EPIDEMIOLOGY AND HEALTH SERVICES RESEARCH BJD British Journal of Dermatology Association between tobacco smoking and prognosis of occupational hand eczema: a prospective cohort study R. Brans, 1,2 C. Skudlik, 1,2 E. Weisshaar, 3 K. Gediga, 1 R. Scheidt, 3 B. Wulfhorst, 1,2 P. Elsner, 4,5 M. Sch€ onfeld, 6 S.M. John 1,2 and T.L. Diepgen 3 for the ROQ study group 1 Department of Dermatology, Environmental Medicine, Health Theory, University of Osnabru ¨ck, 49090 Osnabru ¨ck, Germany 2 Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabru ¨ck and Dermatologic Centre, Trauma Hospital, 21033 Hamburg, Germany 3 Department of Clinical Social Medicine, Centre of Health Systems Research, Occupational and Environmental Dermatology, University of Heidelberg, 69115 Heidelberg, Germany 4 Department of Dermatology, University Hospital Jena, 07740 Jena, Germany 5 Statutory Accident Insurance Clinic of Occupational Diseases, 08223 Falkenstein, Germany 6 Clinic for Occupational Diseases of the VBG (Statutory Accident Insurance), 83435 Bad Reichenhall, Germany Correspondence Richard Brans. E-mail: rbrans@uos.de Accepted for publication 29 May 2014 S.M.J. and T.L.D share last authorship. Funding sources This study was funded by the German Statutory Accident Insurance Deutsche Gesetzliche Unfallver- sicherung (reference number FB 0096). Conflicts of interest None declared. DOI 10.1111/bjd.13169 Summary Background Hand eczema (HE) is a common occupational skin disease. Tobacco smoking is known to be associated with adverse cutaneous effects. However, its influence on the prognosis of occupational HE has not yet been studied. Objectives To evaluate relations between smoking status, severity and prognosis of occupational HE in patients taking part in an interdisciplinary tertiary individual prevention programme (TIP). Methods In a prospective, multicentre, cohort study 1608 patients with occupational HE taking part in a TIP were recruited and followed up for 3 years. The clinical and self-reported outcome data of smokers and nonsmokers were compared. Results Nonsmokers and smokers were equally distributed. During the TIP, the average self-reported daily cigarette consumption and the severity of HE decreased significantly (P < 0Á01). However, at all time points HE was significantly more severe in smokers than in nonsmokers. This association was not dependent on the self-reported number of cigarettes smoked daily. Smokers had significantly more days of absence from work due to occupational HE than nonsmokers in the year before the TIP (P < 0Á01) and in the following year (P = 0Á02). After the TIP, smokers reported significantly more often that they had to give up their occupation (P = 0Á02) than non- smokers. Conclusions The severity of occupational HE is increased in smokers. Tobacco smoking is associated with a higher number of days of absence from work and with not staying in the workforce owing to occupational HE. Thus, smoking confers a worse prognosis and interferes with the outcome of preven- tion programmes. What’s already known about this topic? • Hand eczema (HE) is the most common occupational skin disease. • Prevention programmes improve the prognosis of occupational HE. • Tobacco smoking may be associated with the prevalence of HE. © 2014 British Association of Dermatologists 1108 British Journal of Dermatology (2014) 171, pp1108–1115