Smoking and Alcohol Consumption Significantly Reduce efficacy of Psoriasis Treatment: Study

Psoriasis is a chronic skin condition that affects more than 125 million people worldwide and cannot be cured; however, therapy can be used to reduce the manifestations of this disease. So far, limited attention in the literature has been paid to the combined influence of smoking and drinking on treatment for psoriasis.

This study treated 560 patients with psoriasis at the Shanghai Skin Diseases Hospital between 2021 and 2022. Their smoking and drinking behaviors were evaluated by questionnaires, and their psoriasis severity was evaluated through Psoriasis Area and Severity Index (PASI) scores at weeks 0, 4, and 8. Smoking was defined as smoking ≥ 100 cigarettes in a lifetime, and drinking was defined as the consumption of alcohol ≥ 2 times per week for ≥ 6 months.

Among the 560 patients, 43.8% (n = 245) smoked, 25.4% (n = 142) drank alcohol, and 19.6% (n = 110) both smoked and drank. The patients were categorized under four groups below.

• Group A: None of them had ever smoked or drank, n = 283

• Group B: Never smoked but drank alcohol, n = 32

• Group C: Smoker but never drank, n = 135

• Group D: Smoker and drinker, n = 110

Of subjects, male patients represented the majority (72.9%), with a mean age of 47 years (IQR, 36-61). The median PASI baseline scores for all groups were not significantly different from one another at the beginning of the study and ranged between 7.9 and 16.6 IQR.

Results

• Those with a history of smoking were also significantly at higher risks for treatment failure at the end of 8 weeks of treatment when PASI75 was not achieved (OR, 7.78; 95% CI, 5.26-11.49).

• More often, treatment failure was discovered among alcohol consumers (OR, 5.21; 95% CI, 3.29-8.27).

• The combination of both behaviors had adverse effects on the results of treatment. The OR for failure to attain a threshold for PASI75 was highest in those who smoked and drank (12.74; 95% CI, 7.16-22.67).

The efficacy of the treatment was assessed at 8 weeks instead of at 12 weeks, which is a standard point in time for assessing outcomes of the treatment of psoriasis. Other limitations include a mismatched male: female ratio in patients and a lack of generalizability of the findings to other populations.

Smokers and alcohol drinkers therefore significantly weaken the treatment of psoriasis. It is much more likely for such patients to not respond suitably to treatments targeting their psoriasis. Dermatologists should base their approaches on such findings in the treatment of patients suffering from psoriasis. They should encourage such patients to adopt lifestyle changes that would positively influence the response to treatment.

Reference:

Shen F, Song Y, Qiang Y, et al. Tobacco Smoking Interacted with Alcohol Drinking Could Increase the Failure of PASI75 Achievement at Week 8 Among Patients with Psoriasis: Findings Based on a Psoriasis Cohort. Psoriasis (Auckl). https://doi.org/10.2147/PTT.S484609