The Link Between Psoriasis and Smoking

Medically Reviewed by Stephanie S. Gardner, MD on March 23, 2022
4 min read

Smoking can increase your risk for many complications and conditions. One of them is psoriasis. Experts continue to study why smoking puts you at risk for the skin condition. But many believe that it has to do with how smoking affects your immune system and inflammation in your body.

Many studies have found that smoking makes you more likely to develop psoriasis. One found that long-term smokers just about doubled their risk of psoriasis, when compared to those who’ve never smoked. Another stated that heavy smokers are two times as likely to have psoriasis.

There are many reasons why smoking cigarettes could lead to psoriasis:

Smoking causes oxidative stress and the production of free radicals. These two things affect the pathways in your body that relate to psoriasis.

Nicotine causes reactions that lead to psoriasis. Nicotine is a chemical in tobacco, which is in cigarettes. When you smoke cigarettes, the nicotine causes your body to release more cytokines. These are proteins that affect how your cells interact with each other. All these things can lead to the development of psoriasis.

With psoriasis, your body’s inflammatory response causes skin cells to grow faster. Your body makes too many new skin cells. They start to build up and create the scaly texture common in the condition. Smoking creates more molecules that control your immune system (the free radicals and cytokines).

Your body can become overwhelmed with too many free radicals. If this happens, it can cause cell damage and inflammation. Smoking also harms the cell-to-cell work that cytokines help with. This can lead to the immune response that causes psoriasis.

If psoriasis runs in your family, you may carry genes for the condition. Smoking can trigger these genes to become active. Experts believe that smoking affects aryl hydrocarbon receptors on your DNA. This causes your body to make more inflammatory cytokines. If you are genetically at risk for psoriasis, this can raise your risk.

If you already have psoriasis, smoking can make your condition even worse. It also makes it harder for your doctor to treat your psoriasis. If you smoke, psoriasis treatments, like biologics, may not work as well as they would if you didn’t smoke. One study found that people who have psoriasis and smoke might have a greater need for more intense treatment.

Other risk factors that involve smoking and psoriasis include:

Second-hand smoke. A study from the American Journal of Epidemiology found that early exposure (childhood or prenatal) to smoking increased a person’s chances of having psoriasis later in life by a small amount.

Psoriatic arthritis. If you have psoriasis, you’re more likely to get psoriatic arthritis (PsA). But smoking can make this risk even larger. If you smoke, you raise your chances of PsA. You also put yourself more at risk for having it sooner.

Your weight. If your body mass index (BMI) goes up, you put yourself at a larger risk for PsA. If you smoke and are overweight, you have an even higher chance of PsA.

Development of comorbidities (another condition at the same time). Smoking can affect some of the comorbidities of psoriasis. These include inflammatory bowel disease (IBD), cardiovascular disease, and many types of cancer (especially ones in your respiratory tract).

Periodontal disease. The way that psoriasis and periodontal disease develop is similar. This is a condition that is caused by infections and inflammation to your gums and the bone around your teeth. The two conditions are linked to similar immune-related pathways. A study found that the risk of severe periodontal disease in people with psoriasis was six times higher in people who smoked, compared to nonsmokers.

Serious infections. If you get psoriasis treatment, you might be at a higher risk for harmful infections if you smoke.

While any amount of smoking is unhealthy, more cigarettes could create more severe psoriasis symptoms. One study found that people who smoked more than 20 cigarettes a day were two times more likely to have severe psoriasis than people who smoked fewer than 10 cigarettes a day.

Another study showed that smoking over 10 cigarettes a day greatly heightened psoriasis symptoms in men.

But research on this is mixed. Experts still need to study the relationship between how bad psoriasis is and the number of cigarettes a person smokes per day.

Research suggests that vaping could be just as harmful as smoking cigarettes. If your e-cigarette or vape contains nicotine, it’s very similar to smoking cigarettes. You’re at risk for the same diseases as a cigarette smoker, including psoriasis.

Similarly, smokeless tobacco products like chewing tobacco can also raise your risk for psoriasis. With chewing tobacco, you put the same harmful chemical into your body. This can lead to worsened or new psoriasis just as smoking cigarettes can.

If you smoke, you should talk to your doctor about how to quit. This is especially important if you have psoriasis.

If you’ve recently quit, your chances of having psoriasis are still higher than people who have never smoked before. But don’t lose hope. You can still gain many health benefits if you ditch cigarettes.

When you stop smoking, it’s possible your psoriasis symptoms will improve. In addition, your psoriasis treatment will work better, which could lead to less severe symptoms.

One study even found that over time, you could lower your risk of psoriasis significantly. If you quit smoking, and haven’t smoked for 20 years, your chances of getting psoriasis may be nearly as low as someone who has never smoked before.