Treatment of Psoriasis in the Setting of Excessive Alcohol Intake: From the Medical Board of the National Psoriasis Foundation

A task force of the National Psoriasis Foundation Medical Board was convened to evaluate treatment options for psoriasis in the setting of excessive alcohol intake. Consensus on treatment algorithms was achieved. Background Psoriasis is a chronic, inflammatory, multisystem disease in which alcohol abuse is higher than in the general population. Alcohol may exacerbate psoriasis and can complicate the choices for therapy given the potential for the combined toxicity of ethanol and treatment. Evidence-based data to guide clinicians in managing these challenging patients are quite limited. Objective Our aim was to create treatment recommendations to help dermatologists manage patients with psoriasis in the setting of excessive alcohol intake. Methods A literature review was conducted to examine treatment options for psoriasis in the setting of excessive alcohol consumption. Results Treatment should be dictated by the severity of disease and any patient comorbidities. First-line choices for extensive disease include phototherapy with narrowband ultraviolet B and photochemotherapy with psoralen plus ultraviolet A, as well as the tumor necrosis factor-alpha inhibitors adalimumab and infliximab. Second-line choices are acitretin, alefacept, cyclosporine, etanercept, and ustekinumab. A third-line choice would be methotrexate. Physicians should be vigilant to check liver function tests regularly. Limitations There are few studies examining treatment options for psoriasis in the setting of excessive alcohol consumption. Thus, these recommendations are based on experience and expert opinions. Conclusion Management of psoriasis in the setting of excessive alcohol consumption requires a thorough understanding of the treatment options that are available. Therapy should be based on the extent of the disease balanced with patients' underlying comorbidities.