PsoriasisNet Spotlight Article
Are Lifestyle Choices Affecting Your Psoriasis?

To provide patients with effective care and treatment, researchers are studying how lifestyle affects psoriasis. Recent findings show that people living with psoriasis are more likely than the general population to be overweight, to smoke, and to lead a sedentary lifestyle. People with psoriasis also tend to drink more alcohol.

Given the emotional impact that psoriasis can have on one’s life, these findings are not surprising. Reports of low self-esteem, feeling rejected, and depression are all too common. While lighting up, having more than a few drinks, or eating away the cares of the day may bring some immediate comfort, research shows that these unhealthy habits also can:

• Increase the risk of developing psoriasis

• Increase the severity of psoriasis

• Decrease remission and cause existing psoriasis to flare

• Lessen the effectiveness of psoriasis treatment

• Increase the risk of developing heart disease, diabetes, and other conditions

How Those Extra Pounds Affect Psoriasis
People living with psoriasis tend to be overweight or obese. This weight gain usually occurs after the onset of psoriasis; however, researchers do not know if there is a genetic link between psoriasis and obesity. A recent study conducted in Utah found that obesity does not appear to trigger the onset of psoriasis. However, being overweight or obese can increase severity and reduce the effectiveness of treatment.

Increases severity. Several studies have found that patients who are overweight or obese have more severe psoriasis. The study conducted in Utah confirms this finding, stating that obese patients are more likely to have severe psoriasis than non-obese psoriasis patients. The Utah study also found that inverse psoriasis was more common among obese patients and morbidly obese patients showed a general tendency to develop inverse psoriasis. Inverse psoriasis is a type of psoriasis that develops in skin folds. It can be severe and incapacitating.

Lessens effectiveness of treatment. A clinical trial that looked at patients’ responses to etanercept, a biologic approved for the treatment of moderate to severe plaque psoriasis, found that extremely obese patients were less likely to attain the high response levels seen in patients who were not overweight. Moreover, the study conducted in Utah found that obese patients were more likely than non-obese patients to report that methotrexate was “no longer effective.” However, the researchers did not find that obesity affected the patient’s response to methotrexate, topical corticosteroids, or light-based therapy.

Researchers suggest that further studies are needed to determine whether or not losing weight improves a patient’s response to psoriasis treatment.

How Smoking Affects Psoriasis
Increases risk of developing psoriasis. Study after study continues to show that smoking can increase a person’s risk of developing psoriasis.

Recently, a study found that the risk of developing psoriasis was significantly higher among current and former smokers. Another study, which questioned patients about smoking and the onset of their psoriasis, found that 78% of patients who smoke said they began smoking before the onset of their psoriasis. This and other data led the researchers to conclude that smoking appears to play a role in the onset of psoriasis.

Pustular psoriasis seems most closely linked to smoking. During a study conducted in Sweden, researchers found that 95% of patients who developed palmoplantar psoriasis (a type of pustular psoriasis) began smoking before the onset of their psoriasis. Other studies have found a similarly strong connection between smoking and pustular psoriasis.

Several studies show a similar link between smoking and plaque psoriasis. Women who smoke or used to smoke, research indicates, have an increased risk of developing plaque psoriasis. This risk may be more than three-fold.

Increases severity. Studies suggest that men who have psoriasis and smoke more than 10 cigarettes per day tend to have more severe disease on their extremities. Recently, a two-year study was conducted in Italy to look specifically at the relationship between smoking and the severity of psoriasis. A total of 818 adults with psoriasis were studied. Researchers found that patients who smoked more than a pack of cigarettes per day were 50% more likely to have severe psoriasis than psoriasis patients who smoked 10 cigarettes or fewer per day. The researchers also found that the risk of developing severe psoriasis was strongest for women smokers.

Decreases remission. A study that questioned 104 patients about their psoriasis found that when they asked, “Has your psoriasis ever disappeared completely?”, 77% of nonsmokers experienced one or more remission. Only 8.7% of smokers had at least one complete remission.

Lessens effectiveness of treatment. Researchers who reviewed studies that looked at the relationship between smoking and psoriasis found that among men and women, smoking has been shown to reduce improvement rates. Additionally, a two-year study conducted in Rome concluded that researchers who are conducting clinical trials and observational studies of the effectiveness of psoriasis medications should consider the patient’s smoking history as it may modify the effects of treatment.

How Drinking Affects Psoriasis
Increases risk of developing psoriasis. There appears to be a link between drinking and psoriasis. A study that questioned participants about their drinking habits found that the men who developed psoriasis reported drinking more alcohol than the men who did not have psoriasis. Additionally, several studies have shown a connection between alcohol misuse and the risk of a man developing plaque psoriasis.

Increases severity. An analysis of several studies that looked at the relationship between drinking and plaque psoriasis found that drinking may increase severity in both men and women. This confirms the finding from an earlier study conducted in Finland that found once a person develops psoriasis, the amount of skin affected increases as alcohol consumption rises.

More research is clearly needed to understand this effect as a recent two-year study conducted in Rome found an increased risk of severe psoriasis among drinkers. However, the risk was not statistically significant.

Decreases remission, increases flare-ups. The study that asked patients, “Has your psoriasis ever disappeared completely?,” did not find a correlation between heavy drinking and remission. However, several studies have shown that heavy drinking prevents remission.

Analysis of studies that have looked at the relationship between psoriasis and drinking conclude that drinking may further exacerbate existing psoriasis. Many dermatologists today recommend that their patients who have psoriasis limit drinking, especially during a flare-up.

Lessens effect of treatment. Heavy drinking may prevent treatment from working. Drinking also has been shown to interfere with a patient’s response to treatment. One study found that men who drank heavily had a lower response to treatment.

Increase the risk of developing heart disease, diabetes, and other conditions
While psoriasis is not considered a life-threatening condition, research suggests that people living with psoriasis have an increased risk of developing a life-threatening medical condition.

Studies show that psoriasis patients have a higher-than-average incidence of risk factors for heart disease, stroke, and diabetes. The risk factors for these diseases include obesity, smoking, heavy drinking, high blood pressure, unhealthy cholesterol levels, and a sedentary lifestyle. Since these risk factors affect the body’s metabolism, they are known as the “metabolic syndrome.” Having just one of these risk factors increases a person’s risk of heart disease, stroke, and diabetes. The more risk factors one has, the greater the risk.

Smoking also has been shown to increase the risk of developing other autoimmune diseases, aside from psoriasis. While this connection is not well understood, it is believed that stopping smoking lowers this risk.

Lifestyle Changes
The findings from these studies suggest that lifestyle changes can reduce the severity of one’s psoriasis, increase the effectiveness of psoriasis treatment, boost remission, and decrease one’s risk of developing other life-threatening medical conditions. If you are overweight, smoke, or drink, you may want to conduct your own study to find out if a lifestyle change makes a difference for you.

While the benefits of losing weight, quitting smoking, and limiting alcohol are well known, achieving one of these goals can seem overwhelming. At times, it may feel as if you have set an impossible goal for yourself. If you feel this way, be sure to talk with your dermatologist who may be able to provide you with some helpful options.

References:
Benham SM et al. “Alcohol as a Risk Factor for Plaque-Type Psoriasis.” Cutis. 2005 September;76(3)181-5.

Behnam SM et al. “Smoking and psoriasis.” SKINmed. 2005 May-June;4(3):174-6.

Eriksson MO et al. “Palmoplantar pustulosis: A clinical and immunohistological study.” British Journal of Dermatology. 1998. March;138(3):390-8.

Fortes C et al. “Relationship between Smoking and the Clinical Severity of Psoriasis.” Archives of Dermatology. 2005. December;141(12):1580-84.

Herron MD et al. “Impact of Obesity and Smoking on Psoriasis Presentation and Management.” Archives of Dermatology. 2005. December;141(12):1527-33.

Mease PJ et al. “Quality-of-life issues in psoriasis and psoriatic arthritis: Outcome measure and therapies from a dermatologic perspective.” Journal of the American Academy of Dermatology. 2006. April;54(4):685-704.

Naldi L et al. “Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case-control study.” Journal of Investigative Dermatology. 2005. July;125(1):61-7.

National Psoriasis Foundation. “Time to kick the habit?” Psoriasis Advance. 2005. January/February;3(1):12-13.

Poikolainen K et al. “Smoking, alcohol and life events related to psoriasis among women.” British Journal of Dermatology. 1994. April;130(4):473-7.

Raychaudhuri SP et al. “Psoriasis Risk Factors: Role of Lifestyle Practices.” Cutis. 2000. November;66(5)348-52.

Robinson D et al. “Poster 2822: Increased prevalence of cardiovascular risk factors among psoriasis patients—Results from two large health care databases.” Journal of the American Academy of Dermatology. 2006. March;54(3):AB203.

Strober B et al. “Poster 2890: Levels of response of psoriasis patients with different baseline characteristics treated with etanercept.” Journal of the American Academy of Dermatology. 2006. March;54(3):AB220.

For an overview, visit the AAD pamphlet Psoriasis and Psoriatic Arthritis.