title: Tobacco smoking and hand eczema - is there an association?
abstract: BACKGROUND
  Numerous risk factors have been suggested for hand eczema. This systematic review evaluates the association between tobacco smoking and hand eczema.
  
  
  OBJECTIVE
  To review the literature systematically on the association between smoking and hand eczema.
  
  
  METHODS
  The PubMed and EMBASE databases were searched up to 27 January 2015 for articles on the association between tobacco smoking and hand eczema, including human studies in English and German only. Experimental studies, studies on tobacco allergy, case reports, reviews and studies on second-hand smoking were excluded.
  
  
  RESULTS
  Twenty articles were included. Among studies in occupational settings, three of seven found a statistically significant positive association between tobacco smoking and hand eczema prevalence rate, as did four of eight population-based studies. The association was stronger for studies in occupational settings than for population-based studies. No studies reported tobacco to be a clear protective factor for hand eczema. Two of five studies regarding severity found a positive association between smoking and hand eczema severity.
  
  
  CONCLUSIONS
  Overall, the data indicate that smoking may cause an increased frequency of hand eczema, particularly in high-risk occupations. However, data from studies controlling for other risk factors are conflicting, and few prospective studies are available. Studies controlling for other risk factors are needed, and information regarding the diagnosis of subclasses of hand eczema, as well as severity, may be important.
authors.affiliation: Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, 2400 Copenhagen NV, Denmark.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Sørensen
authors.affiliation: Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, 2400 Copenhagen NV, Denmark.
authors.forename: Kim K
authors.initials: KK
authors.lastname: Clemmensen
authors.affiliation: Occupational Dermatology Research and Education Centre, Skin and Cancer Foundation Inc., 3053 Melbourne, Australia.
authors.forename: Rosemary L
authors.initials: RL
authors.lastname: Nixon
authors.affiliation: Department of Social Medicine, Occupational and Environmental Dermatology, University Hospital, D-69115, Heidelberg, Germany.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Diepgen
authors.affiliation: Department of Dermatology, University of Copenhagen, Bispebjerg Hospital, 2400 Copenhagen NV, Denmark.
authors.forename: Tove
authors.initials: T
authors.lastname: Agner
mesh_terms: D009783:Dermatitis, Occupational / Q000453:epidemiology* / Q000209:etiology; D004485:Eczema / Q000453:epidemiology* / Q000209:etiology; D006229:Hand Dermatoses / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects*
keywords: hand eczema; review; tobacco smoking