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Does smoking cessation aggravate psoriasis?

Q A patient with psoriasis tells me when he gave up smoking (moderately heavy) on two occasions his psoriasis has flared. Is this common?

A A number of studies have demonstrated a link between psoriasis and tobacco smoking. There is a strong link between smoking and the development of both palmo-plantar pustular psoriasis and chronic plaque psoriasis.

Heavy alcohol consumption is also a risk factor. This is a potential confounding factor in the studies on psoriasis and tobacco use, since many smokers are also drinkers, but there does seem to be a real link between smoking and psoriasis when the effects of alcohol are controlled for. The mechanisms are not yet clear.

Most psoriasis patients see little change in their skin on giving up smoking, in contrast to the more frequent improvement on reducing alcohol intake. Alternatively, the stress of withdrawal may result in a flare of psoriasis; many patients notice a link between stress and exacerbation of their skin disease.

There is a recent case report in which three patients with psoriasis developed severe erythrodermic or pustular psoriasis requiring hospitalisation after using bupropion (Zyban) to stop smoking. Use of nicotine patches has been associated with an increased incidence of application site reactions in those with skin disease.

Dr Victoria Swale is specialist registrar in dermatology,

Royal London Hospital

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