More Research Needed About Link Between Psoriasis, Alcohol

A recently published review article recapped what is known about the links between alcohol and psoriasis, given that patients with psoriasis have been reported to consume higher-than-average amounts of alcohol, which may in turn trigger or worsen the chronic inflammatory skin disease.

The neurotransmitters affected by alcohol may have an impact on the underlying inflammatory processes in psoriasis, including the dopaminergic, serotonergic, and tachykinergic systems, the authors wrote. There are several ways in which alcohol might impact psoriasis, such as increased susceptibility to infections, stimulation of lymphocyte and keratinocyte proliferation, and creation of proinflammatory cytokines.

While only a small number of studies have explored the relationship between the severity of psoriasis and alcohol use, the ones that have occurred were mostly retrospective. A positive correlation between alcohol intake and the extent of psoriasis has been reported for women.

There are few prospective studies on the role of alcohol in psoriasis. In the Nurses’ Health Study (NHS II), one of the largest studies of women’s health, beer drinking was linked with an increased risk of developing psoriasis. Other studies have also found that alcohol negatively affected psoriasis area severity index (PASI) scores.

Drinking alcohol “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,” wrote the authors. “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.”

In another study, 95 patients with plaque psoriasis examined their alcohol intake and psychological stress. Between 17% to 30% of patients were rated as having alcohol problems. Thirteen percent had ongoing alcohol issues and 18% of patients had previous alcohol problems; in addition, there was a link between increased alcohol intake and increased anxiety and depression. Patients who indicated they had alcohol problems had more trouble with anxiety and depression, as well as more psoriasis.

Patients with psoriasis are already known to have an increased risk of premature mortality; the most common comorbidities are hyperlipidemia, hypertension, depression, type 2 diabetes, and obesity. A population-based cohort study published in 2017 investigated whether people with psoriasis had a higher risk of alcohol-related death; investigators discovered a 60% greater risk of dying due to alcohol-related causes. Most causes of alcohol-related deaths were alcoholic liver disease, fibrosis and cirrhosis of the liver, and psychological and behavioral disorders stemming from alcohol use.

Some patients may use alcohol to cope with the psychological and social aspect of psoriatic disease, but using alcohol may be associated with worse adherence to treatment.

In addition, the combination of newer biological treatments alongside alcohol intake may result in increased susceptibility to infections. Medications used to treat alcohol dependence may be needed.

Additional research is needed to determine whether alcohol can induce or worsen psoriasis, or if a threshold exists at which the disease worsens or emerges, the authors wrote. However, they noted that there are difficulties in recruiting patients with psoriasis to participate in such studies; stigmatization surrounding both alcohol and psoriasis may make it challenging to gather enough patients.

Reference

Svanström C, Lonne-Rahm SB, Nordlind K. Psoriasis and alcohol [published online August 21, 2019]. Psoriasis (Auckl). doi: 10.2147/PTT.S164104.