Psoriasis is a chronic condition where the immune system becomes overactive, causing skin cells to multiply too rapidly. This accelerated cell turnover results in the development of thick, scaly patches that can become inflamed, itchy, and sometimes painful. Psoriasis most commonly appears on areas such as the scalp, elbows, and knees, although it can affect any part of the body. While the exact cause of psoriasis remains unknown, research indicates that it is linked to both genetic and environmental factors which can contribute to both the onset and progression of the condition. Symptoms of psoriasis tend to flare up over the course of weeks or months, followed by periods of remission.¹ 

While the exact cause remains unclear, certain lifestyle choices and environmental factors have been identified as key triggers for flare-ups. Among these, smoking, alcohol consumption, and obesity stand out as significant contributors to the worsening of psoriasis symptoms. Smoking has long been recognized as a major risk factor, exacerbating inflammation and disrupting immune function. Similarly, excessive alcohol intake has been linked to an increased frequency and severity of psoriasis outbreaks, possibly due to its effects on immune responses. Obesity, another well-established risk factor, not only contributes to systemic inflammation but also makes managing the condition more difficult. While other factors—such as stress and infections—also play a role, the focus of this article will be on the impact of smoking, alcohol, and obesity, which have been consistently shown to trigger or worsen psoriatic symptoms.² 

This article aims to explore the impact of smoking, alcohol consumption, and obesity as risk factors for psoriasis. By examining recent studies and clinical findings, this article will highlight how these lifestyle factors contribute to the onset, severity, and progression of psoriasis, therefore providing insights into preventative measures and management strategies.

Smoking

Literature indicates that smoking has been associated with a greater likelihood of developing psoriasis.^3–5 Smoking has also been linked to the development of pustular lesions in psoriasis patients.^3,6 Researchers have also discovered that the more packs of cigarettes a person smokes and the longer a person smokes greatly increases the likelihood of developing psoriasis.^3,7 

Expanding upon this, research has shown that the relationship between smoking and psoriasis not only relates to the likelihood of developing the condition, but also its severity. A study published in the journal Archives of Dermatology followed 818 patients with psoriasis. Demographic information was collected on the participants, including cigarette smoking history, body mass index (BMI), presence of chronic diseases, and severity of psoriasis. The average age of participants in this study was 46.8 years, with 62 percent being men and 38 percent being women. Smoking data was evaluated by the age at which smoking began, ended, and the average amount of cigarettes used daily, period of smoking (years) and time since stopping smoking (years) were also categorized. Smoking status was categorized as never, current, and former (participants who ceased smoking a minimum of one year prior).⁸ 

In this study, the connection between smoking intensity and severity was further analyzed upon examining the risks associated with varied smoking behaviors. Researchers discovered that smoking intensity was closely linked with psoriasis severity among current smokers. Specifically, individuals who smoked more than a pack of cigarettes per day had twice the risk of developing more severe psoriasis compared to those who smoked 10 or fewer cigarettes daily. Among all smokers (both current and former), cigarette-years were linked to a 30-percent increased risk of more severe psoriasis, equivalent to smoking 20 cigarettes per day for 30 years. Among women, current and recent former smokers had a 72-percent higher risk of more severe psoriasis than those who had never smoked. In both men and women, time since quitting was not associated with a lower risk of more severe psoriasis. Those with more severe psoriasis smoked more cigarettes per day on average compared to those with less severe psoriasis, indicating that both smoking intensity and duration were linked to psoriasis severity.⁸ 

While smoking intensity and duration play significant roles, studies have discovered differences among how smoking affects men and women with psoriasis differently. Other studies analyzing the association between smoking and psoriasis between men and women discovered that the risk for psoriasis was greater among women than men. For example, a study published in the British Journal of Dermatology studied 55 women with psoriasis and 108 women without psoriasis to assess their disease risk with their smoking status. The researchers discovered that the participants who reported smoking 20 cigarettes a day were more than three times likely to develop psoriasis in comparison to those who did not smoke.^8–11 

To further explore the relationship between psoriasis and smoking, a separate study examined the role of cigarette smoking in the development of the condition. The findings revealed that the risk of psoriasis was greater in both ex-smokers and current smokers compared to never-smokers, with estimates amounting to 1.9 for ex-smokers and 1.7 for current smokers. The study also found a strong association between smoking and pustular lesions in 32 patients. Beyond the impact of smoking, researchers determined other factors such as family history, BMI, and stress levels to greatly influence the prevalence of psoriasis. When combining these factors with smoking habits, the risk estimates showed no significant interaction effect. Although the risk for psoriasis was higher in both former and current smokers, there were gender differences among the data. Male ex-smokers had an increased risk of psoriasis, while female ex-smokers had a lower risk. When cigarette types were categorized by tar concentration (very low, low, medium, and high), no substantial differences were observed. About 30 percent of current smokers typically used very low or low tar cigarettes, 63 percent smoked medium tar cigarettes, and 4 percent used high tar cigarettes, with similar proportions in both cases and controls. The average number of pack years was 11.8 for ex-smokers and 10.4 for current smokers.⁶ 

Alcohol

Some research has indicated that there is not enough evidence to support whether alcohol consumption is a direct risk factor for developing psoriasis;³ however, other studies that have also looked at this relationship have determined that alcohol consumption is greatest among individuals with psoriasis compared to individuals without psoriasis. While the link between psoriasis and alcohol depends on several factors, heavy drinking is strongly associated with more severe psoriasis and less effective treatment outcomes.^3,12 

To better understand the potential relationship between alcohol and psoriasis, a prospective study conducted from 1991 to 2005 analyzed data from over 1,000 female participants in the United States. The researchers discovered that women who drank 2.3 or more alcoholic beverages per week were 1.7 times more likely to develop psoriasis compared to women who did not drink alcohol. When researchers looked at different types of alcoholic drinks, they found that drinking non-light beer was associated with a higher risk of developing psoriasis, especially for those who consumed five or more drinks per week. These women were 1.8 times more likely to develop psoriasis compared to those who drank less. However, no significant association was found between psoriasis risk and light beer, red wine, white wine, or liquor. Reported alcohol intake was updated every four years from 1991 to 2003; participants were asked to share their average intake of the following alcoholic beverages: non-light beer, light beer, red wine, white wine, and liquor from none or less than once a month, 1 to 3 drinks a month, 1 drink a week, 2 to 4 drinks a week, 5 to 6 drinks a week, 1 drink a day, 2 to 3 drinks a day, 4 to 5 drinks a day, and 6 or more drinks a day.¹² 

Overall, the findings in this same study concluded that women who consumed five or more non-light beers per week had a greater risk of developing psoriasis compared to those who drank less than five drinks per week. The excess risk of psoriasis for women who drank at least five nonlight beers per week only was 1.53 percent; however, only non-light beer, and no other types of alcohol, was linked to an increased risk of incident psoriasis. This led to an overall increased risk which remained notable after adjusting for factors such as age, BMI, smoking, physical activity, and dietary folate intake. Altogether women who consumed more than 2.3 alcoholic beverages a week were at a higher risk of developing psoriasis. Women who drank five or more nonlight beers per week had a 1.8 times higher risk of psoriasis compared to those who abstained from alcohol. Overall, the risk was 2.3 times higher in women who consumed five or more nonlight beers weekly. These associations were independent of other risk factors for psoriasis, such as age, smoking, BMI, physical activity, and dietary folate intake.¹²

As previously discussed in the context of smoking, the study published in the Archives of Dermatology also gathered data on alcohol consumption and psoriasis risk development. This study also found that alcohol intake, particularly more than two drinks per day, was associated with twice the risk of developing more severe psoriasis. Alcohol consumption, including wine, beer, liquors, and spirits, was divided into three categories: nondrinkers, occasional drinkers (less than daily), and regular drinkers (1–2 drinks per day and >2 drinks per day). A family history of psoriasis and current comorbidities were considered as binary variables (yes/no). Both BMI and self-reported disease duration were treated as continuous variables. Researchers found that consuming more than two glasses of alcohol daily was associated with twice the risk of developing more severe psoriasis. Additionally, patients with a family history of psoriasis were more likely to experience greater disease severity.⁸ 

Obesity

Researchers have discovered that obesity is a strong factor for psoriasis. The literature reports that the link between obesity and psoriasis begins with a pro-inflammatory state along with the presence of excessive adipokines secretion such as leptin in the body, a common occurrence seen in both obesity and psoriasis.^13–18 The literature also indicates that a common risk factor for psoriasis is metabolic syndrome; obesity is strongly associated with the onset and worsening of the disease as obesity is more common among patients with psoriasis as well as there being a higher risk of developing obesity in patients with psoriasis.^19–24,14 Thus, some research has also found that psoriasis patients with obesity  experience less effective treatment for their psoriasis.^{25, 26}

Overall, increases in BMI can lead to obesity, which is linked to metabolic syndrome—a significant risk factor for developing psoriasis. For example, a study published in the Journal of the American Academy of Dermatology followed 1.5 million patients with psoriasis for 11 years. The researchers discovered that the prevalence of psoriasis was 9.5 percent among patients with healthy weights, 11.9 percent among patients with overweight, and 14.2 percent among patients with Grade 1 obesity and 17.4 percent among patients with Grades 2–3 obesity.^27–30

Past research has indicated that lifestyle changes, such as diet, exercise, and weight loss are not only effective at reducing the symptoms of pre-existing psoriasis, but these measures can also aid in the prevention of psoriasis among individuals with overweight and obesity; therefore, various studies have examined the relationship between weight loss, healthy eating, and psoriasis.^31–35 Diets such as the ketogenic diet (KD) and Mediterranean diet (MD) have been recommended to help patients with psoriasis lose weight.^35,36

A study was therefore conducted to determine the effectiveness of the two diets, Mediterranean diet (MD) and ketogenic diet (KD) among 16 patients with psoriasis with a mean age of 52.93 years. Seventy-five percent of the participants were female. The participants were randomly assigned to begin either the MD or KD for eight weeks. After a six-week period, the groups switched to the alternate diet for the remaining eight weeks. By the study’s conclusion, both MD and KD led to significant reductions in weight compared to baseline. In contrast, no significant changes were seen in these markers after following the Mediterranean diet when compared to baseline. Both the MD and KD groups showed significant reductions in weight. Although the KD group had a larger reduction in weight (−10.63kg) compared to the MD group (−7.48kg), the difference was not statistically significant. Additionally, both diets led to significant decreases in waist circumference. Both MD and KD also resulted in significant reductions in total fat mass and visceral fat compared to baseline.³⁵ 

In a separate study, researchers identified BMI as a factor for psoriasis development, with a strong link between the severity of psoriasis and BMI.^{6, 36} As such, plaque psoriasis is associated with obesity in an estimated number of 13 to 34 percent of cases.³⁶ To further investigate this association among high BMIs and psoriasis, researchers conducted a randomized, controlled, investigator-blinded clinical trial over 24 weeks with a total of 61 participants. Eligible patients were 18 years or older with the following characteristics: clinically stable but active plaque psoriasis on at least 10 percent of their body, a Psoriasis Area Severity Index score of 10 or higher, and a BMI from 30 to 45. Thirty patients were assigned to the intervention group; these participants received 2.5mg of cyclosporine orally in two divided doses in combination with a low-calorie diet. The control group only received the medicine. The participants’ average weight reduction was 7.0kg in the intervention group and 0.2kg in the control group. Additionally, the intervention group showed a mean reduction in waist circumference of 3.5cm, while no reduction was observed in the control group.³⁶ 

Conclusion

This article emphasizes the notable impacts that smoking, alcohol, and obesity have on the onset, severity, and progression of psoriasis. Research has shown that smoking not only increases the likelihood of developing psoriasis, but can also worsen its severity, with the amount of cigarettes smoked daily and the length of cigarette smoking being key factors. Similarly, drinking alcohol, especially non-light beer, has been linked to an increased risk of developing psoriasis and more severe symptoms. Obesity is another significant risk factor for psoriasis, as inflammation and metabolic syndrome can further contribute to the severity of the disease and make psoriasis treatments less effective. Therefore, quitting smoking, decreasing alcohol intake, and maintaining healthy weight is essential to managing psoriasis effectively and helping to evade the risk of this disease. 

Sources

1. National Institute of Arthritis and Musculoskeletal Diseases. Overview, symptoms, & causes. Reviewed Oct 2023. Accessed 26 Feb 2025. https://www.niams.nih.gov/health-topics/psoriasis
2. Potestio L, Lauletta G, Tommasino N, et al. Risk factors for psoriasis flares: a narrative review. Psoriasis (Auckl). 2024;14:39–50.
3. Kamiya K, Kishimoto M, Sugai J, et al. Risk factors for the development of psoriasis. Int J Mol Sci. 2019;20(18):4347.
4. Armstrong AW, Harskamp CT, Dhillon JS, et al. Psoriasis and smoking: a systematic review and meta-analysis. Br J Dermatol. 2014;170(2):304–314. 
5. Li W, Han J, Choi HK, et al. Smoking and risk of incident psoriasis among women and men in the United States: a combined analysis. Am J Epidemiol. 2012;175(5):402–413. 
6. Naldi L, Chatenoud L, Linder D, et al. Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case-control study. J Invest Dermatol. 2005;125(1):61–67. 
7. Lee EJ, Han KD, Han JH, Lee JH. Smoking and risk of psoriasis: a nationwide cohort study. J Am Acad Dermatol. 2017;77(3):573–575. 
8. Fortes C, Mastroeni S, Leffondré K, et al. Relationship between smoking and the clinical severity of psoriasis. Arch Dermatol. 2005;141(12):1580–1584. 
9. Naldi L, Parazzini F, Brevi A, et al. Family history, smoking habits, alcohol consumption and risk of psoriasis. Br J Dermatol. 1992;127(3):212–217. 
10. Poikolainen K, Reunala T, Karvonen J, et al. Alcohol intake: a risk factor for psoriasis in young and middle aged men? BMJ. 1990;300(6727):780–783.  
11. Poikolainen K, Reunala T, Karvonen J. Smoking, alcohol and life events related to psoriasis among women. Br J Dermatol. 1994;130(4):473–477.
12. Qureshi AA, Dominguez PL, Choi HK, et al. Alcohol intake and risk of incident psoriasis in US women: a prospective study. Arch Dermatol. 2010;146(12):1364–1369.
13. Barros G, Duran P, Vera I, et al. Exploring the links between obesity and psoriasis: a comprehensive review. Int J Mol Sci. 2022;23(14):7499.
14. Bavoso NC, Pinto JM, Soares MMS, et al. Psoriasis in obesity: comparison of serum levels of leptin and adiponectin in obese subjects – cases and controls. An Bras Dermatol. 2019;94(2):192–197.
15. Kunz M, Simon JC, Saalbach A. Psoriasis: obesity and fatty acids. Front Immunol. 2019;10:1807.
16. Kumar S, Han J, Li T, et al. Obesity, waist circumference, weight change and the risk of psoriasis in US women. J Eur Acad Dermatol Venereol. 2013;27(10):1293–1298.
17. Takeshita J, Grewal S, Langan SM, et al. Psoriasis and comorbid diseases: epidemiology. J Am Acad Dermatol. 2017;76(3):377–390. 
18. Chen L, Li J, Zhu W, et al. Skin and gut microbiome in psoriasis: gaining insight into the pathophysiology of it and finding novel therapeutic strategies. Front Microbiol. 2020;11:589726. 
19. Jensen P, Skov L. Psoriasis and obesity. Dermatology. 2016;232(6):633–639.
20. Bonanad C, González-Parra E, Rivera R, et al. Clinical, diagnostic, and therapeutic implications in psoriasis associated with cardiovascular disease. Actas Dermosifiliogr. 2017;108(9):800–808.
21. Kim HN, Han K, Park YG, et al. Metabolic syndrome is associated with an increased risk of psoriasis: a nationwide population-based study. Metabolism. 2019;99:19–24.
22. Llamas-Velasco M, Ovejero-Merino E, Salgado-Boquete L. Obesity – a risk factor for psoriasis and COVID-19. Actas Dermosifiliogr. 2021;112(6):489–494.
23. Karmacharya P, Ogdie A, Eder L. Psoriatic arthritis and the association with cardiometabolic disease: a narrative review. Ther Adv Musculoskelet Dis. 2021;13:1759720X21998279.
24. Kumar S, Han J, Li T, et al. Obesity, waist circumference, weight change and the risk of psoriasis in US women. J Eur Acad Dermatol Venereol. 2013;27(10):1293–1298.
25. Gisondi P, Fostini AC, Fossà I, et al. Psoriasis and the metabolic syndrome. Clin Dermatol. 2018;36(1):21–28.
26. Hsu S, Green LJ, Lebwohl MG, et al. Comparable efficacy and safety of brodalumab in obese and nonobese patients with psoriasis: analysis of two randomized controlled trials. Br J Dermatol. 2020;182(4):880–888.
27. Norden A, Rekhtman S, Strunk A, Garg A. Risk of psoriasis according to body mass index: a retrospective cohort analysis. J Am Acad Dermatol. 2022;86(5):1020–1026.
28. Alotaibi HA. Effects of weight loss on psoriasis: a review of clinical trials. Cureus. 2018;10(10):e3491.
29. Jensen P, Christensen R, Zachariae C, et al. Long-term effects of weight reduction on the severity of psoriasis in a cohort derived from a randomized trial: a prospective observational follow-up study. Am J Clin Nutr. 2016;104(2):259–265.
30. Paroutoglou K, Papadavid E, Christodoulatos GS, et al. Deciphering the association between psoriasis and obesity: current evidence and treatment considerations. Curr Obes Rep. 2020;9(3):165–178.
31. Upala S, Sanguankeo A. Effect of lifestyle weight loss intervention on disease severity in patients with psoriasis: a systematic review and meta-analysis. Int J Obes (Lond). 2015;39(8):1197–1202.
32. Lambadiari V, Katsimbri P, Kountouri A, et al. The effect of a ketogenic diet versus mediterranean diet on clinical and biochemical markers of inflammation in patients with obesity and psoriatic arthritis: a randomized crossover trial. Int J Mol Sci. 2024;25(5):2475.
33. Chung M, Bartholomew E, Yeroushalmi S, et al. Dietary intervention and supplements in the management of psoriasis: current perspectives. Psoriasis (Auckl). 2022;12:151–176.
34. Gisondi P, Del Giglio M, Di Francesco V, et al. Weight loss improves the response of obese patients with moderate-to-severe chronic plaque psoriasis to low-dose cyclosporine therapy: a randomized, controlled, investigator-blinded clinical trial. Am J Clin Nutr. 2008;88(5):1242–1247.
35. Neimann AL, Shin DB, Wang X, et al. Prevalence of cardiovascular risk factors in patients with psoriasis. J Am Acad Dermatol. 2006;55(5):829–835.
36. Sterry W, Strober BE, Menter A, et al. Obesity in psoriasis: the metabolic, clinical and therapeutic implications. Report of an interdisciplinary conference and review. Br J Dermatol. 2007;157(4):649–655.