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How Can Smoking Trigger Psoriasis Flares?

Medically reviewed by Ariel D. Teitel, M.D., M.B.A.
Posted on May 7, 2021

Psoriasis is a chronic condition caused by abnormal immune system reactions that result in inflammation of the skin. The exact cause of the autoimmune reaction isn’t fully understood, but it’s believed that a combination of genetic and environmental factors triggers the onset of psoriasis. Environmental triggers, such as a sunburn or exposure to cold weather, can also lead to flares. When psoriasis is flaring, symptoms worsen. Skin can become red or purple, scaly, itchy, cracked, and sore.

If you have psoriasis and smoke cigarettes, you may have wondered if smoking has any effect on flares or the severity of your condition. “Does anyone smoke cigarettes? I want to know how it affects psoriasis,” a MyPsoriasisTeam member asked. Cigarette smoking is known to be harmful to your overall health — and there are specific aspects of smoking (including secondhand exposure and even nicotine patches) that may make psoriasis worse.

Smoking and the Development of Psoriasis

Smoking is a risk factor for the development of psoriasis — people who smoke have a higher chance of developing psoriasis during their lifetime than nonsmokers. Approximately 15 percent to 20 percent of psoriatic cases can be attributed to past or current smoking.

Researchers have noted that the psoriasis risk is higher with the increasing number of cigarettes smoked per day but not with the increasing duration of smoking. In other words, psoriasis risk becomes greater as you smoke more cigarettes in a day.

How Smoking Triggers Psoriasis Flares

Nicotine is the compound responsible for the addictive properties of tobacco, but it can also affect the skin. Nicotine increases the production of proinflammatory compounds known as cytokines, including interleukin 12, tumor necrosis factor, and interleukin 2, among others. These compounds play crucial roles in the development of psoriasis. Nicotine also causes the blood vessels to widen, which can further irritate the skin. Some research suggests that nicotine can work in the body to promote proliferation (excess growth) of skin cells, too, which may lead to more skin lesions and plaques.

The effects of nicotine on psoriasis flares may be the same whether you smoke cigarettes or use nicotine patches.

Smoking can also alter the immune system, which can affect autoimmune diseases like psoriasis. Compared to nonsmokers, smokers have increased levels of autoantibodies (antibodies that attack the body’s tissues). More autoantibodies account for the higher susceptibility to autoimmune diseases, such as psoriasis, among smokers.

Smoking also increases the production of free radicals, which can damage cells and interfere with certain biochemical pathways that are involved in psoriasis. To add to the matter, smoking also decreases antioxidants in the body that would normally fight against these free radicals.

Does Secondhand Smoke Affect Psoriasis Flares?

Secondhand smoke (smoke from the burning end of a cigarette or breathed out by smokers) also affects psoriasis. For example, researchers have reported an increased risk of psoriasis associated with secondhand smoke during childhood. Exposure to secondhand smoke from cigarettes during infancy is associated with an increased prevalence of psoriasis during adolescence.

But besides increasing the risk of psoriasis, secondhand smoke exposure can trigger worsened symptoms and contribute to polluted air that can also trigger flares. “I live in a nonsmoking apartment building,” wrote one MyPsoriasisTeam member. “But I have a neighbor who smokes cigars, and the smoke drifts into my apartment and is causing me a lot of discomfort. My psoriasis has flared almost to my very worst point since I have started treatment.”

Smoking and Psoriasis Severity

Smoking is not only a common trigger for psoriasis flares but also a factor that worsens this skin condition, leading to more severe psoriasis. Researchers have reported that palmoplantar pustulosis, a form of psoriasis, improved in people who quit smoking compared to those who did not. Both the severity of psoriasis and the number of pustules or bumps improved after three to six months of not smoking.

“I do notice my psoriatic arthritis getting better when I’m not smoking,” commented one MyPsoriasisTeam member.

The effect of cigarette smoking on the severity of psoriasis may be stronger for women than for men, research suggests.

Smoking and Decreased Response to Treatment

Smoking can also have a negative impact on the response to psoriasis treatments. Researchers have reported that smoking negatively affects the efficacy of biologics, but not of cyclosporine and methotrexate, in the treatment of psoriasis. People with psoriasis who smoke tend to have greater treatment needs than those who do not smoke.

Some research has found that smokers also have lower adherence to their treatment plans, although the reason is unclear. Not following your doctor’s prescribed treatment plan can lead to flares and worsened psoriasis.

What Can You Do?

To reduce your risk of psoriasis flare-ups or worsening of the disease, consider quitting smoking and avoiding being around people who smoke. If you live with smokers, talk with them about how the smoke may be making your psoriasis worse.

If you’re a smoker and need help quitting, try these tips:

  • Talk to your dermatologist or health care provider for their advice or any smoking cessation programs they can refer you to.
  • Call (800) QUIT-NOW for confidential tips.
  • Use online resources such CDC.gov/quit.
  • Sign up for SmokefreeTXT for daily text messages to support you in quitting smoking.
  • Use a mobile app like quitSTART, available for Android and iPhone.
  • Ask your dermatologist about nicotine patches, lozenges, gums, or prescription medications. Be sure to discuss the risks and benefits of nicotine exposure.

Talk With Others Who Understand

MyPsoriasisTeam is the social network for people with psoriasis and their loved ones. On MyPsoriasisTeam more than 92,000 members come together to ask questions, give advice, and share their stories with others who understand life with psoriasis.

Have you noticed that smoking is worsening your psoriasis? Share your experience in the comments below, or start a conversation by posting on MyPsoriasisTeam.

Posted on May 7, 2021
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Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Paz Etcheverry, Ph.D. has an M.S. in food science and nutrition from North Carolina State University and a Ph.D. in food science and technology from Cornell University. Learn more about her here.

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