumption is associated with lupus erythematosus (LE), because this topic is still subject to debate and part of the debate could be related to the fact that smoking and alcohol consumption are specific risk factors for cutaneous LE.
  
  
  METHODS
  Prospective multicenter case-control study.
  
  
  METHODS
  Three French university hospitals. Patients One hundred eight patients with LE and 216 control subjects. Intervention Standardized questionnaire evaluating cigarette smoking and alcohol consumption.
  
  
  METHODS
  The statistical significance of smoking history and alcohol consumption as associated risk factors for LE by estimating matched case-control odds ratios and their 95% confidence intervals, using multiple conditional logistic regression and the Breslow-Day test to investigate differences in quantities of cigarette and alcohol consumption.
  
  
  RESULTS
  Of the LE patients, 73.1% smoked compared with 49.5% of controls, (odds ratio, 2.77; 95% confidence interval, 1.63-4.76). There was no significant difference in alcohol consumption between LE patients and controls. Among the 79 LE patients who smoked, 72 (91.1%) had started smoking before the first manifestation of LE (mean delay between initiation of smoking and first signs of LE, 14.1 years). The LE patients smoked significantly more than controls did (11.7 vs 7.0 pack-years; P = .002). The prevalence of smoking among patients who met more than 4 American College of Rheumatology (ACR) criteria and/or with antinuclear DNA antibodies was lower than the prevalence in patients who met fewer than 4 ACR criteria or than the prevalence in controls (P < .001).
  
  
  CONCLUSIONS
  Cigarette smoking is associated with LE, but alcohol consumption is not. The risk conferred by cigarette smoking seems highest in patients who meet fewer than 4 ACR criteria and/or who do not have antinuclear DNA antibodies.
authors.affiliation: Clinique Dermatologique, 1, Place de l'hôpital, 67091 Strasbourg CEDEX, France.
authors.forename: Peggy
authors.initials: P
authors.lastname: Boeckler
authors.forename: Anne
authors.initials: A
authors.lastname: Cosnes
authors.forename: Camille
authors.initials: C
authors.lastname: Francès
authors.forename: Guy
authors.initials: G
authors.lastname: Hedelin
authors.forename: Dan
authors.initials: D
authors.lastname: Lipsker
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology*; D016022:Case-Control Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008178:Lupus Erythematosus, Cutaneous / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult