Rheumatology International

, Volume 33, Issue 4, pp 943–948 | Cite as

Does cigarette smoking mitigate the severity of skin disease in systemic sclerosis?

  • Geneviève Gyger
  • Marie HudsonEmail author
  • Ernest Lo
  • Russell Steele
  • Canadian Scleroderma Research Group (CSRG)
  • Murray Baron
Original Article


Cigarette smoking has significant negative effects on vascular, pulmonary and gastrointestinal outcomes in systemic sclerosis (SSc). The objective of this study was to study the effect of cigarette smoking on the extent of skin disease in SSc. Subjects were patients enrolled in the Canadian Scleroderma Research Group cohort. Smoking history was obtained by patient self-reports. The extent of skin involvement was measured using the modified Rodnan skin score. The effect of smoking on the skin score was assessed using the comprehensive smoking index (CSI), which integrates smoking intensity, duration and time since cessation into a single covariate of smoking effect. The regression model was adjusted for gender, ethnicity and disease duration. This study included 606 SSc patients, of which 87 % were women and 90 % were white; mean disease duration was 11 (±9) years, and mean modified Rodnan skin score was 10 (±9). Of these, 16 % were current, 42 % past and 42 % never smokers. There was a 16 % reduction in skin score (odds ratio 0.84, 95 % confidence interval 0.75, 0.95, p = 0.0029) for every 0.1 unit change in CSI. The effect of smoking on skin disease appeared cumulative and irreversible. Smoking was significantly associated with less extensive skin disease in SSc. This hypothesis-generating study provides new avenues of research, especially insofar as the role of nicotine in SSc is concerned and given that safe nicotine replacement therapy exists.


Scleroderma Systemic sclerosis Skin Smoking Comprehensive smoking index 



This study was funded in part by the Canadian Institutes of Health Research, the Scleroderma Society of Canada and educational grants from Actelion Pharmaceuticals and Pfizer Inc. Dr. Hudson is supported by New Investigator awards from the Canadian Institutes of Health Research and the Fonds de la Recherche en Santé du Québec. The funding sources had no role in the design of the study, analysis of the data, preparation of the manuscript and decision to submit for publication.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Geneviève Gyger
    • 1
  • Marie Hudson
    • 1
    Email author
  • Ernest Lo
    • 2
  • Russell Steele
    • 1
  • Canadian Scleroderma Research Group (CSRG)
  • Murray Baron
    • 1
  1. 1.Jewish General Hospital and McGill UniversityMontrealCanada
  2. 2.Jewish General HospitalMontrealCanada

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