Dermatologists are advised to discuss alcohol use with their patients who have psoriasis and to familiarize themselves with screening tools and intervention strategies.
So suggest the authors of a literature review published in the American Journal of Clinical Dermatology.
It is well-established that people with psoriasis tend to consume more alcohol than the general population. Alcohol consumption is associated with more severe disease, reduced response to treatment, and increased risk of other conditions like cardiovascular disease and arthritis.
Review authors aimed to better equip clinicians to address the issue. The following study excerpts have been edited for length and clarity.
What were the impetus and specific objectives for this review?
Almost one-third of patients with psoriasis report difficulties with alcohol. Among patients with alcoholic liver disease, 15% have psoriasis, compared with 2% in the general population. This problem may be related to the psychological distress seen in many people with psoriasis.
The review summarizes relevant literature on psoriasis and alcohol, with the goal of informing dermatologists of the importance of screening and providing a framework with information on useful tools and interventions.
There has been conflicting information on whether alcohol interferes with medications for psoriasis. What did the analysis find in this area?
Previous reviews identified scant evidence that alcohol could impact treatments for psoriasis. However, recent data show a strong association between alcohol misuse and poor response to systemic treatments.
In one study, among 266 psoriasis patients taking biologic and systemic treatments, 5.6% reported alcohol misuse. The same study showed that higher scores on alcohol misuse screenings were associated with decreased treatment response.
In another study of 180 patients taking biologics, alcohol use was identified as a risk factor for biologic treatment failure.
What's the key takeaway?
Many dermatologists feel they have a role in screening for alcohol use, but no role in intervention. Study authors suggest that dermatologists discuss alcohol use with all psoriasis patients and to conduct a brief intervention -- taking just a minute during an outpatient consultation to encourage alcohol reduction.
What are some of the screening tools recommended for assessing alcohol use in patients with psoriasis?
These few quick and easy-to-use screening instruments can help identify disordered alcohol use and have previously been evaluated in people with psoriasis:
- Alcohol Use Disorders Identification Test (AUDIT): The AUDIT-C version of the questionnaire is a condensed version of the full AUDIT questionnaire, containing just three questions intended to quickly identify at-risk drinkers. Patients with higher scores can proceed to the longer version of the AUDIT tool for a more detailed assessment.
- CAGE Questionnaire: This questionnaire includes four questions: have you ever felt the need to cut down on your drinking; felt annoyed by criticism of your drinking; had guilty feelings about drinking; or taken a drink as a morning "eye-opener?" The questionnaire has a sensitivity of 93% and specificity of 76%.
- Michigan Alcohol Screening Test (MAST): Slightly more in-depth, the MAST tool contains 25 questions covering issues related to risk-taking, neglect of responsibilities, and loss of control, while creating a more detailed picture of a patient's drinking tendencies and behaviors.
The AUDIT-C questionnaire was found to have the highest reliability among the screening tools, with a sensitivity of 93% and specificity of 94%.
The authors have received honoraria from AbbVie, Almirall, Celgene, Janssen, Lilly, Merck Sharpe Dohme, MoonLake, Novartis, Pfizer and UCB.
Primary Source
American Journal of Clinical Dermatology
Source Reference: Kearney N, Kirby B. "Alcohol and psoriasis for the dermatologist: Know, screen, intervene" Am J Clin Dermatol 2022; 23: 881-890.