The association of smoking with contact dermatitis and hand
eczema – a review
Katelyn A. Zimmer
, Eric S. Armbrecht
, and Nicole M. Burkemper
Dermatology Resident, Medical University
of South Carolina, Charleston, SC, USA,
Saint Louis University School of Medicine,
St. Louis, MO, USA, and
Dermatology, Saint Louis University School
of Medicine, St. Louis, MO, USA
Nicole M. Burkemper,
Department of Dermatology, Saint Louis
University School of Medicine
1755 S. Grand Blvd.
St. Louis, MO 63104
Disclosures: There are no conﬂicts of
interest nor funding sources to disclose
from any author.
Given the high prevalence of allergic contact dermatitis (ACD), irritant contact dermatitis
(ICD), hand eczema (HE), and smoking, and the impact that smoking has on skin disease,
the authors reviewed the existing literature to assess the association between smoking and
contact dermatitis or hand eczema. Using the PubMed and SCOPUS databases, a
literature search identiﬁed articles related to allergic contact dermatitis, irritant contact
dermatitis, and hand eczema and a possible association with smoking. The search period
included articles prior to and including April 2016. Seven of eight articles described a
positive relationship between smoking and allergic or irritant contact dermatitis, while nine
of nineteen articles found a positive association between smoking and hand eczema.
Published studies document that smoking may be an important risk factor for both allergic
and irritant contact dermatitis as well as hand eczema.
Allergic contact dermatitis (ACD) and irritant contact dermatitis
(ICD) are relatively common skin conditions, with around 19.5%
of the general populace of North America and Western Europe
being affected by ACD.
ACD is an eczematous dermatitis
caused by a type four hypersensitivity reaction of the skin, while
ICD is a nonspeciﬁc reaction that occurs after an irritant comes
in contact with skin.
Hand eczema (HE) is a broad term used
to describe inﬂammation of the hands.
HE is most commonly
classiﬁed as ICD or ACD; it can also be atopic by nature.
Other causes of HE include dyshidrotic eczema, hyperkeratotic
hand eczema, and nummular hand eczema, among other
Smoking is prevalent in the United States, with 16.8% of the
population considered smokers in 2014.
Smoking is associated
with many disease processes in different organ systems, and
the skin is no exception. According to a review by Just-Sarob
smoking may be linked to psoriasis, pustulosis palmoplantaris,
scar formation, hidradenitis suppurativa, systemic lupus erythe-
matosus, discoid lupus erythematosus, allergic contact dermati-
tis, Favre-Racouchot syndrome, and lip, oral cavity, and
Additionally, smoking is associated with
cosmetic sequelae, including yellowing of the ﬁngernails and
ﬁngers, discoloration of teeth, and early wrinkle development on
the face, among other problems.
Given the high prevalence of allergic contact dermatitis, irri-
tant contact dermatitis, hand eczema, and smoking, as well as
the impact that smoking has on skin disease, the authors posed
the question: are contact dermatitis and hand eczema associ-
ated with smoking—what is the evidence?
Materials and methods
A literature search was done primarily in April 2016 using
PubMed and SCOPUS databases; the period of search
included all articles prior to and including April 2016. The
authors initially searched for articles relating to allergic and
irritant contact dermatitis and smoking. The PubMed probe
resulted in 153 articles, 11 of which were found relevant to the
topic and were further reviewed. The SCOPUS search yielded
approximately 146 unique articles that were distinct from the
articles found through PubMed, and four additional articles were
added to the review process. A subsequent inquiry was formed
in both PubMed and SCOPUS using the term “hand eczema”
coupled with multiple terms related to smoking, revealing 44
additional results that were reviewed. Reviewing the
bibliographies of the articles revealed additional sources that
ª 2017 The International Society of Dermatology International Journal of Dermatology 2018, 57, 375–387