Review examines psoriasis, smoking link

A review published May 27 in open-access DovePress sheds what the author says is new light on the relationship between smoking and psoriasis. 

Dermatologists and others have known for about 30 years that smoking, which is associated with a number of inflammatory immune-related conditions, impacts psoriasis. But this paper offers pieces of evidence not gathered in the past, providing a whole scenario of the impact of smoking on psoriasis, according to the review’s author Luigi Naldi, M.D., professor of dermatology and director of the GISED Study Center, Bergamo General Hospital, Bergamo, Italy.

The review, according to Dr. Naldi, also offers an account of the most recent pathogenetic data explaining the way smoking may work in psoriasis causation. All these aspects may not be easily available to practicing dermatologists, he says.

“Smoking [not only] affects the onset of psoriasis, about doubling the risk in those smoking more than 25 cigarettes per day, but it also influences the phenotype of psoriasis with an increased risk of pustular and palmo-plantar lesions. Smoking also impacts on the clinical severity of psoriasis, its response to treatment, and may explain some of the psoriasis co-morbidities, [such as,] cardiovascular disease, inflammatory bowel disease and cancer,” Dr. Naldi tells Dermatology Times.

In his review, Dr. Naldi found several pathophysiological mechanisms might explain psoriasis’s association with smoking, including oxidative stress, interaction with signaling pathways active in psoriasis and vascular influences.

Dermatologists, Dr. Naldi says, could play a major role in reducing the health burden of smoking by influencing their patients to change behavior.

"The paper highlights the fact that smoking increase ones chance of getting psoriasis as well making psoriasis worse once you have it. And, yes, stopping smoking can improve psoriasis, which can be an important topic for dermatologists to address with their psoriasis patients who smoke,” says Andrew Blauvelt, M.D., M.B.A., president and investigator, Oregon Medical Research Center, Portland, Ore. “… the paper provides a very nice discussion on the topic for those interested in learning more about the links between psoriasis and smoking."