Smokers with systemic lupus erythematosus at greater risk of skin damage and rashes

MUHC researchers link smoking to skin problems in people with SLE

As if there weren't enough reasons to stop smoking, a team of researchers at the Research Institute of the McGill University Health Centre (RI-MUHC) have just found another. A study led by Dr. Christian A Pineau, Co-Director of the Lupus and Vasculitis clinic at the MUHC, has clearly linked skin damage and rashes to smoking in people with systemic lupus erythematosus (SLE). The study was published in a recent issue of the Journal of Rheumatology.

SLE is a long-term autoimmune disorder affecting about one in every 2000 people. About 90 per cent of SLE patients are women, many of them young. Symptoms are caused by an overactive immune system, and the disease can cause inflammation and damage in almost any organ system, including the skin.

"Up to 85 per cent of people with SLE develop skin involvement at some point," explains Dr. Pineau. "Our study shows that the risk of skin damage such as permanent hair loss and scarring from skin inflammation is significantly increased in smokers. So is the rate of active lupus rash."

While there is no cure for SLE, symptoms can be treated with drugs. "However, smoking may interfere with the effectiveness of some medications used to control skin disease in SLE," says Dr. Sasha Bernatsky, study co-author and physician in the MUHC's Rheumatology Division. "This may be part of the reason why smoking heightens skin damage in SLE.

"Even in healthy people, cigarette smoke has both immediate and long-term effects on the skin, its blood vessels and on hair follicles," she adds. "Exposure to tobacco promotes the release of cytokines - substances in the body that increase immune system activity and inflammation. In fact, some researchers believe that cigarette smoking is actually a risk factor for SLE in the first place."

The study underlines how vital it is for patients with SLE to remain smoke-free. "We already knew these people should not smoke, due to increased risk of adverse events like heart disease," Dr. Pineau says. "Now it appears we have another reason to emphasize smoking cessation. If we can convince people with SLE to stop smoking, we may be able to help them achieve better disease control, and better outcomes."

Dr. Christian A. Pineau is a researcher in the RI-MUHC Musculoskeletal Disorders Axis, as well as co-director of the Lupus and Vasculitis clinic at the MUHC. He is also the Rheumatology Program Director and Assistant Professor in the Department of Medicine at the McGill University Faculty of Medicine.

Dr. Sasha Bernatsky is a researcher in the RI-MUHC Musculoskeletal Disorders Axis, a physician in the Rheumatology Division and a member of the Clinical Epidemiology Division at the MUHC. She is also an Assistant Professor in the Department of Medicine and an Associate Member in the Department of Epidemiology, Biostatistics and Occupational Health at the McGill University Faculty of Medicine.