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

Summary Background There is a known association between psoriasis and heavy alcohol consumption. The association between heavy alcohol consumption and other inflammatory skin diseases remains to be defined. Objectives 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 outpatient department. We recruited 609 patients with either psoriasis, eczema, cutaneous lupus or other inflammatory disorders, and a reference population with skin lesions. Primary outcome was the proportion of patients in each group with an alcohol use disorder (AUD). Results The observed prevalence of AUD was 30·6% in patients with psoriasis, 33·3% in those with eczema, 12·3% in those with cutaneous lupus, 21·8% in those with other inflammatory disease and 14·3% in those with non‐inflammatory disease. Odds ratios (OR) for AUD in patients in the inflammatory groups compared with those in the noninflammatory groups, adjusted for age and sex, were as follows: psoriasis 1·65 [95% confidence interval (CI) 0·86–3·17], eczema 2·00 (95% CI 1·03–3·85), lupus 1·03 (95% CI 0·39–2·71), other inflammatory disease 1·32 (95% CI 0·68–2·56). ORs were reduced if also adjusted for Dermatology Life Quality Index (DLQI). The prevalence of DLQI ≥ 11 was 31·1% for psoriasis, 43·7% for eczema, 17·5% for cutaneous lupus, 17·2% for other inflammatory disease and 2·8% for noninflammatory disease. Conclusions Patients with eczema attending a hospital clinic have been shown to have high levels of AUD of a similar level to patients with psoriasis and higher than patients with noninflammatory skin diseases. What's already known about this topic? A proportion of patients with psoriasis are known to be heavy drinkers, consuming higher‐than‐recommended safe levels of alcohol. Whether their alcohol behaviour is a cause or consequence of their skin disease is not known, although many patients report disease flares following excess drinking. Alcohol consumption can have a serious impact on systemic drug treatment. What does this study add? We show that the level of alcohol use disorders in patients with eczema is as high as in those with psoriasis. We recommend that patients with eczema are asked about their alcohol behaviour to understand fully patterns of disease exacerbation and to accurately assess risks when choosing systemic medications. Respon