If you’re starting a biologic treatment for your psoriasis, you may wonder if it’s safe to drink alcohol. “Can I have wine with Remicade?” one MyPsoriasisTeam member asked. Another replied, “I avoid alcohol like the plague.”

People with psoriasis may drink more alcohol than the general population. One study found that 17 percent to 30 percent of people with plaque psoriasis had signs of drinking-related problems, depending on how alcohol use was measured. Some people in the study also said they had a current or past drinking problem. For comparison, about 10.9 percent of U.S. adults meet the criteria for alcohol use disorder, which includes patterns of alcohol use that cause distress or make it harder to meet daily responsibilities.

Drinking alcohol while taking a biologic can increase your risk of certain side effects. This may include liver damage and infection. Drinking alcohol might also affect how well biologics work.

The safety of alcohol use with psoriasis treatment depends on:

• The type of medication you take
• The amount of alcohol you drink
• Your risk factors

Always talk to your doctor about your alcohol intake before you start a new treatment. Read on to explore the possible risks of drinking alcohol while on biologics.

Increased Risk of Liver Damage

Liver damage is one of the well-known side effects of alcohol use. Your liver processes and filters substances from your blood. It also helps your body digest food and store energy. Alcohol can damage your liver, harming liver function and making it harder for this organ to do its job. Combining alcohol with medications that can also harm the liver increases the risk of liver problems.

Can You Drink Alcohol While on Biologics?

Talk to your doctor about whether it’s safe to drink alcohol while taking biologics. The risk of liver damage with biologics is low overall, but it has been seen in some people. Scientists aren’t sure how certain biologics cause liver damage. They do have some theories, though.

Biologics can increase the risk of developing autoantibodies to liver cells. Antibodies are proteins that are supposed to protect your body. Autoantibodies are antibodies that mistakenly target your body’s own cells, including liver cells, and cause inflammation. This process is similar to what occurs with autoimmune disorders like psoriasis and psoriatic arthritis.

Biologics also suppress the immune system. This can reactivate chronic (long-term) hepatitis B in people who’ve had this disease in the past. Hepatitis B is a virus that attacks the liver. It can eventually lead to liver failure. Screening for hepatitis B should be part of the process when starting a new biologic drug.

Which Biologics Can Cause Liver Damage?

Certain biologic medications used to treat psoriasis are more likely than others to cause liver damage. Tumor necrosis factor-alpha (TNF-alpha) inhibitors have been linked to more reported cases of liver injury than interleukin (IL)-17 or IL-23 inhibitors.

Among the TNF-alpha inhibitors, infliximab (Remicade) has been most often associated with liver problems in published reports. Infliximab works by blocking TNF-alpha, a protein that signals the immune system to attack tissues — a process that goes into overdrive in inflammatory diseases like psoriasis.

Although less common, liver issues have also been reported with other TNF-alpha inhibitors, including:

• Adalimumab (Humira)
• Certolizumab (Cimzia)
• Etanercept (Enbrel)
• Golimumab (sold as Simponi and Simponi Aria)

By contrast, liver damage appears to be rare with IL-17 and IL-23 inhibitors. Still, it’s a good idea to ask your doctor whether a medication you’re considering could affect your liver — especially if you have liver disease or other risk factors.

Can Other Psoriasis Treatments Cause Liver Damage?

Alcohol can increase the side effects of drugs that are combined with biologics to treat psoriasis. For example, some people with psoriasis take retinoids along with biologics. One retinoid used for psoriasis is called acitretin. Another, called isotretinoin, may be prescribed as an off-label psoriasis treatment — meaning it’s approved for other conditions but sometimes used to treat psoriasis when doctors believe it will help. Drinking alcohol while taking a retinoid can be dangerous and cause liver damage.

Drinking alcohol also makes acitretin stay in your body longer than it normally would.

Alcohol may increase the risk of liver damage while taking methotrexate.

Increased Risk of Infection

Biologics and alcohol are both known to reduce your body’s ability to fight infection.

Chronic alcohol use can damage your immune system. This makes it less able to fend off infection. People who drink alcohol frequently or heavily are at higher risk for illnesses like pneumonia and tuberculosis.

Biologic therapies suppress the immune system. This also increases a person’s risk of serious infections. More research is needed to know how much a person’s risk of infection increases when they drink alcohol.

Decreased Treatment Response

People who misuse alcohol may not respond to treatment as well as those who don’t drink. More research is needed, but scientists have theories. One possibility is that people who drink heavily may have difficulty taking their medications as prescribed.

Alcohol may also increase inflammation, which can make certain conditions harder to treat. Research shows that people who drink alcohol may have higher levels of inflammatory proteins, such as TNF-alpha, which play a role in conditions like psoriasis.

Alcohol Intake Recommendations

The Centers for Disease Control and Prevention (CDC) recommends limiting alcohol consumption to moderate levels. The CDC defines moderate drinking as up to two drinks per day for men and up to one drink day for women. A single drink may look different depending on the type of alcohol. For example, one drink is just 1.5 ounces of a distilled spirit but up to 12 ounces of beer.

Drinking less alcohol is better for your overall health. Alcohol use can increase your risk of many chronic diseases and other serious conditions, such as:

• Heart disease
• Hypertension (high blood pressure)
• Certain types of cancer
• Liver disease
• Digestive problems
• Mental health problems
• Dementia
• Alcohol use disorder

Psoriasis and Alcohol

Drinking alcohol is associated with more severe psoriasis and an increased risk of comorbidities (co-occurring conditions). The type of alcohol you drink probably doesn’t matter. But there may be an association between drinking nonlight beer and a greater likelihood of developing psoriasis.

Psoriasis can also increase your risk of developing metabolic dysfunction-associated steatotic liver disease (MASLD). This used to be known as nonalcoholic fatty liver disease (NAFLD). MASLD reduces liver function, raising your risk of liver-related side effects from alcohol and biologics.

Because alcohol may make treatments less effective, drinking can lead to psoriasis flare-ups. Increased alcohol consumption is linked to more severe psoriasis and increased levels of depression and anxiety. Mental health challenges can also trigger psoriasis symptoms.

Talk to your healthcare provider about your drinking habits to make sure you’re getting the best possible results from your treatment. Your doctor can also offer helpful resources if you decide you want to stop or cut back on drinking alcohol.

Talk With Others Who Understand

On MyPsoriasisTeam, people share their experiences with psoriasis and psoriatic arthritis, get advice, and find support from others who understand.

Have you changed your drinking habits because of your psoriasis treatment? Let others know in the comments below.