Differences in Treatments for Atopic Dermatitis in Patients with Secondhand Smoke Exposure

Summary: Introduction: Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease commonly seen in children that is characterized by intense itching, erythema, and eczematous lesions. AD significantly impacts the quality of life of children [1]. Exposure to tobacco smoke can further exacerbate AD symptoms. Tobacco smoke contains harmful chemicals that trigger inflammatory pathways, potentially worsening AD. Previous studies suggest that children exposed to secondhand smoke are at higher risk of developing persistent and severe ADs. This study aims to investigate the relationship between smoke exposure and the persistence and severity of AD in pediatric patients, focusing on the use of high-potency steroids as an indicator of disease severity. Methods: A comparative outcomes analysis was conducted using the TriNetX platform. Two cohorts were defined: children aged 2-12 with AD and documented secondary smoke exposure (13,971 patients) and children with AD without smoke exposure (13,971 patients, matched post propensity score). Outcomes measured included prednisone and acne (indicating persistent AD), and hydrocortisone (indicating less severe AD). Outcomes were controlled for age, race, and sex. Risk analysis was performed with a p-value < 0.05 considered significant. Results: The risk of prednisone use was significantly higher in the smoke-exposed cohort (4.5%) compared to the non-smoke-exposed cohort (1.8%), with a risk ratio of 2.538 (95% CI: 2.195, 2.936; p < 0.0001). For hydrocortisone, usage was lower in the smoke-exposed cohort (27.3% vs. 35.0%), with a risk ratio of 0.779 (95% CI: 0.752, 0.807; p < 0.0001) and a hazard ratio of 0.625 (95% CI: 0.599, 0.652; p < 0.0001). For acne, the risk was higher in the smoke-exposed cohort (0.6% vs. 0.4%), with a risk ratio of 1.517 (95% CI: 1.090, 2.112; p = 0.013) and a hazard ratio of 1.489 (95% CI: 1.058, 2.095; p = 0.022). Conclusion: This study demonstrates that children with atopic dermatitis (AD) exposed to smoke have a higher likelihood of persistent AD, as indicated by increased prednisone use, and a higher risk of developing acne. Conversely, the decreased use of hydrocortisone suggests less use of milder treatments. The findings underscore the exacerbating effect of environmental tobacco smoke on AD severity. Addressing smoke exposure is another part of managing AD and improving outcomes in pediatric patients, warranting further research.