Naldi Luigi
Department of Dermatology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
Study Centre of the Italian Group for Epidemiologic Research in Dermatology (GISED), Bergamo, Italy.
Psoriasis (Auckl). 2016 May 27;6:65-71. doi: 10.2147/PTT.S85189. eCollection 2016.
Smoking is a complex environmental exposure influenced by genetic, environmental, and social factors. Nicotine is the principal alkaloid in tobacco that mediates the addicting effects of tobacco products. Tobacco is a mixture of more than 7,000 chemicals, and smoking is recognized as a risk factor for many diseases in humans, including cardiovascular and pulmonary disease and several cancers, and is the single most preventable cause of mortality worldwide. A number of inflammatory immune-related conditions have been associated with smoking, including psoriasis. Smoking affects the onset of psoriasis. In a pooled analysis of 25 case-control studies, the odds ratio of psoriasis among smokers was 1.78 (95% confidence interval [CI]: 1.53-2.06). A dose-effect relationship is also documented. In a pooled analysis of three cohort studies, the risk of incident psoriasis was 1.81 (95% CI: 1.38-2.36) in those who smoked 1-14 cigarettes per day, and 2.29 (95% CI: 1.74-3.01) in those who smoked ≥25 cigarettes per day. Smoking also impacts on the clinical severity of psoriasis, its response to treatment, and explains some of the associated comorbidities, eg, cardiovascular disease, inflammatory bowel disease, and several cancers (especially those of the respiratory tract). Data on the role of smoking in psoriatic arthritis are less consistent compared with those concerning psoriasis. Several pathophysiological mechanisms may explain the association of psoriasis with smoking, including oxidative stress, interaction with signaling pathways active in psoriasis, and vascular influences. In conclusion, psoriasis is just one of the many diseases associated with smoking, but it is visible and disabling. Dermatologists could play a major role in reducing the health burden of smoking by influencing the patients to change their behavior.
吸烟是一种受遗传、环境和社会因素影响的复杂环境暴露。尼古丁是烟草中的主要生物碱，介导烟草制品的成瘾作用。烟草是7000多种化学物质的混合物，吸烟被认为是人类许多疾病的危险因素，包括心血管和肺部疾病以及几种癌症，并且是全球范围内最可预防的单一死亡原因。许多炎症性免疫相关疾病都与吸烟有关，包括银屑病。吸烟会影响银屑病的发病。在对25项病例对照研究的汇总分析中，吸烟者患银屑病的比值比为1.78（95%置信区间[CI]：1.53 - 2.06）。剂量效应关系也有记录。在对三项队列研究的汇总分析中，每天吸1 - 14支烟的人患银屑病的风险为1.81（95% CI：1.38 - 2.36），每天吸≥25支烟的人患银屑病的风险为2.29（95% CI：1.74 - 3.01）。吸烟还会影响银屑病的临床严重程度、对治疗的反应，并解释一些相关的合并症，如心血管疾病、炎症性肠病和几种癌症（尤其是呼吸道癌症）。与银屑病相关的数据相比，关于吸烟在银屑病关节炎中作用的数据不太一致。几种病理生理机制可以解释银屑病与吸烟的关联，包括氧化应激、与银屑病中活跃的信号通路相互作用以及血管影响。总之，银屑病只是与吸烟相关的众多疾病之一，但它是可见且致残的。皮肤科医生可以通过影响患者改变行为，在减轻吸烟对健康的负担方面发挥重要作用。
