Smoking and other lifestyle factors have long been linked to psoriasis severity. For example, research suggests that people with psoriasis who are overweight or obese see improvements in symptoms when they achieve significant weight loss over a 16-week period. People with a lower body mass index (BMI), also responded better to systemic psoriasis therapy compared to people who were obese.
While achieving and maintaining a healthy body weight is known to lower levels of inflammation, which would benefit psoriasis sufferers, why might quitting smoking help relieve psoriasis?
Quitting Smoking to Relieve Psoriasis
A paper published in The British Journal of Dermatology in 2015 found that smokers have more severe psoriasis. They also noted that people who smoke fewer than 10 cigarettes a day fared better on a psoriasis assessment than those smoking 10 or more cigarettes daily. And, it seems that people who smoke may see less benefit from treatments to relieve psoriasis.
People who smoke are also less consistent with taking medications compared to non-smokers, according to some studies. One study found that people with psoriatic arthritis who also smoked had poorer treatment adherence and poorer response to tumour necrosis factor-a inhibitors. In a 2016 meta-analysis, people with psoriasis were 88% more likely to also smoke, compared to people without psoriasis.
In an earlier study, published in 1999, Naldi and colleagues found that people who smoked more than 15 cigarettes a day had more than a ten-fold increased risk of developing pustular lesions. People who currently smoked or who had smoked in the past had an increased risk of psoriasis compared to people who had never smoked. The increase in risk was greater for women who smoked compared to men who smoked.
In a review just published in the Journal of the American Academy of Dermatology, researchers looked at data over an eight-year period from over 17 million people aged 20 or older. They found and almost four-fold (3.71) increase in the incidence of psoriasis in former smokers, and a 3.54 increased incidence in current smokers. The risk for psoriasis increased the more a person smoked and the longer they smoked.
Why Does Smoking Matter?
The theory is that smoking may interfere with the mechanism of action of certain drugs used to treat psoriasis. For instance, smoking is known to interfere with the drug hydroxychloroquine which is used to treat lupus erythematosus. Smoking is also associated with other unhealthy lifestyle factors, such as a lack of exercise, obesity, and poor diet, that affect psoriasis symptoms.
Alcohol and Psoriasis
In the 1999 study by Naldi, men who consumed higher amounts of alcohol had an increased likelihood of psoriasis. This correlation did not hold for women. However, since the study took place in Italy, where women at the time tended to consume little alcohol, the data may not have sufficient strength to draw worthwhile conclusions.
Alcohol was also found to lower treatment response to psoriasis medications. And, alcohol could increase the risk of infection and mechanical trauma that may then affect psoriasis. Alcohol also affects lymphocyte transformation (part of immune function) which could affect psoriasis. It is important to note that some psoriasis medications, such as methotrexate or acitretin (Soriatane), can interact with alcohol and may cause dangerous side effects, especially in people of child-bearing potential.
So, the bottom line is that if you smoke you’re more likely to develop psoriasis, have worse symptoms, and have a poorer response to treatments. If you drink, you’re also more likely to have psoriasis and less likely to experience periods of remission (where treatments successfully relieve psoriasis). As such, it’s best not to smoke or drink to excess. And, if your parents have psoriasis, definitely avoid starting smoking as the increased risk is even higher.
Unfortunately, psoriasis is often linked to anxiety and stress, and some people use alcohol and smoking as coping mechanisms. If this sounds familiar, it’s time to develop a healthier approach to stress management. This may include meditation, exercise, yoga, reading, volunteering, or simply spending time making and eating healthy food with friends and family.
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