Psoriasis and Alcohol: 4 Reasons to Drink Less

From everydayhealth.com

If you have psoriasis, you’ve likely experienced itchy, scaly, discoloured patches on your skin that can be annoying and uncomfortable. Psoriasis symptoms can disrupt sleep, and the condition is linked with psoriatic arthritis, which can cause pain and joint stiffness.

Because of its symptoms, psoriasis can impact how you feel not only physically but also emotionally. Research suggests this challenge has led many people with the chronic autoimmune disorder to turn to alcohol.

“There is no question people with psoriasis drink more than others — there are many epidemiological studies showing that,” says Mark G. Lebwohl, MD, a dermatologist and the chairman emeritus of the Kimberly and Eric J. Waldman Department of Dermatology at the Icahn School of Medicine at Mount Sinai in New York City.

“Does alcohol make psoriasis worse, or does psoriasis make people consume more alcohol? It’s much easier to demonstrate the latter than the former,” he adds.

Indeed, although some research has shown that alcohol worsens psoriasis symptoms, and may even trigger flares, other studies suggest otherwise.

“Studies to date have been mixed, but it’s been observed by many dermatologists who treat psoriasis that people with the condition become fairly ill after binge drinking, and part of that is that their psoriasis symptoms worsen,” Dr. Lebwohl notes.

In addition, many people with psoriasis also have other health problems — from overweight or obesity to high blood pressure or heart disease — and “drinking alcohol doesn’t make any of those things better,” he adds.

Here are four reasons to limit alcohol consumption if you have psoriasis. 

Increased Severity of Symptoms

Although the exact cause of psoriasis remains a mystery, what is known is that the condition involves problems with the immune system and inflammation.

Normally, the immune system uses inflammation to fight off infections or recover from injury. If you have psoriasis, however, your immune system uses inflammation in error, resulting in the symptoms of the condition.

Alcohol affects the function of brain chemicals called neurotransmitters, which impact your behaviour and body’s responses, including the immune response. 

It’s possible that neurotransmitters also trigger the body’s response in psoriasis. Research suggests that the chemical messengers may also play a role in the inflammation process with psoriasis. That’s just one theory, though.

Meanwhile, recent studies have shown that alcohol may negatively impact the skin barrier, the outermost layer of the skin that functions like a brick wall around the inner layers, preventing moisture from escaping and allergens and viruses from entering.

The skin barrier is made up of skin cells called keratinocytes. Alcohol may cause these cells to proliferate, disrupting the function of the skin barrier and making it easier for allergens and viruses to enter it, studies have found.

This could worsen the symptoms of psoriasis, research suggests.

                                                         Excessive drinking can worsen psoriasis symptoms and interfere with treatment.
                                                                                                                             Martí Sans/Stocksy; Everyday Health

Impaired Effectiveness of Treatments

Alcohol may also limit the effectiveness of certain psoriasis treatments and reduce a person’s adherence to their treatment regimen.

A 2021 analysis found that excessive alcohol consumption was associated with reduced response to both conventional and biologic systemic treatments.

“[Biologics] are the newer and better drugs we have to treat psoriasis,” Lebwohl says.

Furthermore, a study published in 2022 found that any alcohol use at all was associated with a higher risk for treatment failure among people with psoriasis on biologic therapy.

Part of the reason for this is that people with psoriasis who drink are less likely to adhere to their treatment as prescribed.

At least one study has found that drinking alcohol is a key reason many people with psoriasis don’t follow their treatment course as recommended by their doctor, which ultimately influences how well these drugs work to control symptoms.

Raised Risk of Comorbidities

Comorbidities are medical conditions that coexist with another diagnosis and may affect your health and treatment as a result.

Because of psoriasis’s effect on the immune system, people who have it are at an increased risk for certain comorbidities.

Here are the most common comorbidities associated with psoriasis and their potential relationship with alcohol consumption.

Psoriatic Arthritis If you have psoriasis, you’re at high risk for psoriatic arthritis, which occurs when the inflammation caused by the condition affects your joints. About 30 percent of people with psoriasis develop psoriatic arthritis, research shows.

Most studies assessing the relationship between alcohol use and psoriatic arthritis risk among people with psoriasis have found little if any correlation. But a 2020 analysis observed that people with psoriasis who consumed one to three alcoholic drinks per day had a 57 percent higher risk for psoriatic arthritis.

Heart Disease People with psoriasis are already at increased risk for heart disease. Alcohol use is also a known risk factor for heart problems, as it has been shown to increase blood pressure, and it has been linked with conditions such as coronary heart disease, stroke, peripheral arterial disease, and cardiomyopathy.

Liver Disease Alcohol use can cause liver disease, and an analysis of data from multiple studies published in 2022 found that people with chronic plaque psoriasis are nearly twice as likely to develop metabolic dysfunction–associated steatotic liver disease (MASLD) (formerly known as non-alcoholic fatty liver disease), as people who don’t have psoriasis.

“People with psoriasis tend to be overweight or obese, which means their lipid levels tend to be higher,” Lebwohl says. “That’s why they are at higher risk for fatty liver disease.”

Lipids are organic compounds in the body that include fats and cholesterols.

Because both alcohol use and psoriasis can increase a person’s risk of liver problems, dermatologists writing in the American Journal of Clinical Dermatology recommend that people with psoriasis be discouraged from “excess” alcohol consumption.

In addition, several of the newer biologic therapies for psoriasis carry U.S. Food and Drug Administration (FDA) warnings concerning potential harm to the liver, according to Lebwohl, much like the drug methotrexate, which, though older, is still often used to treat psoriasis (at least in small doses).

“By themselves, these drugs are no more harmful for the liver than many others we use all the time,” Lebwohl says.

But some drugs, including methotrexate, can lead to hepatic fibrosis when used in combination with alcohol.

This could lead to serious health complications, including cirrhosis.

Possible Increase in Mental Health Issues

Numerous studies have shown that people with psoriasis often have depression, and a significant percentage have anxiety, sometimes along with depression. Depression and anxiety are often related and are themselves comorbidities for each other.

One study found that people with psoriasis had a 21 percent higher risk of depression and a 17 percent higher risk of anxiety than the general population.

Although some studies have found that excessive alcohol use among people with psoriasis is associated with higher rates of depression or anxiety, that’s not always the case.

Still, rates of depression and anxiety are higher among people with alcohol use disorder, according to the National Institute on Alcohol Abuse and Alcoholism, and alcohol use is known to worsen symptoms of anxiety, while reduced consumption may lead to “substantial reductions” in depression symptoms.

If you’re concerned that your alcohol intake is affecting your mood, your psoriasis, or any other part of your life negatively, talk to your doctor about alcohol use disorder treatments. Options include therapy programs, support groups, medication, and, often, a combination of these.

The Takeaway

• If you have psoriasis, cutting back on alcohol can benefit your skin and your overall health.
• Alcohol can interact with some commonly used psoriasis treatments and lower the chances you’ll follow your treatment regimen.
• Alcohol raises the risk of heart and liver disease and may raise your risk of psoriatic arthritis.

https://www.everydayhealth.com/skin-conditions/psoriasis-and-alcohol-reasons-to-drink-less/