Alcohol Use, Smoking, and Their Association with Early Onset and Severity of Psoriasis: a Case-Control Study.

BACKGROUND: Psoriasis is a chronic inflammatory disorder shaped by genetic, immune, and environmental factors. Alcohol and smoking may worsen the severity and trigger early onset. This study evaluated their prevalence, patterns, and impact among male patients. METHODS: A case-control study was conducted at a tertiary care center, including 153 male psoriasis patients and 153 age-matched male controls. Data were collected on alcohol use, smoking status, Psoriasis Area and Severity Index (PASI), Alcohol Use Disorders Identification Test (AUDIT), and Addiction Severity Index (ASI). Appropriate statistical analyses were applied. FINDINGS: Alcohol use was more frequent in cases than controls (60.8% vs. 44.4%, P=0.005). Among cases, alcohol users had earlier psoriasis onset (30.5 vs. 35.2 years, P=0.002), higher AUDIT (18.6 vs. 15.2, P=0.003), and higher ASI scores (20.1 vs. 14.2, P<0.001). PASI correlated with AUDIT (r=0.29, P=0.005), ASI (r=0.32, P=0.002), smoking pack-years (r=0.25, P=0.016), and inversely with onset age (r=-0.27, P=0.008). In pustular psoriasis, alcohol users had higher PASI (27.8 vs. 22.1, P=0.014) and earlier onset (28.7 vs. 34.1 years, P=0.009). Logistic regression identified alcohol use, AUDIT, ASI, and smoking as predictors of psoriasis. CONCLUSION: Alcohol use, smoking, and addiction severity are linked with early-onset psoriasis and greater severity, particularly in pustular subtypes, underscoring the need for lifestyle modification and targeted interventions.