High prevalence of alcohol use disorders in patients with inflammatory skin diseases

Abstract

Background

There is a known association between psoriasis and heavy alcohol consumption. Causality remains unclear with evidence supporting both alcohol triggering psoriasis and psoriasis predisposing to heavy alcohol consumption. However, the association between heavy alcohol consumption and other inflammatory skin diseases remains to be defined.

Objective

To examine the prevalence of heavy drinking using the Alcohol Use Disorders Identification Test (AUDIT) in patients with inflammatory skin disease.

Methods

We conducted an observational cross sectional study in a single hospital out-patient department. We recruited 609 patients in 5 groups; psoriasis, eczema, cutaneous lupus (lupus), other inflammatory disorders and a reference population with skin lesions. The primary outcome was the proportion of patients in each group with an alcohol use disorder (AUD).

Results

Observed prevalence of AUD was: psoriasis (30.6%), eczema (33.3%), cutaneous lupus (12.3%), other inflammatory disease (21.8%) and non-inflammatory disease (14.3%). Odds ratios(OR) (95% CI) for AUDs in inflammatory groups compared with non-inflammatory, adjusted for age and gender were: psoriasis 1.65 (0.86-3.17), eczema 2.00 (1.03-3.85), lupus 1.03 (0.39-2.71), other inflammatory 1.32 (0.68-2.56). OR were reduced if also adjusted for DLQI. The prevalence of DLQI of ≥11 was: psoriasis 31.1%, eczema 43.7%, cutaneous lupus 17.5%, other inflammatory 17.2% and non-inflammatory 2.8%.

Conclusions

Patients with eczema attending a single site hospital clinic have been shown to have high levels of alcohol use disorders of a similar level to patients with psoriasis and higher than patients with non-inflammatory skin diseases. The role of alcohol in the exacerbation of eczema needs further investigation. Caution and a full alcohol history is recommended when treating eczema patients with potentially hepatotoxic medication. By identifying heavier drinking patients we may be able to support them with interventions to reduce alcohol intake and potentially improve their skin disease.

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