At your yearly physical you probably receive a questionnaire about your alcohol intake and drinking habits. One in five people admit to lying to their doctor about how much alcohol they drink, likely because they know it is bad for their health and they do not want to listen to yet another lecture. 
“Several studies suggest that alcohol use may increase a person’s risk of developing psoriasis and/or lead to worsening of their disease,” explains Jason E. Hawkes, M.D., M.S. from the University of California, Davis, “Psoriasis patients also tend to consume more alcohol than the general population.”
Adam Friedman, M.D., FAAD from the George Washington University School of Medicine and Health Sciences agrees and explains that this is due to those with psoriatic disease “self-treating” with alcohol. Unfortunately, this will often lead to the opposite of what they are hoping for. “Alcohol in general will worsen psoriasis, as it will almost any inflammatory skin disease,” says Dr. Friedman, “Alcohol intake can cause dehydration and nutritional issues, but just by itself can create oxidative stress and inflammation.”
In addition, both Drs. Friedman and Hawkes mention the possibility of alcohol interacting with medications taken for psoriatic disease. For example, the inflammation caused by alcohol can decrease or negate the anti-inflammatory effects of biologic treatments. Additionally, because many medications are processed in the body through the liver, Dr. Hawkes says that alcohol should be avoided in people taking methotrexate or in people with a pre-existing liver disease such as non-alcoholic fatty liver disease. Dr. Friedman notes that alcohol should also be avoided in people taking acitretin, as it can prolong some of the negative side-effects of this medication, including teratogenesis in women of child-bearing potential.
Not all alcohol may be equally bad for your health. “It has been suggested that non-light beer may confer a higher risk of developing psoriasis compared to other alcohol drinks like wine or liquor,” says Dr. Hawkes, but more research is needed to confirm this. “There will certainly be a lot of interest in this area of research given the increasing attention surrounding diet and autoimmune [and immune-mediated] diseases like psoriasis,” he adds.
While not everyone fudges the numbers on their alcohol questionnaire, half of people surveyed said that they are not likely to cut down their alcohol intake on their doctor’s advice.  “There is an element of quality of life that you have to consider. So, it's all about moderation. I imagine very low intake – a glass of wine here or there – won't be problematic,” says Dr. Friedman, “But I think certainly an excess of any type of alcohol would be bad for [people with] psoriasis and psoriatic arthritis.”
If you are not sure if alcohol is safe for you to use, be sure to discuss it with your health care provider, and remember to talk with your dermatologist or rheumatologist as well, since they may best understand the special considerations for someone with a chronic, systemic, immune-mediated disease like psoriasis or psoriatic arthritis. If you are worried about alcohol abuse, call SAMHSA’s National Helpline, 1-800-662-HELP (4357).