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How does alcohol affect psoriasis?

Alcohol isn’t an essential part of our diets, but it plays a big role in social culture and having a glass of wine or beer is one of the ways we might choose to relax.

But how does alcohol affect psoriasis? 

 Learning points

→ Heavy drinking is linked with both an increase in the risk and severity of psoriasis.

→ Alcohol may impact psoriasis by aggravating inflammation or reducing the effectiveness of treatment.

→ More than 80-100 grams of alcohol (around 4 alcoholic drinks a day) appears to be the threshold for aggravating psoriasis activity, but lower levels may also be a risk factor.

What we know about alcohol and psoriasis

Although the relationship between alcohol and psoriasis isn’t fully understood, studies show that drinking a lot of alcohol is linked with an increase in both the risk and severity of psoriasis.1 

Stretching back to the 1980’s, researchers noted high alcohol intakes were more common in patients with psoriasis, but few studies controlled for the effects of smoking2. Since then, better-controlled research has shown that drinking a lot of alcohol is both a risk a factor for developing psoriasis, particularly in men, and for the severity of the disease and the amount of skin involved3 4 5. The question is, why? 

Experts think alcohol may affect psoriasis by:6 7

  • reducing how compliant you are with medication 

  • slowing the effectiveness of drug treatment, or stopping it altogether 

  • suppressing your immune function, which may increase the risk of skin infection 

  • increasing the number of inflammatory molecules which aggravate psoriasis

We also know that alcohol can affect the skin by triggering itching, redness, flushing and eczema.8 9 

How much is too much?

This is where it gets tricky, because it’s unethical to ask people to consume lots of alcohol in order to measure the effect on their psoriasis. 

Instead we have to rely on observational studies that look for patterns. For example, some studies track the alcohol intake of psoriasis patients over a number of years and compare this to psoriasis severity; others look at drinking habits before diagnosis, and compare this to a control group.10

“Heavy drinking is linked with both an increase in the risk and severity of psoriasis.”

In one large U.S. study of women, consuming more than 2.3 alcoholic drinks per week was assated with a significantly increased risk of new-onset psoriasis11. The same study found that drinking more than five beers a week was an independent risk factor in women for developing psoriasis. 

For men, excess alcohol intake (more than 100 grams per day) has been found to be a risk factor for the development and increased severity of psoriasis12 13. More than 80 grams of alcohol a day has also been associated with less treatment-induced improvement in men.14

In the UK, drinks are measured in units, and one unit is equal to 8 grams. A pint of beer (568ml) or a large glass of wine (250ml) both contain around 2.5 units or 20 grams of alcohol, so four drinks would be equivalent to 80 grams, but the strength of a drink determines how many units of alcohol it contains.

Alcoholic Drink Units Grams of alcohol
Large glass (250ml) Wine (14%) 3.5 28
Pint of lager (5.2%) 3 24
Large measure of spirit e.g. vodka 2
16

Side effects

Alcohol is processed in your liver, where many medicines are also metabolised. For this reason, alcohol can reduce the effectiveness of drugs such as methotrexate or acitretin, which are used to treat psoriasis, but it can also increase the risk of liver damage from these drugs.

Drinking a lot of alcohol also increases the risk of heart disease, stroke and cancer, and can disrupt sleep and lower your mood.
 

What the dietician says

- Section written by Laura Tilt, dietician

"Alcohol may directly affect psoriasis by aggravating inflammation and drying out the skin. It may have an indirect affect by reducing the number of vitamins absorbed, which can affect immune function. Deficiencies in zinc and vitamin C are common in heavy drinking, and these can affect wound healing.

Drinking a lot of alcohol also reduces sleep quality, and because it’s high in calories, can contribute to excess weight – and both high levels of body fat and a lack of sleep can aggravate inflammation in the body15. If you’re drinking, you’re also less likely to make good food choices.

We don’t know what the ‘safe’ level of alcohol is for psoriasis, but for general health, the recommendation is no more than 2-3 units a day for women and 3-4 for men. Aim for 2-3 alcohol-free nights a week and explore new ways to de-stress or relax if you use alcohol to unwind."

About Laura Tilt

Laura is an experienced dietitian and health writer who believes in the power of food to improve health and wellbeing. After studying a bachelor’s degree in nutrition she moved to London to complete a Masters in Public Health Nutrition followed by a diploma in Dietetics, becoming a Registered Dietitian in 2012.

With over 10 years of nutrition experience across specialties including weight loss, digestive health, oncology and sports nutrition, Laura is skilled in researching, writing and counseling practical ways to treat and manage medical conditions through diet.

Knowing the huge impact of psoriasis on wellbeing, Laura is passionate about helping people understand the links between food and psoriasis, and how changing diet can help.

 

Reference List

  1. Behnam, S. M., Behnam, S. E. & Koo, J. Y. Alcohol as a risk factor for plaque-type psoriasis. Cutis. 76, 181–5 (2005).

  2. Monk, B. E. & Neill, S. M. Alcohol consumption and psoriasis. Dermatologica 173, 57–60 (1986).

  3. Poikolainen, K., Reunala, T. & Karvonen, J. Smoking, alcohol and life events related to psoriasis among women. Br. J. Dermatol. 130, 473–7 (1994).

  4. Naldi, L., Peli, L. & Parazzini, F. Association of early-stage psoriasis with smoking and male alcohol consumption: evidence from an Italian case-control study. Arch. Dermatol. 135, 1479–84 (1999).

  5. Behnam, S. M., Behnam, S. E. & Koo, J. Y. Alcohol as a risk factor for plaque-type psoriasis. Cutis. 76, 181–5 (2005).

  6. Farkas, Á. & Kemény, L. Psoriasis and alcohol: Is cutaneous ethanol one of the missing links? Br. J. Dermatol. 162, 711–716 (2010).

  7. Kazakevich, N., Moody, M. N., Landau, J. M. & Goldberg, L. H. Alcohol and skin disorders: with a focus on psoriasis. Skin Therapy Lett. 16, 5–6 (2011).

  8. Kazakevich, N., Moody, M. N., Landau, J. M. & Goldberg, L. H. Alcohol and skin disorders: with a focus on psoriasis. Skin Therapy Lett. 16, 5–6 (2011).

  9. Higgins, E. M. & du Vivier, a W. Cutaneous disease and alcohol misuse. Br. Med. Bull. 50, 85–98 (1994).

  10. Poikolainen, K., Reunala, T., Karvonen, J., Lauharanta, J. & Kärkkäinen, P. Alcohol intake: a risk factor for psoriasis in young and middle aged men? BMJ 300, 780–3 (1990).

  11. Qureshi, A. a, Dominguez, P. L., Choi, H. K., Han, J. & Curhan, G. Alcohol intake and risk of incident psoriasis in US women: a prospective study. Arch. Dermatol. 146, 1364–1369 (2010).

  12. Poikolainen, K., Reunala, T., Karvonen, J., Lauharanta, J. & Kärkkäinen, P. Alcohol intake: a risk factor for psoriasis in young and middle aged men? BMJ 300, 780–3 (1990).

  13. Gupta, M. A., Schork, N. J., Gupta, A. K. & Ellis, C. N. Alcohol intake and treatment responsiveness of psoriasis: a prospective study. J. Am. Acad. Dermatol. 28, 730–2 (1993).

  14. Gupta, M. A., Schork, N. J., Gupta, A. K. & Ellis, C. N. Alcohol intake and treatment responsiveness of psoriasis: a prospective study. J. Am. Acad. Dermatol. 28, 730–2 (1993).

  15. Mullington, J. M., Simpson, N. S., Meier-Ewert, H. K. & Haack, M. Sleep loss and inflammation. Best Pract. Res. Clin. Endocrinol. Metab. 24, 775–784 (2010).

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