BACKGROUND:
Smoking is a well-established risk factor for developing psoriasis and is associated with development of more severe disease. Smoking cessation does not appear to result in clinical improvement of psoriasis. Whether smoking in psoriatic patients impacts response to systemic therapy is unknown.

OBJECTIVE:
We examined whether smokers with psoriasis +/- psoriatic arthritis respond to systemic agents as well as non-smokers.

METHODS:
We performed a retrospective review of patients with moderate-to-severe psoriasis +/- psoriatic arthritis seen at our institution who were either active smokers or non-smokers and calculated changes in Physician Global Assessment (PGA) scores after 3-16 months of systemic treatment. We also calculated average number of systemic treatments tried per patient.

RESULTS:
66 patients (46 non-smokers; 20 smokers) met our inclusion criteria. Changes in PGA scores between baseline and 3-16 months post-initiation of systemic treatment did not significantly differ between smokers and non-smokers, nor did average number of systemic treatments tried per patient. We detected a borderline significant trend in percentage of patients who had significant outcomes after treatment, with a higher percentage of patients smoking <10 cigarettes achieving target PGA scores compared to those smoking >10 cigarettes daily. Limitations of our study include its retrospective nature and relatively small number of patients meeting our inclusion criteria.

CONCLUSIONS:
In our retrospectively studied cohort smoking did not affect response to systemic treatment in psoriatic patients. A prospective study examining the complex relationship between smoking, psoriasis and response to systemic therapy is warranted to better explore this association. This article is protected by copyright. All rights reserved.