Otezla and alcohol consumption

Beer studied for psoriasis risk

“Women who drank five or more beers a week doubled their chances of developing psoriasis,” said a report in the Daily Mail.

This study examined the drinking habits of more than 80,000 US nurses over an average of 14 years, during which 1.4% developed psoriasis. Women who drank an average of 2.3 or more alcoholic drinks a week were 72% more likely to develop the condition. For specific types of drinks, women who drank five or more non-light beers a week were found to be 76% more at risk.

This research has several limitations. Only a few women who developed psoriasis were also in these highest categories of alcohol consumption, which increases the probability that these results are due to chance. The study is also based on individuals’ responses to a questionnaire, raising the possibility that the women’s responses were inaccurate and leaving the question of the size and strength of alcoholic intake open to interpretation.

A link between psoriasis and high alcohol intake is feasible, and other studies have indicated an association between the two. However, the evidence to date is not strong and the only proven risk factor is down to genetics. Further study is needed to clarify whether alcohol also has an effect.

Where did the story come from?

The study was carried out by researchers from Brigham and Women’s Hospital, Harvard Medical School and Harvard School of Public Health, and Boston University. It was funded by the National Institutes of Health and the National Cancer Institute. The study was published in the peer-reviewed medical journal, Archives of Dermatology.

Both BBC News and Daily Mail have correctly reported the findings of the study, but they have not mentioned certain limitations.

What kind of research was this?

This cohort study assessed how alcohol in general, and particular types of alcoholic beverage, affect the risk of developing psoriasis. Psoriasis is a skin condition in which the skin cells replace themselves faster than usual, leading to a build up of plaques (red scaly, flaky patches) on the skin. The condition commonly affects the back of the elbows, knees and scalp, but can affect other areas depending on the type of psoriasis.

Aside from family history, the causes and triggers for psoriasis are not known, although certain drugs and stress have been implicated. Several studies have noted an association between alcohol consumption and an increased risk of psoriasis. This research used a cohort study design, which is the most suitable method for assessing this possible cause-and-effect relationship. However, it is likely that the study has some limitations due to the difficulty in accurately quantifying a person’s alcohol intake, which is also likely to vary over time.

What did the research involve?

This study used members of the Nurses’ Health Study II (NHS II), an ongoing study of registered female nurses from across the United States. The nurses were enrolled in 1989 when they were between the ages of 25 and 42, and since then they have been asked to complete questionnaires every two years. Of the 116,430 women enrolled, 82,869 responded to a question in the 2005 questionnaire asking if they had ever been diagnosed with psoriasis. A subset of the women who responded yes had their diagnosis confirmed by a special screening tool for psoriasis.

The 1991 version of the survey was the first to ask about alcohol intake. Of the women who said they had psoriasis in 2005, the researchers excluded 1,280 women who had also reported it in 1991. This left them with 1,069 women who had developed psoriasis since first answering a question on alcohol intake in 1991.

Questions on alcohol included the women’s average intake of beer (light and non-light), red wine, white wine and liquor. The women were asked to pick one of nine answers to rate how many alcoholic drinks they consumed, ranging from no drinks or less than one a month, to six or more drinks a day. Alcohol content was estimated to be 12.8g for a glass, bottle, or can of beer (360 ml), 11g for a glass of wine (120 ml), and 14g for a shot of liquor (45 ml). One drink was considered to be 12.8g of alcohol.

The researchers examined how total alcohol intake affected the risk of developing psoriasis. Intake was put into the following caegories:

  • no alcohol
  • one to four grams per week
  • five to nine grams per week
  • 10 to 14 grams per week
  • 15 to 29 grams per week
  • 30 grams per week or more

They also analysed the risk of psoriasis according to how much of each type of drink was consumed (beer, red or white wine and liquor). Possible answers included: none, one-to-three drinks a month, one drink a week, two-to-four drinks a week, or five or more drinks a week.

The calculations took into account the women’s age, BMI, smoking status, energy intake and physical activity (assessed at each follow-up), but not socioeconomic factors or stress.

What were the basic results?

There were 1,150 new cases of patients with psoriasis, 1,069 of whom had also reported their alcohol intake in 1991 and were included in the analysis. There was a 72% increased risk of psoriasis in women who drank an average of 2.3 drinks a week or more compared with women who did not drink alcohol (relative risk 1.72, 95% confidence interval 1.15 to 2.57). There was no association between psoriasis and drinking less than this amount.

For specific types of alcoholic drink, there was a 76% increased risk found for women who drank five or more drinks of non-light beer a week (RR 1.76, 95% CI 1.15 to 2.69). There was no association between psoriasis and light beer, red wine, white wine or liquor.

Although the researchers had reportedly also analysed by total grams of alcohol consumed, these results are not provided in the research paper.

How did the researchers interpret the results?

The researchers conclude that non-light beer intake is associated with an increased risk of developing psoriasis among women.

Conclusion

This study has several strengths, including its large size and the fact that it is reported to have followed up 90% of its participants over an average of 14 years. However, when concluding that alcohol, and non-light beer in particular, is associated with increased risk of psoriasis there are some important points to note:

  • There were relatively few new cases of psoriasis: of the 82,869 women responding to the question on psoriasis in 1995, only 1.4% of them had developed psoriasis. Although an association was found with women who drank more than 2.3 alcoholic drinks a week on average, only 28 women who developed psoriasis had consumed this amount. The small number included in the calculations increases the risk of chance findings. Likewise, although an association was found for five or more drinks of non-light beer a week, only 22 women who developed psoriasis had consumed this amount.
  • Although the researchers adjusted for some confounders, they did not take into account others that may have affected the results. Family history is an important risk factor for psoriasis, and socioeconomic factors and stress have also been associated. However, these were not taken into account.
  • Accurately quantifying alcohol intake in a questionnaire is difficult, as the size of one drink or type of drink may mean different things to different people. Although an alcohol content was assigned to each drink, this is unlikely to be completely accurate unless the women had accurately given the volume of the container they were drinking from and its exact alcohol content. Furthermore, alcohol consumption is likely to vary over time and responses at one time-point may not indicate a lifelong pattern.
  • These results cannot be applied to men, and as the study is from the US there may be some differences within the UK, both in alcohol intake and psoriasis incidence. This is demonstrated by the fact that this study considered one drink to be 12.8g of alcohol, which is substantially more than the UK equivalent unit of 8g (about half a pint of weak lager).

Family history is the only clearly established risk factor for psoriasis. However, it is possible that there is an association with excess alcohol intake, and this research is likely to lead to other studies. For now, the advice remains the same: people should not consume more than the recommended daily alcohol intake, which is two-to-three units for women and three-to-four units for men.

Analysis by Bazian
Edited by NHS Website

Links to the headlines

Women beer drinkers ‘increase psoriasis risk’.

BBC News, 18 August 2010

Beer-loving women at ‘greater risk of developing psoriasis’.

Daily Mail, 18 August 2010

Links to the science

Qureshi AA, Dominguez PL, Choi HK et al.

Alcohol Intake and Risk of Incident Psoriasis in US Women.

Archives of Dermatology 2010. Published online August 16 2010

Further reading

Mason AR, Mason J, Cork M, Dooley G, Edwards G.

Topical treatments for chronic plaque psoriasis.

Cochrane Database of Systematic Reviews 2009, Issue 2

In honor of Psoriasis Awareness Month, we’re devoting August to raising awareness about psoriatic disease and its effects on the more than 7.5 million people living with this condition. This week, we are taking a look at how drinking alcohol can affect your psoriasis. Heavy drinking has been linked to both an increase in the risk and the severity of psoriasis, particularly in men. Having psoriasis can be very stressful and drinking alcohol to relieve this stress can be very tempting, however, having more than one or two drinks in a day may very likely cause your psoriasis to become more severe and spread to larger areas on your skin. Researchers believe that heavy alcohol consumption affects psoriasis by:

  • Lessening compliance with taking medications
  • Slowing down or stopping the effects of medications
  • Lowering your immune function, which can increase your risk of skin infection
  • Increasing inflammation in your body which triggers psoriasis flare-ups
  • Causing dehydration in the body and drying out the skin

Findings of a Recent Study In a large US study about the correlation between drinking alcohol and psoriasis, a connection was found for women drinking who drank more than 2.3 drinks per week with new onset of psoriasis. Women who drank more than five beers per week experienced an increase in the severity of their psoriasis. For men who drank an excessive amount of alcohol (about 4-5 drinks per day, according to this study), they were at an increased risk for the development and severity of psoriasis. Go Easy for the Sake of Your Skin According to Dr. Donnelly, a dermatologist with Forefront Dermatology in Carmel, Indiana, “For many people, identifying the source of stressors can really make a difference for managing their psoriasis. Sometimes a change in employment, loss of a loved one or stressors at school and home can drive people to seek relaxation with alcohol, and often even a slight increase in alcohol consumption can trigger flares for psoriasis sufferers. What starts as an extra drink after dinner can easily escalate to two or three, which may trigger psoriasis to really flare. Once patients take stock of what is stressing them out, it’s often easier to identify what triggers them to have a drink, and they can then work towards finding healthier alternatives to relax.” So what amount of drinks is safe to have for psoriasis suffers? Your best bet is to use common sense and limit drinks to no more than 2 at a time, no more than two times per week. Alcohol is a diuretic, which means that it is taking moisture out of skin that is already predisposed to being dry and flaky. If you are going to drink, be sure to drink plenty of water to keep skin hydrated. In addition, follow these psoriasis and alcohol tips:

  • Do not drink alcohol while taking certain medications to treat psoriasis. Alcohol can be very dangerous for patients taking mexotrexate. Consult your Forefront Dermatologist if you have questions about the medication you are taking and whether it is safe to drink alcohol.
  • Find healthy ways to cope with stress, such as meditation, counseling, healthy diet and exercise.
  • Try keeping a journal of your daily food and alcohol intake to determine if you can find a pattern between things you are eating and drinking and your flare-ups.
  • If you have children, be sure they are aware of the increased risk of developing psoriasis if they smoke or drink heavily—smokers with a family history of psoriasis increase their risk of getting it themselves as much as nine times.

Living with Psoriasis: How Can You Feel Better? If you or a family member is living with psoriasis, there are many things that you can do to feel better. Find the Forefront physician nearest you to learn about treatment options and lifestyle changes that can help prevent flare-ups and eliminate psoriatic disease symptoms in many cases.

While the exact cause of eczema and psoriasis is not known, there are many factors that can make the symptoms worse, diet being one of them. If you have eczema or psoriasis there are certain foods that can cause flare ups. Both conditions are extremely uncomfortable and can be embarrassing for some, but there are a number of things that an individual can do to help reduce these symptoms.

What is the difference between eczema and psoriasis? Eczema is a skin condition which causes rough and inflamed patches of skin. With eczema, the skin is usually itchy and can sometimes crack and blister. Psoriasis is an autoimmune condition that causes the skin to regenerate every 3-4 days (normally this takes about a month). The rapid regeneration of skin sells causes a buildup of cells that causes scaling on the skins surface. Inflammation, itchiness, and redness are also symptoms.

Here are some foods that make eczema and psoriasis worse:

  • Red Meat: Red meat is high in saturated fat and saturated fat can increase inflammation in your body. Try to limit or even eliminate foods that are high in saturated fat, including foods like butter and cheese.
  • Gluten: Some people with eczema and psoriasis have found that by removing or limiting gluten in their diet their flare-ups have decreased. Gluten is a protein found in processed foods such as bread, pasta, and cereal, just to name a few.
  • Alcohol: Beer and red wine are also triggers to inflammation. Moderation is the key to avoiding a massive flare-up. If you do drink alcohol, try to eliminate the amount you drink as well as the frequency that you drink.
  • Eggplant: This one may seem strange, but eggplants are among a group of vegetables called nightshade vegetables. Studies have shown that people who experience bad eczema flare-ups have tried an elimination diet that removed night shade vegetables. These people did experience success in reducing their flare-ups. Some other vegetables that are in the nightshade category are tomatoes, peppers, and potatoes.
  • Dairy: Full fat milks and cheese as well as yogurt, ice cream, and chocolate, can contain a protein called casein that is difficult for the digestive tract to process. Casein has been found to increase inflammation.

There are many dietary modifications that you can make, that can help keep your eczema and psoriasis flare-ups to a minimum. Try to limit the foods listed above and try to add foods that are high in Omega 3 fatty acids, vitamin C, and vitamin E. If you have any questions or would like further information, please call our office to schedule your appointment.

Disclaimer: This blog provides general information and discussion about medical, cosmetic, mohs, and surgical dermatology. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately-licensed dermatologist or other health care worker.

Psoriasis Mortality Rises with Alcohol

The risk of dying as a result of alcohol-related causes is about 60% greater in persons who have psoriasis than in their peers of the same age and sex in the general population.

Alcohol consumption appears to be a key contributor to the premature mortality gap in persons with psoriasis.

Researchers at the University of Manchester in the United Kingdom delineated an incident cohort of patients with psoriasis aged 18 years and older using the Clinical Practice Research Datalink and linked them to Hospital Episode Statistics and Office for National Statistics mortality records. Patients who had psoriasis were matched on age, sex, and general practice with up to 20 comparison patients who did not.

Some findings:

• During a median (interquartile) of 4.4 (6.2) years of follow-up, the alcohol-related mortality rate was 4.8 per 10,000 person-years for the psoriasis cohort vs 2.5 per 10,000 for the comparison cohort.

• The hazard ratio for alcohol-related death in patients with psoriasis was 1.58 compared with patients without psoriasis.

• Patients with psoriasis died from alcohol-related causes on average 3 years younger than those without psoriasis who died from these causes.

• Women with psoriasis died from alcohol-related causes at about 5 years younger than women without psoriasis who died from these causes.

• The incidence of alcohol-related mortality increased much more rapidly during follow-up in patients with psoriasis.

• Together these 3 causes accounted for 96.7% of the deaths among the patients with a diagnosis of psoriasis.

“Excessive alcohol consumption is recognized in as many as one-third of patients with moderate to severe psoriasis,” the researchers noted. “Furthermore, there is a correlation between increased alcohol intake and extent of body surface area involvement by psoriasis.”

The investigators suggested that health care practitioners who have responsibility for the care of patients with psoriasis should be more aware of the psychological difficulties they face. “Patients with increased alcohol intake may also report significantly higher levels of anxiety, depression, and psychosocial challenges,” they stated. “Consequently, alcohol misuse may be considered as a maladaptive behavior, used by affected individuals to manage their psychological distress.”

Because of the elevated risk of alcohol-related mortality found in persons with psoriasis, the authors recommended routine screening, identification, and treatment with use of the simple Alcohol Use Disorders Identification Test (AUDIT-C) to detect alcohol consumption and misuse among these patients.

They reported their findings in the September 15 online edition of JAMA Dermatology.

Introduction

Psoriasis is a chronic inflammatory skin disease affecting 2–5% of the population in Western countries. The disease is characterized by increased cell proliferation in the basal epidermal layer and disturbed differentiation in the apical part of the epidermis. Pathoetiological mechanisms include both innate and acquired immune systems.1

There is a complex interplay between genetic and environmental factors linked to the severity and triggering of psoriasis.2,3 Such triggering/worsening factors include damage to the skin and streptococcal infection. Studies have also shown that psychological stress, due to emergency crises and family stress, may contribute to the onset of psoriasis. Other factors that can worsen psoriasis are drugs, such as beta-blockers, lithium, and interferon-α. Smoking may also have a negative effect on the disease.4 Recently Zink et al5 reported various forms of addiction in psoriasis, with alcohol dependence being a substantial one.

The present review discusses the role of alcohol (ethanol) in psoriasis.

General effects of alcohol

Alcohol by itself can be harmful, but there is an important role of its oxidative metabolite acetaldehyde, in disruption of the intestinal barrier, associated with alcohol consumption.6 This disruption acts synergistically with acetaldehyde. Alcohol and its metabolite acetone may promote keratinocyte proliferation in vitro and may thus enhance the permeability of the skin, disrupting its barrier function.7

Alcohol also has an effect on the metabolism of lipids, such as triglycerides and cholesterol, and may thus also affect the lipid composition of the skin barrier.8 Alcohol has been shown to induce rapid peroxidation of lipids in cerebral vascular smooth muscle cells in rats, which may be a triggering pathway for proinflammatory events in alcohol-induced brain vascular injury.9 It may also activate microglia and neurons in rats.10

Alcohol may be both an initiating and aggravating factor in inflammation. It can affect both innate and adaptive immunity. Previous studies have suggested mechanisms such as increased proinflammatory cytokines, eg, increased production of tumor necrosis factor -α (TNF-α) from peripheral blood monocytes and macrophages, and increased lymphocyte proliferation and activation, caused by alcohol.11 Alcohol-induced liver injury in mice resulted in an impairment of skin barrier function, possibly mediated via plasma TNF-α.12 Alcohol may also have an impact on the number and function of murine epidermal T cells.13 The methylation changes in CD4+ T cells are greater in patients with psoriasis than in healthy control subjects.14 Alcohol may have an impact on migration of murine dermal dendritic cells to draining lymph nodes after sensitization.15 In female mice, alcohol caused a reduced dendritic function, compared to male mice.16

Mast cells are believed to play a role in the pathogenesis of psoriasis, and alcohol may affect the number of mast cells as well as their degranulation.17–19

The skin and central nervous system share a common origin through the ectoderm.

Alcohol affects the brain in several ways. Like other drugs, it stimulates the brain’s reward center via several neurotransmitter systems, depending on the phase of alcohol dependency of the individual.20

Alcohol and psoriasis

Patients with psoriasis consume more alcohol than the general population.21 Alcohol may affect psoriasis through several mechanisms, such as increased susceptibility to infections, stimulation of lymphocyte and keratinocyte proliferation, and production of proinflammatory cytokines.11,22

Only a limited number of studies have investigated the relationship between the severity of psoriasis and alcohol use. In these, mostly retrospective, studies, a positive correlation between alcohol intake and the extent of psoriasis has, in general, been reported for women. An association between total body surface area and alcohol use was found in a case–control study on women in- and out patients with mixed subtypes of psoriasis.23 A multicenter study of 1203 inpatients with different subtypes of psoriasis demonstrated a correlation between the psoriasis area severity index (PASI) score and level of alcohol consumption, but only for women.24 The level of alcohol use was estimated based on medical record data, and the majority of patients were social drinkers according to self-report. In a limited cross-sectional study, we have shown a correlation in women between alcohol consumption, measured by phosphatidylethanol (PEth) and Lifetime Drinking History (LDH) interview, and extent of psoriasis.25 However, an earlier case–control study showed alcohol to be a risk factor for psoriasis in young and middle-aged men.26

There are few prospective studies on the role of alcohol in psoriasis. In the Nurses’ Health Study (NHS II), intake of non light beer in a cohort of US nurses was associated with an increased risk of developing psoriasis.27 In 150 outpatients enrolled in a 3-month observational study, therapeutic outcome, as measured by achieving 75% PASI recovery, with conventional psoriasis therapy, was hampered due to obesity, female sex, tobacco or smoking habits, and alcohol habits.28 In a Pakistani study on outpatients with psoriasis, PASI score was significantly associated with drinking alcohol.29 In the Department of Dermatology, Karolinska University Hospital, Solna, we have performed a small prospective study on 22 patients with low–moderate intake of alcohol and mild–moderate extent of psoriasis, using Christmas and New Year as the exposure periods, when alcohol intake is expected to increase.30 Although alcohol intake increased, there was only a marginal increase in the extent of psoriasis.

Alcohol consumption has not only been associated with a more severe and a higher incidence of psoriasis, but also with a distinctive nature and distribution of the disease. Patients with psoriasis and alcohol overconsumption tend to have more severe inflammation, with minimal scale, typically distributed in the face, groin, and flexures, or typically hyperkeratotic lesions with a predominant acral distribution.31

Alcohol intake may induce pruritus by lowering its threshold and thus has been suggested to increase pruritus in psoriasis. However, several studies have failed to show such an association.25,32,33

A study of 95 patients with plaque psoriasis examined their alcohol intake and psychological stress and found that 17–30% of patients were rated as having alcohol problems. Thirteen percent and 18% of patients with psoriasis were classified with ongoing or previous alcohol problems, respectively, and there was a link between increased alcohol intake and increased anxiety and depression. In addition, the patients who considered that they had alcohol problems had more trouble with anxiety and depression, and also more psoriasis.34

People with psoriasis have an increased risk of premature mortality. The reason for this is not fully understood, but is likely to be multifactorial. The most common comorbidities for patients with psoriasis are hyperlipidemia, hypertension, depression, diabetes mellitus type 2, and obesity.35 A Finnish cohort admitted to inpatient treatment with psoriasis as the principal diagnosis showed an excess mortality caused by alcohol. Among men, these causes included alcohol-related psychosis, liver disease, and alcohol dependence, and, in women, liver disease.36 A population-based cohort study investigated whether people with psoriasis had a higher risk of alcohol-related mortality and found that patients with psoriasis had a 60% greater risk of dying due to alcohol-related causes compared to others of the same age and sex in the general population. This indicated that alcohol may be a great contributor to the premature mortality gap. The predominant causes of alcohol-related deaths were alcoholic liver disease, fibrosis and cirrhosis of the liver, and psychological and behavioral disorders due to alcohol.37 There is an increased proportion of liver disease, both alcoholic and non alcoholic, in psoriatic patients, and the prevalence of psoriasis in patients with alcoholic liver disease is higher than the predicted value in the normal population.31,38 In this respect, TNF-α, a key cytokine in psoriasis pathogenesis, may have a role.

Therapeutic neurotransmitter targets

The current therapy for psoriasis per se includes topical desquamating drugs, potent topical glucocorticoids, topical calcipotriol, and, for severe disease, systemic treatments, such as UV light, methotrexate, and biologicals, such as anti-TNF-α agents. A problem with regard to classical systemic treatments, such as biologicals, is that, due to inhibition of cells that destroy invading microorganisms, alcohol intake may result in increased susceptibility to infections.22

It should also be noted that alcohol use may be associated with worse adherence to treatment of their skin disease. In addition, alcohol consumption may be used by patients with psoriasis to cope with their debilitating skin disease.38

It may be attractive to use a neuro endocrine approach for patients with psoriasis who present with overconsumption of alcohol.

Targets for treatment of alcohol dependence per se may focus on the neuronal circuits of reward, addiction, and satisfaction, in addition to the biochemical pathways of alcohol metabolism.20 These include dopaminergic, serotonergic, tachykinergic and acetylcholine (ACh), opioid, gamma-aminobutyric acid (GABA), and glutamatergic-mediated transmissions. Pharmacologic drugs in such systems used for treatment of alcohol dependence are: dopamine (DA) 2 receptor (R) and serotonin (5-HT)2R antagonists (eg, olanzapine), selective serotonin reuptake inhibitors (SSRIs) (eg, sertraline), 5-HT3R antagonist (ondansetron), and naltrexone. As regards the tachykinergic system, recently neurokinin (NK)-1R antagonism has been implicated in modulating alcohol consumption and reward.39,40

Regarding the inflammatory process in psoriasis per se, we and/or others have found receptors for biogenic amines, such as 5-HT,41,42 tachykinins, including the NK-1R,43 and ACh receptors,44 in psoriasis. Expression of such receptors has been found in the basal and/or differentiating zones of the epidermis and on dermal inflammatory cells, while dendritic inflammatory cells in the epidermis and dermis show expression of SERT.45 A cohort study by Thorslund et al46 found that patients with psoriasis who had undergone SSRI treatment were less often switched to systemic treatment. Interestingly, brainstem 5-HT transporter availability has been shown to be correlated with circulating TNF-α.47 5-HT2R activation may suppress TNF-α-induced inflammation,48 and polymorphism of the 5-HT2AR gene is associated with late-onset psoriasis in a Thai population.49

A relationship between DA and the pathophysiology of psoriasis has been known since the 1970s. Thus, levodopa resulted in the resolution of inverse psoriasis when being used for Parkinson’s disease, possibly due to an increase in cyclic AMP.50 Moreover, bromocriptine, a strong D2R agonist, has been used in patients with psoriasis with different results on the clinical outcome.51–53

The anti depressive drug bupropion, a noradrenaline and DA reuptake inhibitor, has been reported to result in a reduction in psoriasis-affected skin surface.54

N-methyl-D-aspartate is a glutamate receptor abnormally expressed in psoriasis. Disturbed expression of subunits of such receptors has been reported in the basal and apical part of the epidermis.55,56 GABA and GABAAR expression has previously been found mainly in inflammatory cells in psoriasis.57

Future therapies for alcohol and psoriasis might thus be targeted at neurotransmitter networks involved with both alcohol intake and the inflammatory processes.

More research is needed in order to determine whether alcohol can induce or worsen psoriasis. Studies should examine whether there is a threshold to alcohol intake at which the disease worsens or debuts, and whether the type of alcohol plays a part and, if so, to what extent.

It is difficult to interpret study results, because patients with psoriasis may smoke and suffer from metabolic syndrome, ie, there are several confounders. Furthermore, the measure of alcohol intake differs in different studies, and it is, therefore, difficult to compare results and draw a valid conclusion.

There are difficulties in recruiting patients with psoriasis to participate in studies concerning the correlation of their disease with alcohol intake. Stigmatization concerning both alcohol and psoriasis may make it difficult to recruit a sufficient number of patients. In this respect, register studies or studies in which patients may answer inquiries and rate their ongoing intake of alcohol and the extent of their psoriasis anonymously would be of importance. Also, the effect of ceasing alcohol intake on the extent of the disease should be studied.

Animal experiments are warranted; however, such experiments are at present limited by the lack of a suitable animal model for psoriasis.

In addition, more prospective studies, including during seasonal periods/festivals when patients consume a higher than normal amount of different types of alcohol, may be of substantial value.

Alcohol isn’t an essential part of our diets, but it plays a big role in social culture and having a glass of wine or beer is one of the ways we might choose to relax.

But how does alcohol affect psoriasis?

Learning points

→ Heavy drinking is linked with both an increase in the risk and severity of psoriasis.

→ Alcohol may impact psoriasis by aggravating inflammation or reducing the effectiveness of treatment.

→ More than 80-100 grams of alcohol (around 4 alcoholic drinks a day) appears to be the threshold for aggravating psoriasis activity, but lower levels may also be a risk factor.

What we know about alcohol and psoriasis

Although the relationship between alcohol and psoriasis isn’t fully understood, studies show that drinking a lot of alcohol is linked with an increase in both the risk and severity of psoriasis.1

Stretching back to the 1980’s, researchers noted high alcohol intakes were more common in patients with psoriasis, but few studies controlled for the effects of smoking2. Since then, better-controlled research has shown that drinking a lot of alcohol is both a risk a factor for developing psoriasis, particularly in men, and for the severity of the disease and the amount of skin involved3 4 5. The question is, why?

Experts think alcohol may affect psoriasis by:6 7

  • reducing how compliant you are with medication

  • slowing the effectiveness of drug treatment, or stopping it altogether

  • suppressing your immune function, which may increase the risk of skin infection

  • increasing the number of inflammatory molecules which aggravate psoriasis

We also know that alcohol can affect the skin by triggering itching, redness, flushing and eczema.8 9

How much is too much?

This is where it gets tricky, because it’s unethical to ask people to consume lots of alcohol in order to measure the effect on their psoriasis.

Instead we have to rely on observational studies that look for patterns. For example, some studies track the alcohol intake of psoriasis patients over a number of years and compare this to psoriasis severity; others look at drinking habits before diagnosis, and compare this to a control group.10

“Heavy drinking is linked with both an increase in the risk and severity of psoriasis.”

In one large U.S. study of women, consuming more than 2.3 alcoholic drinks per week was assated with a significantly increased risk of new-onset psoriasis11. The same study found that drinking more than five beers a week was an independent risk factor in women for developing psoriasis.

For men, excess alcohol intake (more than 100 grams per day) has been found to be a risk factor for the development and increased severity of psoriasis12 13. More than 80 grams of alcohol a day has also been associated with less treatment-induced improvement in men.14

In the UK, drinks are measured in units, and one unit is equal to 8 grams. A pint of beer (568ml) or a large glass of wine (250ml) both contain around 2.5 units or 20 grams of alcohol, so four drinks would be equivalent to 80 grams, but the strength of a drink determines how many units of alcohol it contains.

Side effects

Alcohol is processed in your liver, where many medicines are also metabolised. For this reason, alcohol can reduce the effectiveness of drugs such as methotrexate or acitretin, which are used to treat psoriasis, but it can also increase the risk of liver damage from these drugs.
Drinking a lot of alcohol also increases the risk of heart disease, stroke and cancer, and can disrupt sleep and lower your mood.

What the dietician says

– Section written by Laura Tilt, dietician

“Alcohol may directly affect psoriasis by aggravating inflammation and drying out the skin. It may have an indirect affect by reducing the number of vitamins absorbed, which can affect immune function. Deficiencies in zinc and vitamin C are common in heavy drinking, and these can affect wound healing.
Drinking a lot of alcohol also reduces sleep quality, and because it’s high in calories, can contribute to excess weight – and both high levels of body fat and a lack of sleep can aggravate inflammation in the body15. If you’re drinking, you’re also less likely to make good food choices.
We don’t know what the ‘safe’ level of alcohol is for psoriasis, but for general health, the recommendation is no more than 2-3 units a day for women and 3-4 for men. Aim for 2-3 alcohol-free nights a week and explore new ways to de-stress or relax if you use alcohol to unwind.”

About Laura Tilt

Laura is an experienced dietitian and health writer who believes in the power of food to improve health and wellbeing. After studying a bachelor’s degree in nutrition she moved to London to complete a Masters in Public Health Nutrition followed by a diploma in Dietetics, becoming a Registered Dietitian in 2012.
With over 10 years of nutrition experience across specialties including weight loss, digestive health, oncology and sports nutrition, Laura is skilled in researching, writing and counseling practical ways to treat and manage medical conditions through diet.
Knowing the huge impact of psoriasis on wellbeing, Laura is passionate about helping people understand the links between food and psoriasis, and how changing diet can help.

Reference List

Filtered Water For Psoriasis

If you’ve encountered a rash that doesn’t go away with any over-the-counter medicine, then it’s time to visit your doctor for a professional medical diagnosis. It may be an immune-mediated disease that leaves your skin red, scaly, and raised. Psoriasis commonly affects the outer part of the elbow, knees, and scalp. However, it may appear in different areas of the human body. According to medical experts, it is associated with other life-threatening diseases such as heart disease and diabetes. So if you’re experiencing symptoms similar to that of psoriasis, contact your doctor and set a schedule.

Medical experts and scientists do not know the exact cause of the chronic autoimmune condition. However, both genetics and the immune system contribute to the development of psoriasis. When triggered, the skin cells of an individual grow at an abnormal rate. As a result, psoriasis lesion begins to develop in different areas of the human body.

Drinking plenty of water is beneficial to people suffering from psoriasis. Super-hydration is vital for people with psoriasis since the human body takes longer than normal to process and acquire the water. The intake of gallons of water every day helps prevent the decline of an individual’s immune system. Drinking plenty of water on a daily basis also assist the body in its fight with inflammation.

Super-hydration or the idea of drinking a lot of water helps flush out toxins within the body. Since sick people take medicines to alleviate or cure their disease, they more than ever need to drink a lot of water to remove the meds from their system. The idea is to flush off the medicines to prevent the side effects of the drugs. Therefore, you won’t have to deal with more health issues in the process of treating psoriasis.

According to studies, drinking alcohol and smoking may increase the risk of developing the chronic autoimmune condition. In most cases, people smoke a cigarette and drink alcoholic beverages to drown the sorrows caused by psoriasis. Unfortunately, these vices do more harm than good to an individual’s current medical condition. Drinking alcohol has been proven to worsen the condition of psoriasis. On the other hand, drinking coffee and other non-alcoholic beverages are found to have no direct link to the development of the chronic autoimmune condition. In fact, drinking coffee count towards your 1 gallon a day goal.

Prolonged drinking and exposure to hard water may have an adverse effect on the skin. It may contribute to eczema, dermatitis, or psoriasis if the pH level isn’t addressed. Psoriasis is made worse by continual exposure to hard water or water contaminated with harmful minerals like calcium and magnesium. Showering or washing your hands in hard water and soap will also increase the risk of developing psoriasis. While it may vary from one individual to the other, people inflicted with psoriasis experience flare-ups when the water they use is hard.

Chlorinated water can also be harsh for people suffering from psoriasis or any other chronic skin condition. Chloramine can aggravate the skin causing it to flare-up. Drinking chlorinated water may also increase the risk of developing the chronic autoimmune condition.

Water contamination can have adverse effects on human health, as well as on the skin of people with a skin disorder. If you are suffering from psoriasis, eczema, or any type of skin condition, chances are water contamination is making it worse. What you don’t see may actually hurt you. If you haven’t run a series of water test on your tap water, then you’re not safe from contaminations in your drinking water. Aside from worsening your skin disorder, drinking contaminated water increases the risk of acquiring new diseases. Contaminants such as calcium, magnesium, and cadmium are found to contribute to the development and aggravation of psoriasis. Cadmium worsens the inflammation of the skin upon exposure to the chemical element. According to studies, scientists found a direct relationship between cadmium and skin inflammatory disease. Both calcium and magnesium trigger the skin condition and makes it worse when you shower with contaminated water.

Consult with your doctor regarding the best treatment and solution to your skin problem. Afterward, make sure your water is safe, clean, and clear of any impurities that may contribute to the decline of your skin and general health.

A water softener or water filtration system such as the Aquaox will correct the pH level of the water going into the faucet of your home. If contaminants are the cause of the worsening of your chronic skin condition, then the best approach is to use a water filter that catches and removes these impurities. Find the cause of your hard water so you can come up with the best solution. If you need a water filtration system, make sure you buy and install the right one to achieve maximum efficiency and success.

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