Is Your Smoking Making Your Psoriasis Worse?

Smoking may have led to you having psoriasis, and continuing to smoke can make the situation worse. Learn about the link between psoriasis and smoking.

It's no secret that smoking hurts the heart and lungs, but the damage doesn't stop there. Smoking has been linked to psoriasis as well.

“Many studies have linked psoriasis and smoking," says Natasha Mesinkovska, MD, PhD, assistant professor of dermatology at UC Irvine School of Medicine in California. “Smoking may trigger psoriasis, and the more you smoke, the worse the psoriasis can be."

According to a study published in March 2012 in the American Journal of Epidemiology, smokers have almost double the risk of developing psoriasis compared with people who’ve never smoked. In a smaller study published in February 2016 in the International Journal of Dermatology that looked at twins, heavy smokers were more than twice as likely to have psoriasis.

How Does Smoking Increase the Risk of Psoriasis?

“In people who have a genetic tendency for psoriasis, smoking may trigger the genes to become active," Dr. Mesinkovska says. "People who smoke may also have more stress, and stress is a trigger for psoriasis."

Psoriasis is an autoimmune disease, which means that the immune system — the body’s defense system — attacks normal tissues instead of invaders like germs. “Nicotine alters the immune system, which may partially explain the link between psoriasis and smoking,” Mesinkovska says.

But nicotine may not be the only link. “The ingredients in tobacco smoke may cause a type of cell damage called oxidative damage," Mesinkovska says. "This may be why smoking makes psoriasis worse."

For people that also have psoriatic arthritis, the effects of smoking can be even more pronounced. Those with psoriatic arthritis who smoke are less likely to get the best response from treatments such as biologic drugs, according to a Danish study published in December 2015 in the journal Annals of the Rheumatic Diseases.

Quitting Smoking May Improve the Condition

One of the most important studies to link smoking and psoriasis was the Nurses’ Health Study II. In this landmark study, more than 78,000 nurses were followed for 14 years. Researchers found that current and past smoking increased the risk for psoriasis, that nurses who had been exposed to secondhand smoke as children had an increased risk for psoriasis, and that quitting smoking gradually reduced the odds of developing psoriasis.

Research suggests that women who smoke have a higher risk of developing psoriasis than men who smoke, so if you're a female smoker, you have even greater motivation to quit.

Take these steps to improve your outcomes:

- If you smoke, quit.
- Warn your children to never start smoking. If psoriasis runs in your family, those genes might be triggered by smoking.
- Make sure you and your children avoid secondhand smoke.

Find a Smoking Cessation Tool That Works for You

Most people with psoriasis can use all the same smoking cessation tools as people who don't have psoriasis, Mesinkovska says. These include nicotine products, medication, and smoking cessation classes. Work with your doctor to find the best smoking cessation plan for you. For example, the nicotine skin patch isn't recommended, according to the American Academy of Family Physicians.

“Doctors are increasingly aware of how important healthy lifestyle habits are for psoriasis," Mesinkovska says. "Smoking cessation is a must for people with psoriasis. Start by reducing the number of cigarettes until you get down to none,” she says. “Quitting smoking is one of the best things you can do for psoriasis and your overall health.”