Clinical study Alcohol consumption and smoking in psoriatics Alcohol co,zsumptwn and smoking lwbits in patients with psorinsis F. Gruber, E. Simonic, A. Jonjic, M. Lenkovic, and V Peharda ABSTRACT Background. Patients suffering from psoriasis can hardly cope with the disease and have psychic problems, which can lead to alcoholism and cigarette smoking. Objective. Our purpose was to determine whether or no psoriatic patients drink more and smoke more than a control group. Methods. By means of a questionnaire and a careful history we determined the alcohol consumption and smoking habits in 150 patients and compared the results with a control group (patients with contact dermatitis). Results. Sixty percent of psoriatic patients drank alcohol, while among the controls only 28.1 % (p<0.05). There was a difference in drinking habits between psoriatic patients with and without stress. Alcohol consumption was more common in psoriatic men than in psoriatic women. Analysis of the smoking habits revealed that psoriatic patients smoked in a higher percentage than patients of the control group. Conclusion. The results demonstrated that psoriatic patients drink more frequently, and in excess than other people. The authors believe there is necessity for preventive measures in this risk group. Introduction Psoriasis is among the commonest hyperproliferative and inflammatory dermatoses with a chronic- recurring clinical course. Although many cases of the disease occur sporadically, it is recognized as genetically influ- enced. Since recently considerable evidence exists that psoriasis is immunologically mediated Cl-3). The chronicity and frequent relapses of psoriasis , have important social, economical and health impli- cations. It is known that skin disease.Š damage one's self-image and one 's self-esteem. The patients feel the disease as an attack upon their sense-respect ancl clesirability. They also feel a negative attitucle of most persons towarcl them, which creates personal, as well as interpersonal problems. The unaesthetic aspect of acta dermatovenerologica A.P.A. Vol 8, 99, No 3 --------------------- - --- - ---- 10.5 Alcohol consumption and smoking in psnriatics psoriatic lesions, the inconvenience caused by shedding of the skin, problems in sexual life and at work are well known and can cause a stigmatization feeling, fear of rejection and so negatively influence the psyche of the patients (4, 5). In psoriatics, the altered somatic appearance creates problems, which affect the psyche, and vice versa, lea- ding to depression, anxiety and sometimes to drinking asa solution . The skin being an organ of communication has an important role in influencing the mind. The present study was made to determine whether or not psoriatic patients clrink alcohol beverages and smoke more than a control group. Material and methods A total of 164 consecutive patients w ith psoriasis were admitted to the Department ofDermatolo6ry during the years 1995-1996. The diagnosis of psoriasis was made on the basis of clinical findings and in some cases by histology. Patients on clrugs known to be hepa- totoxic, or had hepatitis in the histo1y, and those patients who refusec.! to answer the questionnaire were excluded Table 1 . Questionnaire. Age Sex Profession Last school finishec.! Do you drink alcoholic drinks? a) eve1y day b) often (more of 3 times/week) c) selc!om d) teetotaler flyou drink, what you p refer: Wine Beer Brandy Is the disease the reason ol your drin!eing? YesNo Do you drin!e more after the onset of the disease? YesNo Do you smolee? a) eve1y day b) someti.mes c) ex smoker d) no smoker How long are you su:fleringfrom psoriasis? 106 from the study. A control group comprised 150 patients with other skin cliseases (contact dermatitis) . After an accurate histo1y and interview to evaluate the role of stress in the onset of psoriasis, a simple questionnaire, previously valiclatecl (5) was distributed to all subjects . It inclucled demographic questions , questions about the alcohol consumption (drinking eve1y clay, often i. e. 3 or more tirne a week, occasionally or not clrinking at all), cigarette smoking habits and the cluration of the disease (Table l. ). In a subgroup of the psoriatics, consisting of 80 patients drinking one tirne or more /week ancl in 80 control patients the !iver tests gamma glu tamil transa- minase (gamma GT), alanin transaminase (ALT), aspar- tate transaminase (AST or SGOT) and bilirubin, were determined with standard methods. The results were statistically analyzec! by the chi square test and Student's t test. Results The results of the study are shown in tables 2- 4. From the 164 enrolled patients with psoriasis, 14 were excludec.!: 8 because oftaking hepatotoxic clrugs, and 6 because not answering the questionnaire. Therefore remainecl 150 patients for the analysis: 98 males (65 .3%) and 52 females (34.6 %) aged 17-70 (mean 36 3). Ninety patients w ith psoriasis (60.0 %) drink a lcoholic beve- rages ancl 38 of them every day (Table 2.) . The control group consistec.! of 87 males (58.0 %) and 63 females (42.0 %), their ages ranging from 18 to 65 years (mean 33.9) . In the control group 42 patients clrank alcohol (28.1 %) but only few eve1y day. The difference was significant (p<0.05). Striking was the number of patients w ith psoriasis w ith stress in histo1y that drank every day (28.8 %). The statistical analysis revealed that there was a difference in c!rinking habits among the sexes in both groups, with the males drinking in a greater proportion. The patients in both grou ps pre- ferrecl w ine, beer being in the second place. The questionnaire revealed that among 64 patients with psorias is who consumed alcohol every c.!ay or often , 39 sa icl that they drink because of the cliseases, while 21 dic.! not think so, and 4 clid not explain the reason. Among these 64 patients, 34 said that they were drinking more since the beginning of the c!isease. An interesting deta il was that 31 ( 48 %) of the psoriatics that were clrinking often or eve1y day, were suffering from the disorcler for more than 10 years. Table 3 shows the results of the laborato1y analyses among the psoriatics compared to the control group. The results indicated a significant (p<0.05) increase in the alanin transaminase, the mean values being however within the normal limits. C lini ca! study acta dermatovenerologica A.P.A. Vol 8, 99, No 3 Clinical study Alcohol consumption and smoking in psoriatics Table 2. Alcohol consumption among psoriatic patients and in the control group. Habits Psoriatics (N=lS0) Control group (N=lS0) with stress without stress No(%) No(%) Drink every day 30 (28.8) 8 (17.3) Drink often 16 (15.3) 10 (21.7) Drink seldom 17 (16.3) 9 (19.5) Teetotaler 41 (39.4) 19 ( 41.3) Tota! 104 46 *p<0.05. The smoking habits are shown on table 4. Psoriatic patients smoke in a greater percentage than the controls. Interestingly psoriatics without stress smoked in a higher proportion than those with stress. Discussion Skin diseases can be caused or aggravated by alcohol abuse, but the association of psoriasis and alcoholism is stil! controversial. Our results indicate that there are differences in the alcohol consumption of psoriatic patients compared to the control group. On the basis of the questionnaire it seems that patients with psoriasis clrink more than the general population, but this was significant only in males. This was corroboratecl by some of the !iver tests that were significantly higher than in the control group (p