Clinical Research Study
Smoking and the Risk of Psoriasis in Women: Nurses’ Health Study II

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Abstract

Background

Psoriasis is a common, chronic, inflammatory skin disorder. Smoking may increase the risk of psoriasis, but no prospective data are available on this relation.

Methods

We prospectively examined over a 14-year time period (1991-2005) the relation between smoking status, duration, intensity, cessation, and exposure to secondhand smoke, and incident psoriasis in 78,532 women from the Nurses Health Study II. The primary outcome was incident, self-reported, physician-diagnosed psoriasis.

Results

We documented 887 incident cases of psoriasis. Compared with those who had never smoked, the multivariate relative risk (RR) of psoriasis was 1.78 (95% confidence interval [CI], 1.46 to 2.16) for current smokers and 1.37 (95% CI, 1.17 to 1.59) for past smokers. Compared with nonsmokers, the multivariate RR of psoriasis was 1.60 (95% CI, 1.31 to 1.97) for those who had smoked 11-20 pack-years and 2.05 (95% CI, 1.66 to 2.53) for those who had smoked ≥21 pack-years. Compared with never smokers, the multivariate RR of psoriasis was 1.61 (95% CI, 1.30 to 2.00) for those who quit smoking <10 years ago, 1.31 (95% CI, 1.05 to 1.64) for 10-19 years ago, and 1.15 (95% CI, 0.88 to 1.51) for ≥20 years ago. Prenatal and childhood exposure to passive smoke was associated with an increased risk of psoriasis.

Conclusions

In this prospective analysis, current and past smoking, and cumulative measures of smoking were associated with the incidence of psoriasis. The risk of incident psoriasis among former smokers decreases nearly to that of never smokers 20 years after cessation.

Section snippets

Methods

The Nurses Health Study II (NHS II) is an ongoing longitudinal study of 116,608 female registered nurses between the ages of 25 and 42 years at baseline. Participants from 15 states completed and returned an initial questionnaire in 1989. The NHS II focuses on women’s health outcomes in a population younger than the original Nurses’ Health Study I cohort. The NHS II is followed with biennial questionnaires and the follow-up rate exceeds 90% for each 2-year period. In 2005, we asked participants

Baseline Characteristics

We documented 887 incident cases of psoriasis during the 14 years of follow-up. The baseline characteristics of the cohort according to smoking status are shown in Table 1. Alcohol consumption tended to increase from the never to the current smoker group, as did duration of smoking and number of cigarettes smoked per day. Current smokers were more likely to have been exposed to passive smoking than were never and past smokers.

Smoking Status, Intensity, Duration, and Risk of Incident Psoriasis

Compared with those who never smoked, the multivariate RR for

Discussion

Our objective was to prospectively evaluate the relation between smoking and the incidence of psoriasis in a large cohort of women. We found that both past and current smokers were at increased risk for developing psoriasis, and the risk was greater for current smokers. The risk was graded and increased with the duration, intensity, and pack-years of smoking. Furthermore, the risk of incident psoriasis decreased with increasing years of smoking cessation reaching nearly that of never smokers 20

Acknowledgments

We thank the participants in the Nurses Health Study II for their dedication and continued participation; the entire staff of the Nurses Health Study II; and Rong Chen, for her assistance with programming.

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    This study was supported in part by grant 5 T32 AR007258-29 from the NIH and by Nurses’ Health Study II grant CA50385.

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