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Peggy Boeckler, MD; Anne Cosnes, MD; Camille Francès, MD; Guy Hedelin, PhD; Dan Lipsker, MD, PhD

Arch Dermatol. 2009;145(9):1012-1016.

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.

Design  Prospective multicenter case-control study.

Setting  Three French university hospitals.

Patients  One hundred eight patients with LE and 216 control subjects.

Intervention  Standardized questionnaire evaluating cigarette smoking and alcohol consumption.

Main Outcome Measures  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.

Author Affiliations: Clinique Dermatologique (Drs Boeckler and Lipsker) and Laboratoire d’Épidémiologie et de Santé Publique (Dr Hedelin), Faculté de Médecine, Université de Strasbourg, Strasbourg, France; Study Group of Systemic Diseases in Dermatology (EMSED: Etude des Maladies Systémiques en Dermatologie), France (Drs Boeckler, Cosnes, Francès, and Lipsker); Service de Dermatologie, Centre Hospitalier Universitaire de Créteil, Créteil, France (Dr Cosnes); and Services de Médecine Interne, Centre Hospitalier Universitaire Pitié/Tenon (Dr Francès), and Centre Hospitalier Universitaire Pitié/Tenon (Dr Francès), Paris, France.

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