The Negative Effects of Smoking with Psoriasis

Psoriasis is a common autoimmune disease involving the skin and joints. Psoriasis affects about 3.2 percent of people in the United States. It’s estimated that psoriasis affects about 125 million people worldwide.

Smoking isn’t the only preventable risk factor for psoriasis, though it’s a big one. Other factors include:

• obesity
• alcohol consumption
• significant stress
• genetic predisposition, or family history

Family history can’t be changed. You can stop smoking, though, even if you think you can’t. If you do, there’s a good chance your psoriasis risk or severity might just decrease with your smoking frequency.

What exactly does research say on this topic? First off, numerous studies have found smoking to be an independent risk factor for psoriasis. That means people who smoke are more likely to have psoriasis. The more you smoke, and the longer you’ve smoked, the higher your risk.

“A cross-sectional study from Italy found that heavy smokers, those who smoke more than 20 cigarettes [per] day, had twice the risk of having severe psoriasis,” says Ronald Prussick, MD.

Prussick is an assistant clinical professor at George Washington University and the medical director of the Washington Dermatology Center in Rockville, MD. He also serves on the medical board for the National Psoriasis Foundation (NPF).

Prussick refers to two more studies that illustrate smoking’s link to psoriasis.

One, a sub-analysis from the Nurses’ Health Study, found that nurses who smoked more than 21 pack years were twice as likely to develop psoriasis.

A pack year is determined by multiplying the number of years you’ve smoked by the number of cigarette packs you smoke per day.

Another study, on prenatal and childhood exposure to smoking, found that early exposure to smoking slightly increases the risk of developing psoriasis later in life.

Need more reasons to quit smoking? Prussick says some promising reports have shown that when people quit smoking, their psoriasis may become more responsive to various treatments.

Christine’s story

Many might be surprised to know Christine Jones-Wollerton, a health-minded doula and lactation consultant from Jersey Shore, New Jersey, struggled with a smoking addiction.

She grew up surrounded by smoke. Her mother was a regular cigarette smoker, and her father smoked a pipe. It’s not surprising then (at least it shouldn’t have been) that she tried the habit out for herself at the age of 13.

“Although I didn’t truly start smoking until I was about 15, I quickly became a pack-and-a-half-a-day smoker,” she says.

After successfully adopting several healthier habits, such as vegetarianism, it remained especially hard for her to quit smoking. She tried to quit throughout her young adulthood, but she says it would always call her back.

That changed when she watched her mother’s declining health, no doubt due at least in part to her smoking. “She died after a decade-long battle with bladder and lung cancer when I was five months pregnant with my first child, never getting to meet her first grandchild.”

That was it for Jones-Wollerton, who knew she didn’t want that scenario to play out for her child. With her unborn child in mind, she quit at the age of 29.

It wasn’t until a year later (six months after her first child was born) that Jones-Wollerton’s psoriasis showed up. She was taken by complete surprise.

Since she was adopted, there was no family history to clue her in to her risk. She made no connection to her smoking at that time, but she admits that from what she knows now it could have played a part.

“I later learned though my research on the National Psoriasis Foundation website that smoking with a history of psoriasis in the family can increase your likelihood of developing psoriasis up to nine times!” she says.

While Jones-Wollerton did notice positive health changes following quitting smoking, it took almost two years for her severe psoriasis to start responding to treatment.

“I now know that smoking and drinking can decrease the effectiveness of some treatments, including biologic medications,” she says, adding that she’s now convinced that smoking impacted her psoriasis in multiple ways.

“I am sure that my years of heavy smoking and drinking were a trigger for my psoriatic disease,” she says. “Who knows if the long-term effects of smoking caused my slow response to treatment?

“What I do know is that once I stopped smoking and began the right biologic medication, coupled with PUVA and topical medication, my psoriasis eventually cleared up. I went from 95 percent coverage to less than 15 percent coverage, down to 5 percent.”

John’s story

When John J. Latella, of West Granby, Connecticut, started smoking in 1956 (at the age of 15), it was a different world. He, too, had parents who smoked, along with many relatives. During the 50s, he admits it was “cool” to walk around with your cigarettes rolled up in your T-shirt sleeve.

“In the service, cigarettes were cheap and always available, so smoking was a way to pass time,” he says. “I quit smoking in 1979, and at the time I was smoking cigars, about 10 a day, ” he says.

When Latella was first diagnosed with psoriasis in 1964 (at the age of 22), he says not much was known about psoriasis. His doctor didn’t bring up the connection between smoking and psoriasis.

Though he ended up quitting for health reasons, it wasn’t because of his psoriasis, directly.

He says that when he was first diagnosed, “I traveled by car quite a bit and smoking kept me awake.” He says, “From 1977 through 1979, I was diagnosed with bronchitis each year. In 1979, after spending several months clearing my torso of psoriasis, I got bronchitis.

Within 24 hours, all the effort I had used in the previous several months was wiped away, and my upper torso was covered with guttate psoriasis because of the respiratory infection.”

He remembers his doctor didn’t mince words. The doctor told him to expect recurring bouts of bronchitis if he planned to continue smoking. So he quit, cold turkey.

“It was one of the most difficult challenges that I have ever had to undertake,” he says. Latella encourages others to go through the process with assistance, if possible.

Latella’s psoriasis continued to get progressively worse in spite of his quitting smoking. Yet his respiratory issues did lessen. He doesn’t remember getting guttate psoriasis since.

Even though he didn’t see a drastic improvement to his symptoms after quitting smoking, he’s still glad he did. He encourages everyone still smoking to do the same.

“I am happy to see that so many dermatologists are suggesting that psoriasis patients think about quitting,” he says. He only wished his doctor had given him that recommendation 40 years ago.

Sure, there’s still much that’s not yet known about how smoking causes this increased risk and severity of psoriasis. Not everyone sees a change in their symptoms after quitting. Researchers continue to investigate the ins and outs of this connection.

Regarding the research that exists today, Prussick says it’s a topic that doctors should be addressing with all psoriasis patients.

“Given our knowledge that smoking increases the risk of developing psoriasis and makes psoriasis more severe, it’s important to have this discussion with our patients,” he says.

“The immune system can respond positively to healthy diet and lifestyle changes and quitting smoking is an important part of this behavioral change.”

Whether you consider quitting for yourself, for your children, or a reason that’s entirely unique to you, know that you can do it.

“There are so many reasons to stop smoking,” says Jones-Wollerton. “But if you have a history of psoriasis in your family or you have already been diagnosed, please try. If you’ve tried before, try again and keep trying.

“Any amount that you reduce is a benefit. You may see a reduction in severity, the amount of flares, and a better response to treatment. What better time to quit than right now!”