How Does Drinking Alcohol Affect Psoriasis?
Whenever Sarah-Jane (42), from Traverse City, Michigan, has too much to drink, she gets more than a typical hangover. Along with the headache and dehydration comes a flare-up of her psoriasis. “I definitely notice a difference in my skin the day after I’ve been drinking,” she says. “It’s just redder and itchier overall.”
Sarah-Jane’s experience of alcohol triggering flare-ups is backed by some research. Eighteen of 23 studies included in a systematic review published in the Journal of the European Academy of Dermatology and Venereology found a link between alcohol consumption and psoriasis. But scientists still don’t know for sure what the exact connection is. Here’s what we know so far about how drinking can affect psoriasis, and what you can do if you suspect alcohol might be a factor in your symptoms.
Exploring the Link
One theory is that alcohol consumption leads to inflammation in the body, which is the start of the body’s natural healing process. However, in people with psoriasis, the inflammation doesn’t stop. When the body’s T cells (a type of white blood cells) get involved, they release inflammatory proteins called cytokines. This extra inflammation may cause the skin cells in someone with psoriatic disease to regenerate excessively, says the National Psoriasis Foundation.
Other ways in which alcohol may affect psoriasis, according to the authors of a review article published in Psoriasis: Targets and Therapy, include an increased susceptibility to infections and an increase in the production of lymphocyte (another type of white blood cell) and keratinocyte (a type of skin cell).
Alcohol as a First-Time Trigger
As well as worsening symptoms in people who already have psoriasis, research also suggests that alcohol can trigger a first episode of the disease. A study of 82,869 women over a 14-year period published in Skin Therapy Letter found that women who consume more than two to three alcoholic beverages per week were more likely to experience the onset of psoriasis.
While alcohol may be a well-known trigger for inflammation in the body, and therefore lead to a worsening of psoriasis, the reverse may also be true—having psoriasis may make someone more likely to drink alcohol. “Those with psoriasis do have an increased incidence of higher alcohol use, as well as a higher incidence of anxiety and depression,” says board-certified dermatologist Erum Ilyas, M.D., of Montgomery Dermatology in King of Prussia, Pennsylvania.
Alcohol May Interfere with Treatment
Small studies also suggest that excessive alcohol intake may decrease psoriasis patients’ response to treatment—and a person’s sex may be a factor. In a Journal of the American Academy of Dermatology study of 94 inpatients (48 men and 46 women), male patients who consumed more than 2.8 ounces of alcohol per day experienced less improvement in the percentage of the total body-surface area affected by psoriasis than male patients who didn’t drink. However, the treatment-induced improvement in the women wasn’t affected by their alcohol consumption.
However, Sarah-Jane says that she definitely can’t overindulge without a flare-up. “I’d say a couple of glasses of wine is my limit,” says Sarah-Jane. “Any more than that, and my psoriasis symptoms get worse. Also, darker drinks, like red wine and whiskey, tend to have more of a negative effect.”
Patients with psoriasis and increased alcohol intake may be more likely to have poor treatment outcomes because of low compliance. In a Archives of Dermatology study assessing compliance of 201 patients with psoriasis, drinking alcohol was reported as the main reason patients didn’t comply with treatment.
Discuss Your Drinking Habits with Your Doctor
Whether you have psoriasis or not, official guidelines from the Centers for Disease Control and Prevention and the National Institutes of Health recommend that people stick to “moderate drinking.” This is defined by the Dietary Guidelines for Americans 2015-2020 (from the U.S. Department of Health and Human Services and U.S. Department of Agriculture) as up to one drink per day for women and up to two drinks per day for men. And some people with psoriatic disease may get the go-ahead from their doctor to follow that guideline.
“I focus on the word moderation,” Ilyas says. “Alcohol is such an interesting ‘culprit’ in that it can be found to help some conditions in low volumes and to worsen others, especially with high consumption.” But find out for sure from your doctor. When Ilyas is advising psoriasis patients on alcohol consumption, she takes into account their quality of life and the role alcohol plays in their life and routine, as well as taking into account any impact alcohol can have on medications they are taking.
She says for some of her patients, social and minimal drinking is fine, as long as they’re not on a medication that’s passed through the liver. But if you’re on a systemic medication, such as acitretin or methotrexate, drinking in excess can actually worsen your psoriasis and overall health. In that case, she usually recommends avoiding alcohol entirely.
Keep an Eye Out for Triggers
So, can alcohol trigger a psoriasis flare-up? “There isn’t a definitive or easy answer to share with the patient,” says Todd Minars, M.D., of Minars Dermatology in Hollywood, Florida. He says the information from studies, and the data available, is often too “sparse and unreliable” to from a clinical perspective to prove that what someone eats and drinks can cause a flare-up. But many people find that adjusting their diet seems to help and identifying possible triggers can be a good place to start trying to find ways to manage your condition. “I'd much rather someone cut something from their diet to solve an ailment than take a medication for it,” he says.
How to know? Minars suggests it can be as simple as asking something like, “When you enjoy a glass of red wine, do you notice your psoriasis gets worse or that it is unaffected?"
If they answer that nothing happens when they drink alcohol, “that could be evidence that it's not contributing to their symptoms,” Minars says. “However, if they reply something along the lines of, ‘Yes, I do see it getting worse when I drink on the weekends and my flare-ups coincide with my drinking habits,’ then it would be a good indicator that they should try abstaining.”
If you think drinking alcohol might be a trigger for your psoriasis, try cutting it out completely for several weeks to see what difference it makes to your skin. Some people like to keep a food and beverage journal to try and pinpoint potential triggers. If you’re struggling to cut down or quit drinking, or if you are concerned about the amount of alcohol you drink in general, ask your doctor to help you find the right treatment path for you.